Necessary but not sufficient: a scoping review of legal accountability for sexual and reproductive health in low-income and middle-income countries

Abstract

BackgroundThis paper is a scoping review of the impact of legal accountability efforts for sexual and reproductive health and rights (SRHR), exploring the links between legal accountability strategies and changes in the desired SRHR outcomes.MethodsWe defined legal accountability as use of the judicial system following state failure to respect, protect or fulfil SRHR as enshrined in national law, as well as individuals’ or the state’s use of criminal law mechanisms to prevent unwanted behaviour and to provide remedy. We undertook a keyword search in PubMed, Scopus and LexisNexis and then consulted a group of experts to provide guidance regarding further peer-reviewed and grey literature, yielding a total of 191 articles.ResultsThe majority of the empirical, peer-reviewed articles identified were regarding abortion law and abortion care availability, followed by violence against women. Most of these articles explore the gaps between law and practice. We identified seven key factors that shape the efficacy of legal accountability efforts, including the ways a law or court decision is formulated, access to courts, the (dis)advantages of criminal law in the given context, cultural norms, politics, state capacity and resources and the potential for further litigation. Many articles explained that use of the judiciary may be necessary to effect change and that the act of claiming rights can empower, but that legal avenues for change can be imperfect tools for justice.ConclusionsLegal accountability can be effective as part of a broader, long-term strategy, with due attention to context.

Aborto legal na infância: o discurso oficial e a realidade de um caso brasileiro

“…Os demais foram publicados em anos anteriores, uma vez que ampararam legalmente e influenciaram o desfecho do caso; o primeiro foi o ECA, de 1990. Quanto aos tipos de publicações, destacaram-se notas (8), notícias (6), resoluções (6), leis (3), manifestos (2), recomendações (2), decretos (2), cartas (2) e relatórios (2). Foram ainda encontrados um ofício, uma decisão da Corregedoria Nacional de Justiça, uma política nacional, um plano nacional, uma portaria e um documento base da XI Conferência Nacional dos Direitos da Criança e do Adolescente.…”

“…Uma revisão de escopo sobre a responsabilidade legal dos países de baixa e média renda na saúde sexual e reprodutiva constatou que os estudos relacionados ao aborto destacaram a necessidade de implementação da legislação como orientação para a prática de atendimento. Dentre as razões para a não implementação, foram elencadas ausência de conhecimento por parte das interessadas, oposição ideológica de membros da comunidade ou profissionais e prática da objeção de consciência (6) .…”

Legal abortion in childhood: the official discourse and the reality of a Brazilian case

“…The others were published in previous years, as they legally supported and influenced the outcome of the case; the first was ECA, from 1990. As for the types of publications, notes (8), news (6), resolutions (6), laws (3), manifestos (2), recommendations (2), decrees (2), letters (2) and reports (2) stand out. A letter, a decision by the Brazilian National Justice Department, a national policy, a national plan, an ordinance and a base document of the XI Brazilian National Conference on Children's and Adolescents' Rights were also found.…”

“…A scoping review of the legal responsibility of low- and middle-income countries in sexual and reproductive health found that studies related to abortion highlighted the need to implement legislation as a guide to practice of care. Among the reasons for non-implementation were lack of knowledge by stakeholders, ideological opposition of community members or professionals, and practice of conscientious objection ( 6 ) .…”

Organized Breast and Cervical Cancer Screening: Attendance and Determinants in Rural China

“…On the one hand, women feel more respected when notified by community leaders [ 12 ]; on the other hand, as providers of public services and managers of public affairs, community leaders may be more trusted than GPs as notifiers of two-cancer screening. Recent studies show that lack of trust and inadequate performance ratings among public health agencies are a global phenomenon [ 35 , 36 , 37 ].…”