Legal Epidemiology For A Clearer Understanding Of Abortion Laws And Their Impact

Skuster, Patty

doi:10.2139/ssrn.3849493

Cited by 3 publications

(7 citation statements)

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“…Indeed, an initial WHO review of GAPD data suggests there may be numerous inaccuracies [ 22 ]. In addition, both GAPD and Countdown consider only national legislation, which may not fully capture domestic policy landscapes—sub-national regulations, clinical guidelines, and other policy documents may also structure domestic legal frameworks [ 26 , 27 ]. These limitations challenge the criterion validity of the policy indicator, i.e., how well the indicator reflects actual policy.…”

Section: Introductionmentioning

confidence: 99%

“…Conceptually, the legal status of abortion may be a poor proxy for the accessibility of legal or safe abortion [ 28 ]—compliance with existing laws may be inconsistent [ 26 , 29 , 30 ], health facilities and healthcare providers may have differing interpretations of legal constructs [ 30 , 31 ], and some legal constructs may be more subject to variance in interpretation and implementation than others [ 32 , 33 ]. Facilities and providers may also discriminate in providing access to abortion, regardless of legality [ 34 , 35 ].…”

Section: Introductionmentioning

confidence: 99%

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Improving measures of access to legal abortion: A validation study triangulating multiple data sources to assess a global indicator

et al. 2023

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Background Global mechanisms have been established to monitor and facilitate state accountability regarding the legal status of abortion. However, there is little evidence describing whether these mechanisms capture accurate data. Moreover, it is uncertain whether the “legal status of abortion” is a valid proxy measure for access to safe abortion, pursuant to the global goals of reducing preventable maternal mortality and advancing reproductive rights. Therefore, this study sought to assess the accuracy of reported monitoring data, and to determine whether evidence supports the consistent application of domestic law by health care professionals such that legality of abortion functions as a valid indicator of access. Methods and findings We conducted a validation study using three countries as illustrative case examples: Argentina, Ghana, and India. We compared data reported by two global monitoring mechanisms (Countdown to 2030 and the Global Abortion Policies Database) against domestic source documents collected through in-depth policy review. We then surveyed health care professionals authorized to perform abortions about their knowledge of abortion law in their countries and their personal attitudes and practices regarding provision of legal abortion. We compared professionals’ responses to the domestic legal frameworks described in the source documents to establish whether professionals consistently applied the law as written. This analysis revealed weaknesses in the criterion validity and construct validity of the “legal status of abortion” indicator. We detected discrepancies between data reported by the global monitoring and accountability mechanisms and the domestic policy reviews, even though all referenced the same source documents. Further, provider surveys unearthed important context-specific barriers to legal abortion not captured by the indicator, including conscientious objection and imposition of restrictions at the provider’s discretion. Conclusions Taken together, these findings denote weaknesses in the indicator “legal status of abortion” as a proxy for access to safe abortion, as well as inaccuracies in data reported to global monitoring mechanisms. This information provides important groundwork for strengthening indicators for monitoring access to abortion and for renewed advocacy to assure abortion rights worldwide.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Improving measures of access to legal abortion: A validation study triangulating multiple data sources to assess a global indicator

et al. 2023

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“…This field has applied epidemiologic methods to evaluate and enhance the implementation of law to improve population health, with recent expansion into machine learning, cumulative legal exposure and treatment heterogeneity 2–4. While the bulk of legal epidemiology has focused on the evaluation of domestic law, the context of globalisation and the recentring of global health equity as a core mission of public health have encouraged legal epidemiology scholars to translate this growing suite of approaches to the global level 5 6…”

Section: Introductionmentioning

confidence: 99%

“…The second principle extends core public health functions to the systematic monitoring of laws of public health significance, which has led to the more regular and widespread practice of legal surveillance 6 8. The final principle proposes that because laws have significant and complex population-level impacts, they should be evaluated through rigorous analysis to ensure that their impacts are beneficial and equitable and to inform the design of future laws 1 4–6 9…”

Section: Introductionmentioning

confidence: 99%

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Principles and methods of global legal epidemiology

Poirier

Viens

Penney

et al. 2022

J Epidemiol Community Health

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Although the theory and methods of legal epidemiology—the scientific study and deployment of law as a factor in the cause, distribution, and prevention of disease and injury in a population—have been well developed in the context of domestic law, the challenges posed by shifting the frame of analysis to the global legal space have not yet been fully explored. While legal epidemiology rests on the foundational principles that law acts as an intervention, that law can be an object of scientific study and that law has impacts that should be evaluated, its application to the global level requires the recognition that international laws, policies and norms can cause effects independently from their legal implementation within countries. The global legal space blurs distinctions between ‘hard’ and ‘soft’ law, often operating through pathways of global agenda setting, legal language, political pressures, social mobilisation and trade pressures to have direct impacts on people, places and products. Despite these complexities, international law has been overwhelmingly studied as operating solely through national policy change, with only one global quasi-experimental evaluation of an international law’s impact on health published to date. To promote greater adoption of global legal epidemiology, we expand on an existing typology of public health law studies with examples of policymaking, mapping, implementation, intervention and mechanism studies. Global legal epidemiology holds great promise as a way to produce rigorous and impactful research on the international laws, policies and norms that shape our collective health, equity and well-being.

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Integrating child rights standards in contraceptive and abortion care for minors in Africa

Kangaude

Macleod

Coast

et al. 2022

Intl J Gynecology & Obste

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Some 22 years ago, this journal carried an article that expressed concern about the "widespread failure of national healthcare services to address the issue of adolescent pregnancy, childbirth and sexually transmitted infections (STIs)" 1 (p. 13). The authors encouraged governments to comply with the international legal instruments on the rights of the child, including recognizing adolescents' capacity to decide about their sexual and reproductive health care. Adolescent girls' access to contraceptive and abortion care is still a pressing problem in Africa.Adolescent pregnancy and childbearing have serious health and social consequences for girls, including complications of pregnancy and birth, child marriage, intimate-partner violence, and mental health issues. 2 Complications in pregnancy and childbirth are the leading cause of injury and death among girls aged 15 to 19 in African countries. 3 The risk of complications from abortion is highest in sub-Saharan Africa, where more than three quarters (77%) of all abortions are unsafe. 4 Adolescents are more likely to experience complications than older women, because they are more likely to delay seeking an abortion, encounter barriers to accessing safer services, use less safe methods, and present late when complications arise. 5 Yet, access to high-quality child-friendly sexual and reproductive health services provided by well-trained health providers could transform the situation. 6 This article focuses on contraceptive and abortion care for minors. African countries that have ratified the Protocol to the African Charter on Human and Peoples' Rights on the Rights of Women in Africa (Maputo Protocol), the United Nations Convention on the Rights of the Child (UNCRC), and the African Charter on the Rights and Welfare of the Child (ACRWC), have an obligation to ensure

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Legal Epidemiology For A Clearer Understanding Of Abortion Laws And Their Impact

Cited by 3 publications

References 0 publications

Improving measures of access to legal abortion: A validation study triangulating multiple data sources to assess a global indicator

Improving measures of access to legal abortion: A validation study triangulating multiple data sources to assess a global indicator

Principles and methods of global legal epidemiology

Integrating child rights standards in contraceptive and abortion care for minors in Africa

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