United Nations Population Fund
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Assessment 04

Human Rights Standards on Comprehensive Abortion Care

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Human Rights Standards on Comprehensive Abortion Care

Access to legal and safe abortion services is essential to the attainment of the right to health, as recognized by WHO. Comprehensive abortion care includes information, goods, services, and facilities for safe abortion – which can be completed through medication or surgery – and the provision of post-abortion care. Medical abortion plays a critical role in expanding access to care, particularly in early pregnancy, because it can be self-managed, or supported on an outpatient basis, can be administered by a range of providers, including fami ...

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Key questions

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Are abortion-related facilities, goods, information, and services in the country available, physically accessible and affordable, including, at a minimum, in cases where the pregnancy threatens the life or health of the pregnant person and in cases of rape, incest, or fetal impairment incompatible with life, as defined in the standards of UN treaty monitoring bodies?

Always
Often
Sometimes
Rarely
Never

Example for implementation

  • Support health officials at all levels in ensuring that abortion services are readily available in public and private clinics (e.g., by supporting procurement and training of health workers, task-sharing where appropriate, telehealth services, and modification of facilities to ensure accessibility for all).
  • Engage with the drug regulation authority to ensure that all essential medicines for abortion (as recognized in the WHO Model List of Essential Medicines) – including misoprostol and mifepristone, as well as the combination regimen of misoprostol and mifepristone – are legally permitted, registered for abortion, and available in practice.
  • Review public insurance plans and budget processes to ensure the affordability of services, including the inclusion of safe abortion and post-abortion care in public health insurance schemes and their subsidization.
  • Support national health officials in recognizing abortion as an essential health service (including its role in preventing maternal mortality and morbidity) and in implementing measures to ensure continued access to abortion in line with international human rights standards, including in times of emergency or crisis.
  • Conduct values clarification and attitude transformation programs with health sector actors, including health care providers and health officials, to address stigma and misconceptions around abortion.
  • Build the capacity of national health officials concerning the safety and practical implementation of self-care interventions for abortion, in line with WHO standards and public health evidence.

Where states allow health care providers to exercise conscientious objection, do they ensure that access to abortion and post-abortion care is not impeded?

Always
Often
Sometimes
Rarely
Never

Example for implementation

  • Engage with national health officials to raise awareness of human rights standards on conscientious refusal of care and to monitor compliance to guarantee that such refusals do not impede access to abortion at institutions that could otherwise provide the service, that refusals are never permitted in life-threatening conditions or emergencies, and that referrals are always provided.
  • Support local health officials in implementing patient feedback mechanisms, including concerning reasons for delays or denials of comprehensive abortion care, whether referrals were made, whether care was ultimately received, and whether quality of care was maintained.

Are individuals seeking services able to make informed, autonomous, and confidential decisions about abortion, without spousal, parental, or other third-party consent?

Always
Often
Sometimes
Rarely
Never

Example for implementation

  • Support youth networks and groups in the generation of evidence on the impact of laws on abortion access (e.g., laws on parental consent or mandatory reporting of sexual activity below the minimum legal age for consent to sex), and share findings with relevant government officials. Facilitate youth participation in shaping abortion-related programming, laws, and policies.
  • Collaborate with civil society to provide capacity-building and sensitization programs for health officials, judges, and legislators to raise awareness of human rights standards on third-party consent for abortion, including recommendations by human rights bodies of a presumption of capacity to consent for adolescents seeking sexual and reproductive health services.
  • Support national health officials in developing training curricula for health care workers to raise awareness about the harm of third-party consent requirements and to dispel stereotypes and social norms that may lead to requests for third-party consent, even where legally not required (e.g., stereotypes that women cannot make decisions about their health independently or that decisions about pregnancy belong to a woman’s partner or family).
  • Support national and local health offices in creating private spaces for confidential counseling, examination, and treatment and in implementing policies that clarify that examinations should include only the patient, unless they request the presence of a spouse or another person.

Has the state ensured the availability of comprehensive, unbiased, scientifically accurate information on abortion, including its legal status and how to access safe services, in a manner that is understandable to all (considering age, language, ability, etc.)?

Always
Often
Sometimes
Rarely
Never

Example for implementation

  • Develop communication campaigns targeting providers and the public to destigmatize abortion and dispel misconceptions and misinformation concerning abortion and its legal status that create barriers in accessing services.
  • Partner with and train journalists on issues related to comprehensive abortion care, build champions who can support the dissemination of evidence-based information, and build awareness of issues around access.
  • Support health officials and civil society organizations in developing know-your-rights materials regarding abortion for pregnant individuals in a variety of formats (e.g., Braille, audio, and local languages).
  • Facilitate collaboration between health officials and civil society organizations to establish local accompaniment models to support individuals seeking abortions, establish and sustain hotlines to respond to questions regarding abortion confidentially, and refer individuals to skilled providers.

Has the state taken steps to guarantee quality, respectful post-abortion care, irrespective of the legal status of abortion, including by removing any policies or practices requiring health care workers to report individuals suspected of having an abortion or requiring individuals seeking post-abortion care to provide a confession of undergoing an illegal abortion?

Always
Often
Sometimes
Rarely
Never

Example for implementation

  • Engage with national and local health officials to adopt policies and programs guaranteeing legal access to humane, dignified post-abortion care, even where abortion is restricted, and to remove any policies requiring that individuals suspected of having an abortion be reported or requiring them to attest to having an abortion before being able to receive care. Ensure the participation of women’s rights groups, including groups from marginalized communities, in such processes.
  • Partner with professional networks of health providers, including medical professional associations, to ensure that ethical rules concerning post-abortion care align with human rights standards and to build their capacity as advocates to champion human rights standards around comprehensive abortion care.
  • Partner with local health facilities to provide training on skills necessary to provide post-abortion care, confirm the legality of provision of such care, and utilize tools such as values clarification to destigmatize abortion.
  • Provide capacity building to law enforcement officials and the judiciary to avoid unnecessary arrests and prosecutions of individuals for abortion-related crimes.

Has the state repealed laws, policies, or regulations that criminalize abortion (in all circumstances), including by eliminating criminalization for health care providers who provide abortion services safely and with pregnant individuals’ voluntary and informed consent?

Always
Often
Sometimes
Rarely
Never

Example for implementation

  • Host capacity-building programs with legislators, government officials, and the judiciary concerning human rights standards on abortion criminalization and the impact of criminalization on health and rights.
  • Support civil society organizations in mapping and presenting evidence to public officials regarding how criminal laws impact access to abortion and human rights (e.g., laws criminalizing abortion either entirely or outside of limited exceptions; laws criminalizing self-managed abortions; and laws criminalizing certain populations, such as sex workers).
  • Support national human rights institutions in conducting inquiries into the impact of criminalization of abortion on rights, with a focus on marginalized populations.

Are the state’s laws aligned with international human rights standards, ensuring, at a minimum, that abortion is legal:

  • where the pregnant person’s life is at risk,
  • where the pregnant person’s health is at risk, and
  • where carrying a pregnancy to term would cause the pregnant person substantial pain or suffering, such as where the pregnancy is the result of rape or incest and in cases of severe or fatal fetal impairments?
Always
Often
Sometimes
Rarely
Never

Example for implementation

  • Work with national health officials to develop tools that offer health care providers guidance from human rights law on the scope and nature of exceptions (e.g., by clarifying that health exceptions should be interpreted in line with WHO’s definition of health).
  • Engage with national and local health officials to ensure that clinical standards, guidelines, and related documents are aligned with human rights standards.
  • Convene expert briefings with national health and judicial officials to clarify local laws in the context of international human rights law and to ensure coherence across laws, policies, and regulations on abortion.

Has the state removed non-evidence-based requirements for access to abortion, including mandatory waiting periods, consent to postpartum contraception, requirements of multiple providers’ approval for abortion, and biased counseling requirements?

Always
Often
Sometimes
Rarely
Never

Example for implementation

  • Convene expert briefings with national health officials to debunk misconceptions on the necessity of such requirements and raise awareness of the impact of these preconditions on access to care, especially for marginalized groups.

Has the state taken measures to address discriminatory gender and other stereotypes, as well as abortion-related stigma, that may hinder access to services and decision-making?

Always
Often
Sometimes
Rarely
Never

Example for implementation

  • Support government officials, including law and justice officials, in addressing wrongful gender stereotyping in laws, policies, and cases by lower courts.
  • Engage with medical schools to provide training to medical students and facility-based health workers on how to recognize and dismantle discriminatory stereotypes.
  • Engage with women’s rights associations and legal champions for gender equality to integrate SRHR into broader legal movements for women’s rights and gender equality.
  • Together with women’s rights associations and broader civil society organizations, create public awareness campaigns that seek to address and dismantle discriminatory stereotypes that impede comprehensive abortion care.
  • Strengthen the capacity of judicial sector actors to recognize discriminatory stereotypes in the context of abortion, and raise awareness of state obligations to address them.

Are special measures being taken to ensure that comprehensive abortion care is provided to marginalized groups, including adolescents, people with disabilities, and people in remote areas and humanitarian settings, to the full extent of the law?

Always
Often
Sometimes
Rarely
Never

Example for implementation

  • Support civil society organizations in advocating for and monitoring the delivery of quality comprehensive abortion care, and facilitate discussions among users (particularly those from marginalized groups), service providers, and government officials.

Has the state ensured administrative or judicial safeguards in instances where an individual is improperly denied comprehensive abortion care or faces delays or abuse while seeking care, including at the facility, district, and community level and through the courts?

Always
Often
Sometimes
Rarely
Never

Example for implementation

  • Create awareness-raising campaigns and legal aid programs to provide individuals who face violations of their rights around comprehensive abortion care with information on the possibility of seeking administrative and judicial redress.
  • Support the creation of confidential and timely facility-based appeals mechanisms for individuals who face denials of their rights around comprehensive abortion care. Publish materials to raise awareness of where remedies can be sought. Engage civil society movements to guide the development of such mechanisms.
  • Work with national judicial academies and national human rights institutions to develop and implement capacity-building programs for judges and human rights officials on comprehensive abortion care as a human rights concern (including international and regional human rights standards, comparative perspectives, and public health standards from WHO).
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