Table 2.

Impact of criminalisation on abortion seekers

Outcome	Overall conclusion of evidence (A)	Application of HR standards (B)	Conclusion evidence+HR (C)
Delayed abortion	Overall, evidence from three studies suggests that criminalisation contributes to abortion delay. While evidence from two of these studies suggests that criminalisation leads to healthcare providers delaying care for women who are suffering from severe pregnancy complications, evidence from one study indicates that while criminalisation does not stop women from having an abortion, it complicates women’s abortion pathways and thereby delays abortion.	Criminalisation engages states’ obligations to protect, respect and fulfil the rights to life and health (by taking steps to reduce maternal mortality and morbidity including addressing unsafe abortion, by protecting people from the risks associated with unsafe abortion, to protect people seeking abortion and by ensuring abortion regulation is evidence-based and proportionate).	Criminalisation can result in delayed access to abortion care. Such delays may be associated with unsafe abortion or increased risks of maternal mortality or morbidity, with negative implications for rights.
Continuation of pregnancy	Overall evidence from four studies suggests that criminalisation indirectly contributes to increased continuation of pregnancy; decriminalisation is associated with reductions in birth rates. While two of these studies suggests that criminalisation affects the birth rates of women 20–29 and 20–34 years in particular, 1 study points to a greater impact among adolescents. Evidence from one study suggests that criminalisation does not impact adolescent birth rates.	Criminalisation engages states’ obligations to protect, respect and fulfil the rights to life and health (by ensuring abortion regulation is evidence based and proportionate), to equality and non-discrimination, to decide the number and spacing of children. It can also result in a violation of the state’s obligation to ensure abortion is available where the life and health of the pregnant person is at risk, or where carrying a pregnancy to term would cause her substantial pain or suffering, including where the pregnancy is the result of rape or incest or where the pregnancy is not viable.	Criminalisation is associated with continuation of pregnancy. Where that is undesired, this has negative implications for rights.
Opportunity cost	Overall, evidence from 14 studies suggests that criminalisation contributes to opportunity costs including travelling for abortion, delayed abortion and postabortion care, apprehension of legal repercussions, poor quality post abortion care, emotional distress, financial costs, internalised and experienced stigma, confusion about accessing abortion, and sexual and financial exploitation. Evidence from two studies suggests these opportunity costs disproportionately impact some groups of women. Evidence from two studies suggests that although criminalisation may create fear among women it does not impact the decision to have an abortion.	Criminalisation engages states’ obligations to protect, respect and fulfil the rights to life and health (by protecting people from the risks associated with unsafe abortion, and ensuring ensure abortion regulation is evidence-based and proportionate).	Criminalisation contributes to opportunity costs for those accessing or seeking abortion, with negative implications for rights.
Unlawful abortion	Overall, evidence from 11 studies suggests that criminalisation contributes to unlawful abortion. These abortions are either self-managed or conducted in healthcare facilities. They are sometimes unsafe and may lead to death.	Criminalisation engages states’ obligations to protect, respect and fulfil the rights to life and health (by taking steps to reduce maternal mortality and morbidity including addressing unsafe abortion, by protecting people from the risks associated with unsafe abortion, to protect people seeking abortion, and by ensuring abortion regulation is evidence-based and proportionate). It can also result in a violation of the state’s obligation to ensure abortion is available where the life and health of the pregnant person is at risk, or where carrying a pregnancy to term would cause her substantial pain or suffering, including where the pregnancy is the result of rape or incest or where the pregnancy is not viable.	Criminalisation is associated with access to unlawful abortion. Such unlawful abortion may be unsafe and/or increase risks of maternal mortality and morbidity, with negative implications for rights.
Self-managed abortion	Overall, evidence from four studies suggests that criminalisation contributes to self-managed abortion. These abortions are sometimes unsafe.	Criminalisation engages states’ obligations to protect, respect and fulfil the rights to life and health (by taking steps to reduce maternal mortality and morbidity including addressing unsafe abortion, by protecting people from the risks associated with unsafe abortion).	Criminalisation may be associated with recourse to self-managed abortion. Where such self-managed abortions are unsafe, or increase risks of maternal mortality or morbidity, criminalisation has negative implications for rights.
Criminal justice procedures	Overall, evidence from three studies suggests that criminalisation contributes to criminal justice procedures against women and girls, some of which lead to convictions. Evidence from two studies indicates that criminalisation creates fear of legal repercussions among women undergoing abortions, and evidence from another study suggests that prosecutions and convictions against women are rare.	Criminalisation engages states’ obligation to protect, respect and fulfil the right to information (where information provision is criminalised), the rights to life and health (by protecting people seeking abortion and ensuring the availability of postabortion care without criminal sanction), and the right to privacy.	Criminalisation exposes women and girls to criminal proceedings, and to the risks associated with not accessing, support, timely information or timely postabortion care. This has negative implications for rights.