Table 3.

Impact of criminalisation on abortion providers

Outcome	Overall conclusion of evidence (A)	Application of HR standards (B)	Conclusion evidence+HR (C)
Workload implications	Overall, evidence from four studies suggests that criminalisation has increased workload implications for healthcare providers who, in order to comply with regulations and avoid criminal investigations, have to refer women to other health professionals, provide detailed written statements and ensure documentation does not put themselves or their patients at risk.	Criminalisation engages states’ obligations to protect, respect and fulfil the rights to life and health (by protecting healthcare professionals providing abortion care, and by ensuring abortion regulation is evidence based and proportionate).	Workload implications arising from criminalisation place significant burdens on healthcare professionals providing abortion care, with negative implications for both their rights and the rights of persons seeking to access comprehensive abortion care.
Referral to another provider	Overall, evidence from two studies suggests that criminalisation of abortion, including abortion referrals, will complicate women’s pathways to a safe and legal 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 complications in accessing safe abortion care. Where such complications increase risks of maternal mortality or morbidity, they have negative implications for rights. Criminalisation may deter people seeking abortion or for those who have availed of abortion from accessing comprehensive abortion care, including referral within the formal medical system, with negative implications for rights.
Perceived impact on provider–patient relationship	Evidence from three studies suggests that criminalisation negatively impacts the provider patient relationship.	Criminalisation engages states’ obligations to protect, respect and fulfil the rights to life and health (by protecting people seeking abortion, and by ensuring abortion regulation is evidence based and proportionate).	Criminalisation can impact negatively on the doctor–patient relationship, with negative implications for women and girls’ right to health.
Antiabortion sting operations	Overall, evidence from two studies suggests that criminalisation contributes to apprehension of anti-abortion sting operations.	Criminalisation engages states’ obligations to protect, respect and fulfil the rights to life and health (by protecting healthcare professionals providing abortion care).	Where criminalisation is associated with antiabortion sting operations, this may put healthcare professionals who conscientiously provide comprehensive abortion care and information at risk of legal or professional sanction, with negative implications for their rights and the rights of abortion seekers or those who have had abortions.
Criminal justice procedures against healthcare providers	Overall, evidence from one study indicates that criminalisation leads to criminal justice procedures against abortion information providers and evidence from five studies suggests that healthcare providers anticipate criminal justice procedures against them resulting from their clinical practice. In addition, evidence from two of these studies indicates that fear of criminal justice procedures leads to hesitancy to provide abortion care, including in cases of non-viable pregnancies.	Criminalisation engages states’ obligations to protect, respect and fulfil the rights to life and health (by protecting healthcare professionals providing abortion care, and by ensuring abortion regulation is evidence-based and proportionate).	Actual or apprehended criminal justice procedures against healthcare providers associated with criminalisation may result in reduced or hindered access to comprehensive abortion care. Where this is the case, criminalisation interferes disproportionately with rights to health and to physical and mental integrity.
Availability of trained providers	Overall, evidence from three studies suggests that criminalisation contributes to lower availability of trained providers and a loss of relevant skills.	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, by ensuring that where it is lawful abortion is safe and accessible, and by ensuring abortion regulation is evidence-based and proportionate).	Criminalisation is associated with reduced availability of trained providers and a loss of relevant skills, with implications for the availability of competent providers for exceptions to criminalisation, for the reduction of maternal mortality and morbidity and, thus, for human rights.
Reporting of suspected unlawful abortion	Overall, evidence from eight studies suggests that some healthcare providers report or would report a woman suspected of an induced abortion, while evidence from two studies indicate that healthcare providers generally do not report women to authorities. Where abortion is criminalised, there is not always a consensus among healthcare providers about whether and when one should report. While some never report in order to avoid being dragged into an investigation, others report to protect themselves from any legal repercussions.	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, by protecting healthcare professionals providing abortion care, by ensuring abortion regulation is evidence-based and proportionate, and by ensuring the availability of post-abortion care without criminal sanction), and the right to privacy.	Where criminalisation requires or results in healthcare professionals reporting suspected unlawful abortion, this may deter women and girls from seeking or safely accessing abortion information with negative implications for rights. Where criminalisation requires or results in healthcare professionals reporting suspected unlawful abortion, this may put healthcare professionals who conscientiously provide comprehensive abortion care and information at risk of legal or professional sanction, with negative implications for their rights and the rights of abortion seekers or those who have had abortions.
System costs	Overall, evidence from 12 studies suggests that criminalisation contributes to system costs. Four of these studies suggest that criminalisation, indirectly, contributes to system costs by showing how decriminalisation impacts birth weight positively, decreases unplanned pregnancies and fertility, and increases maternal mortality and severe abortion morbidity. Evidence from four studies shows that criminalisation contributes to system costs by creating a black market for abortion medication, by delaying abortion and post-abortion care until women are severely ill, by contributing to poor quality of postabortion care, and by preventing women from accessing evidence based, safe and effective treatment. Evidence from one study indicates that criminalisation does not contribute to any system costs related to adolescent birth rates and finally, evidence from one study suggests that factors related to maternal healthcare and health status impact maternal mortality and not abortion legislation itself.	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, by ensuring abortion regulation is evidence based and proportionate).	Criminalisation is associated with system costs, including those related to access to unlawful abortion, unsafe abortion, and increased maternal morbidity and mortality. Thus, criminalisation has negative implications for rights.
Harassment	No evidence identified.	Criminalisation engages states’ obligations to protect, respect and fulfil the right to health (by protecting healthcare professionals providing abortion care).	Criminalisation of abortion may expose healthcare professionals to risks of harassment, criminal prosecution, or sting operations. The implications for healthcare professionals of criminalisation may reduce the no of willing providers of lawful abortion, abortion information or postabortion care with implications for the health and rights of abortion seekers or persons who have accessed abortion including unsafe abortion.
Stigmatisation	No evidence identified.	Criminalisation engages states’ obligations to protect, respect and fulfil the right to health (by protecting healthcare professionals providing abortion care).	Criminalisation of abortion may lead to stigmatisation of abortion care provision with implications for the professional life, health and well-being of healthcare professionals.