{"id":39912,"date":"2017-11-01T10:28:54","date_gmt":"2017-11-01T09:28:54","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=39912"},"modified":"2017-11-13T14:50:40","modified_gmt":"2017-11-13T13:50:40","slug":"joanna-erdman-the-global-abortion-policies-database-legal-knowledge-as-a-health-intervention","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2017\/11\/01\/joanna-erdman-the-global-abortion-policies-database-legal-knowledge-as-a-health-intervention\/","title":{"rendered":"Joanna Erdman: The global abortion policies database\u2014legal knowledge as a health intervention"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-40520\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/08\/joanna_erdman.jpg\" alt=\"\" width=\"160\" height=\"160\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/08\/joanna_erdman.jpg 160w, https:\/\/blogs.bmj.com\/bmj\/files\/2017\/08\/joanna_erdman-150x150.jpg 150w\" sizes=\"auto, (max-width: 160px) 100vw, 160px\" \/>In 2012, Savita Halappanavar died in an Irish hospital from miscarriage complications after being refused an abortion. The treating physicians believed that because the fetus still had a beating heart their &#8220;hands were tied.&#8221; Under Irish law, abortion is a criminal offence unless necessary to save the life of the pregnant woman, yet there is little clarity on this exception. Following nationwide protests, the government introduced the <a href=\"http:\/\/www.oireachtas.ie\/documents\/bills28\/acts\/2013\/a3513.pdf\"><em>Protection of Life During Pregnancy Act 2013<\/em><\/a> to clarify the law and to regulate access under it. Years earlier, the <a href=\"https:\/\/www.reproductiverights.org\/sites\/crr.civicactions.net\/files\/documents\/crr_ABC_Factsheet.pdf\"><em>European Court of Human Rights<\/em><\/a> called for precisely such regulation moved by the impossible position of physicians who \u201cfaced criminal charges, on the one hand, and an absence of clear legal, ethical, or medical guidelines, on the other.\u201d<\/p>\n<p>The circumstances in Ireland are tragic, but not uncommon. Abortion laws are often written in vague terms, breeding uncertainty and even conflict as to what the law allows in an individual case. This creates a &#8220;chilling effect&#8221; on service providers and women, both cautious against an uncertain risk of criminal prosecution. A <a href=\"http:\/\/www.un.org\/Docs\/journal\/asp\/ws.asp?m=A\/66\/254\">UN human rights report<\/a> named the lack of access to information, specifically on when and how abortions may be lawfully obtained or provided, as a key public health harm of criminalization.<\/p>\n<p><a href=\"http:\/\/sandpit.bmj.com\/graphics\/2017\/abort-pol\/\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-40522\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/11\/infog_ww_abortion_regs_v24_540.png\" alt=\"\" width=\"540\" height=\"350\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/11\/infog_ww_abortion_regs_v24_540.png 540w, https:\/\/blogs.bmj.com\/bmj\/files\/2017\/11\/infog_ww_abortion_regs_v24_540-300x194.png 300w\" sizes=\"auto, (max-width: 540px) 100vw, 540px\" \/><\/a><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>The World Health Organization (WHO) and the United Nations Department of Economic and Social Affairs have thus launched the <a href=\"http:\/\/srhr.org\/abortion-policies\/\">Global Abortion Policies Database<\/a><strong>, <\/strong>an open-access repository of abortion laws, policies, standards, and guidelines for 197 countries. Designed to strengthen efforts to eliminate unsafe abortion, the database acknowledges and engages law and policy as a social determinant of safe abortion. The <a href=\"http:\/\/www.who.int\/reproductivehealth\/publications\/general\/lancet_4.pdf\">association between restrictive laws and unsafe abortion<\/a> is well documented, especially among marginalized social groups. Beyond prohibiting abortion and forcing women to seek services across borders or in clandestine settings, restrictive abortion laws also decrease the availability of, deter and delay access to lawful care through burdensome authorization procedures, unnecessary service delivery requirements, and increased costs.<\/p>\n<p>The breadth of abortion law captured in the database is one of its key innovations. <a href=\"http:\/\/worldabortionlaws.com\/about.html\">Global abortion maps<\/a> and other collections tend to focus on the legal grounds for abortion, classifying countries on this basis. The database provides a more comprehensive picture, capturing a range of &#8220;policy domains&#8221; (legal grounds, gestational limits, authorization and service delivery requirements), as well as, the complexities and subtleties of regulation in multiple and sometimes conflicting standards or sub-national variation. Moreover, while abortion was historically addressed in penal codes, these have been increasingly replaced or supplemented by health legislation, constitutional court decisions, and other forms of soft regulation such as clinical guidelines and medical ethics codes. The database captures these many sources of regulation, and thereby dispels the myth of a single &#8220;abortion law.&#8221;<\/p>\n<p>Through this comprehensive picture, the database endeavors to make accessible clear and accurate information on abortion law and policy, and thereby suggests that <em>knowledge <\/em>is perhaps the more critical determinant of safe abortion. Women\u2019s limited or inaccurate knowledge of abortion law influences how they seek services, including in countries with liberal laws. [1][2][3] Service providers\u2019 legal knowledge also influences how and whether they provide care, with studies showing a correlation between accurate knowledge and progressive attitudes. [4][5][6] The same holds true for policy-makers, who often do not know what the law allows or what obligations it entails for them. [7][8]<\/p>\n<p>Beyond the European Court, other international courts and commissions, as well as, constitutional and supreme courts have recognized legal obligations on government to create regulatory frameworks for lawful abortion, including clear criteria and procedural protections. [9][10] To support governments in meeting these obligations, the database links country profiles with human rights standards on abortion law and policy. Moreover by providing accurate and accessible information on these standards, the database supports community actors to hold governments accountable for gaps between these entitlements and abortion practice on the ground. Last by facilitating comparison across countries and geographical regions, the database raises the standard for government justification. It is harder to defend a restrictive law or policy in the face of available legal alternatives, much less against evidence-based <a href=\"http:\/\/www.who.int\/reproductivehealth\/publications\/unsafe_abortion\/9789241548434\/en\/\">WHO technical and policy guidance<\/a>, which the database conveniently provides to supplement country-level data.<\/p>\n<p>Yet formal law and policy is not always the path to justice. One of the most striking lessons of the database is the silence of law, the <em>domains it leaves undecided. <\/em>There is a danger to more law, more standards, and more procedures in the name of clarity and security. Many criticize the new Irish law because its narrowly formulated ground and procedures to strictly confine its interpretation entrench a fundamentally unjust law. The history of abortion decriminalization is marked, rather, by physicians who have worked the gaps and ambiguities of law in the name evidence-based medicine and in the protection of women\u2019s health and human rights.<\/p>\n<p><em><strong>Joanna Erdman<\/strong> is the MacBain Chair in Health and Policy Law at the Schulich School of Law, Dalhousie University in Halifax, Canada.<\/em><\/p>\n<p><em><strong>Declaration of interests<\/strong>: None<\/em><\/p>\n<p><em><strong>References:<\/strong><\/em><\/p>\n<p>[1] NI. Abeyasinghe et al., \u201cAwareness and Views of the Law on Termination of Pregnancy and Reasons for Resorting to an Abortion among a Group of Women Attending a Clinic in Colombo, Sri Lanka\u201d (2009) 16 J Forensic &amp; Leg Medicine 134-137.<\/p>\n<p>[2] HM. Marlow et al., \u201cWomen\u2019s Perceptions about Abortion in their Communities: Perspectives from Western Kenya\u201d (2014) 22:43 Reproductive Health Matters 149-158. doi:10.1016\/S0968-8080(14)43758-3<\/p>\n<p>[3] CH. Rocca et al., \u201cUnsafe Abortion After Legislation in Nepal: A Cross-sectional Study of Women Presenting to Hospitals\u201d (2013) 120:9 BJOG 1075-1084. doi:10.111\/1471-0528.12242<\/p>\n<p>[4] C. de Costa, H. Douglas &amp; K. Black, \u201cMaking it Legal: Abortion Providers\u2019 Knowledge and use of Abortion Law in New South Wales and Queensland\u201d (2013) 52 Australian and New Zealand J of Obstetrics and Gynecology 184-189.<\/p>\n<p>[5] CM. Payne et al., \u201cWhy Women are Dying from Unsafe Abortion: Narratives of Ghanaian Abortion Providers\u201d (2013) 17:2 Afr J Reproductive Health 118-128.<\/p>\n<p>[6] Silvina Ramos, Mariana Romero &amp; Agustina Ram\u00f3n Michel, \u201cHealth care providers\u2019 opinions on abortion: a study for the implementation of the legal abortion public policy in the Province of Santa Fe, Argentina\u201d (2014) 11:72 Reproductive Health 1-10.<\/p>\n<p>[7] AM. Moore, R. Kibombo &amp; D. Cats-Baril, \u201cUgandan Opinion-leaders\u2019 Knowledge and Perceptions of Unsafe Abortion\u201d (2014) 29 Health Policy &amp; Planning 893-901. doi:10.1093\/heapol\/czt070<\/p>\n<p>[8] FE. Okonofua et al., \u201cPerceptions of Policymakers in Nigeria Toward Unsafe Abortion and Maternal Mortality\u201d (2009) 35:4 Intl Perspectives on Sexual &amp; Reproductive Health 194-202.<\/p>\n<p>[9] RJ Cook, JN Erdman &amp; DM Dickens, \u201cAchieving transparency in implementing abortion laws\u201d (2007) 99:2 Int J Gynaecol Obstet. 157-61.<\/p>\n<p>[10] JN Erdman, \u201cThe Procedural Turn: Abortion at the European Court of Human Rights,\u201d in R.J. Cook, J.N. Erdman and B.M. Dickens eds., <em>Abortion Law in Transnational Perspective: Cases and Controversies<\/em>, 121-142 (University of Pennsylvania Press, 2014).<\/p>\n","protected":false},"excerpt":{"rendered":"<p>In 2012, Savita Halappanavar died in an Irish hospital from miscarriage complications after being refused an abortion. The treating physicians believed that because the fetus still had a beating heart [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2017\/11\/01\/joanna-erdman-the-global-abortion-policies-database-legal-knowledge-as-a-health-intervention\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":40522,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[223],"tags":[],"class_list":["post-39912","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-guest-bloggers"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Joanna Erdman: The global abortion policies database\u2014legal knowledge as a health intervention - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2017\/11\/01\/joanna-erdman-the-global-abortion-policies-database-legal-knowledge-as-a-health-intervention\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Joanna Erdman: The global abortion policies database\u2014legal knowledge as a health intervention - The BMJ\" \/>\n<meta property=\"og:description\" content=\"In 2012, Savita Halappanavar died in an Irish hospital from miscarriage complications after being refused an abortion. 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