Access to abortion under the heath exception: a comparative analysis in three countries.

Publisher: BioMed Central Country of Publication: England NLM ID: 101224380 Publication Model: Electronic Cited Medium: Internet ISSN: 1742-4755 (Electronic) Linking ISSN: 17424755 NLM ISO Abbreviation: Reprod Health Subsets: MEDLINE

Original Publication: [London] : BioMed Central, 2004-

Cross-Cultural Comparison* ; Human Rights*/legislation & jurisprudence; Abortion, Induced/*legislation & jurisprudence ; Abortion, Legal/*legislation & jurisprudence ; Health Services Accessibility/*legislation & jurisprudence; Abortion, Induced/statistics & numerical data ; Abortion, Legal/statistics & numerical data ; Colombia ; England ; Female ; Health Policy ; Health Services Accessibility/statistics & numerical data ; Humans ; Maternal Health Services ; Mexico ; Pregnancy ; United Kingdom

Background: Despite Britain, Colombia, and some Mexican states sharing a health exception within their abortion laws, access to abortion under the health exception varies widely. This study examines factors that result in heterogeneous application of similar health exception laws and consequences for access to legal abortion. Our research adds to previous literature by comparing implementation of similar abortion laws across countries to identify strategies for full implementation of the health exception.
Methods: We conducted a cross-country comparative descriptive study synthesizing data from document and literature review, official abortion statistics, and interviews with key informants. We gathered information on the use and interpretation of the health exception in the three countries from peer-reviewed literature, court documents, and grey literature. We next extracted public and private abortion statistics to understand the application of the law in each setting. We used a matrix to synthesize information and identify key factors in the use of the law. We conducted in-depth interviews with doctors and experts familiar with the health exception laws in each country and analyzed the qualitative data based on the previously identified factors.
Results: The health exception is used broadly in Britain, somewhat in Colombia, and very rarely in Mexican states. We identified five factors as particularly salient to application of the health exception in each setting: 1) comprehensiveness of the law including explicit mention of mental health, 2) a strong public health sector that funds abortion, 3) knowledge of and attitudes toward the health exception law, including guidelines for physicians in providing abortion, 4) dissemination of information about the health exception law, and 5) a history of court cases that protect women and clarify the health exception law.
Conclusions: The health exception is a valuable tool for expanding access to legal abortion. Differences in the use of the health exception as an indication for legal abortion result in wide access for women in Britain to nearly no access in Mexican states. Our findings highlight the difference between theoretical and real access to legal abortion. The interpretation and application of the health exception law are pivotal to expanding real access to abortion.

Reprod Health Matters. 2014 Nov;22(44):61-9. (PMID: 25555763)
Issues Brief (Alan Guttmacher Inst). 2012 Apr;(1):1-4. (PMID: 22629596)
Contraception. 2016 Nov;94(5):453-460. (PMID: 27456713)
Salud Publica Mex. 2011;53 Suppl 2:s144-55. (PMID: 21877080)
Am J Public Health. 2013 Apr;103(4):590-3. (PMID: 23409907)
PLoS One. 2016 Mar 24;11(3):e0152224. (PMID: 27010629)
Salud Publica Mex. 2011;53 Suppl 2:s220-32. (PMID: 21877087)
Womens Health (Lond). 2010 Nov;6(6):849-60. (PMID: 21118043)
Harv Law Rev. ;130(1):397-406. (PMID: 28117562)
Reprod Health Matters. 2009 May;17(33):120-32. (PMID: 19523589)
Reprod Health Matters. 2012 Dec;20(40):22-9. (PMID: 23245405)
Salud Colect. 2013 Aug;9(2):235-46. (PMID: 23989628)
Contraception. 2014 Dec;90(6 Suppl):S39-48. (PMID: 24825123)
Reprod Health Matters. 2010 Nov;18(36):118-26. (PMID: 21111356)
Lancet. 2016 Jul 16;388(10041):258-67. (PMID: 27179755)
Reprod Health Matters. 2014 Nov;22(44):42-51. (PMID: 25555762)

SFPRF11-02 Society of Family Planning; R01 HS025155 United States HS AHRQ HHS; SFPRF9-JI2 Society of Family Planning Research Fund; K12HS022981 Agency for Healthcare Research and Quality; K12 HS022981 United States HS AHRQ HHS

Keywords: Abortion; Causal Salud; Family planning; Great Britain; Health exception; Law and policy; Mexico; Colombia; Public health

Date Created: 20180614 Date Completed: 20181126 Latest Revision: 20231112

20240105

PMC5998589

10.1186/s12978-018-0548-x

29895292