Download ABORTION POLICY SCAN for advocacy

PATHFINDER INTERNATIONAL
abortion
policy scan
for advocacy
objectives
This tool is intended to help organizations:
• Assess the legal context for abortion.
• Assess the actual/on-the-ground context for abortion.
• Identify challenges to and opportunities for improving access to
safe abortion through policy change.
Advocacy for Safe Abortion Access
Unsafe abortion is a major cause of death and disability for women around
the world, especially in low-income countries. A woman’s right to have an
abortion must be upheld to reduce high maternal mortality and morbidity,
but also because it is essential to protect a woman’s right to make her own
choices about her body, her reproduction, and her life. Although the factors
that cause a woman to have an unintended pregnancy (e.g., lack of access
to contraception, gender inequality, violence) can be reduced through
reproductive health and social programming, they cannot be eliminated. To
protect women’s right to bodily sovereignty and to eliminate maternal
mortality and morbidity from unsafe abortion, safe abortion must be
accessible by all women, without restrictions. Organizations can use
advocacy as a tool to increase access to safe abortion.
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Overview
Section 1: Abortion Law vs. Practice
This section will help you analyze the official policies and laws governing
abortion care (“by law”) as compared with the actual situation in a given setting
(“in practice”). For example, by law abortion may be legal to protect the health
of a woman, but in practice providers generally only provide abortion to save the
life of the woman. When law and practice are in conflict, it is often an
opportunity for advocacy.
In Section 1, you will identify what the law says and what is happening on the
ground in relation to the following:
1.1 Abortion Access – The circumstances under which a woman can legally
obtain an abortion
1.2 Abortion-related Communications – The information about abortion and
abortion services that people can give women
1.3 Abortion Penalties – Legal consequences for obtaining, giving, or otherwise
participating in an abortion
Note: More than one abortion law or policy may be in effect in
federal states. The scan can be adapted to the national, regional,
and local levels, as applicable. It can also be applied to the
institutional level (e.g., hospital policies).
1.4 Abortion Approvals – Whose approval is required for a woman to have an
abortion?
1.5 Waiting Periods – The time between a woman’s request for an abortion and
receiving the abortion
1.6 Special Requirements – The documents or procedures a woman has to
produce or go through in order to obtain an abortion
1.7 Conscientious Objection – When a provider refuses to give abortion care
because of his/her personal beliefs or opinions
Section 2: Opportunities for Advocacy
Use this section to reflect on all the information you gathered in Section 1.
You can start thinking about the places where law and practice do not match
up. You can also begin identifying the legal and in-practice barriers to
abortion access that you want to address in the short and long term.
1.8 Performing Institutions and Personnel – Where abortions can be
performed and by whom
1.9 Time Limits – The maximum length of time when abortion is permitted
1.10 Abortion Methods – The kinds of surgical and medical abortion that are
legal and available
1.11 Abortion Protocols – Written government documents and international
agreements addressing abortion
1.12 Consent and Confidentiality – Procedures to ensure the woman willingly
gives her permission and that her privacy is protected
1.13 Counseling Requirements – What providers should include in pre- and
postabortion counseling
1.14 Cost – Fees associated with getting an abortion
abortion policy scan for advocacy | pathfinder international | www.pathfinder.org
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How to Use this Tool
It is best to plan to complete this scan as a team or small group. We recommend
that the group meet to review this tool and Pathfinder’s three Straight to the Point
Advocacy tools, which will help you plan your advocacy initiative. Come to
agreement about the team’s objectives, working process, and timeline. Then
divide up the workload by assigning sections to individuals or pairs. Each team
member will work to finish their assignment (either alone or in pairs). Then the
whole group can meet again to analyze the findings.
Next, set aside a day when the whole group can meet again to work collectively
on planning an advocacy initiative using the Straight to the Point Advocacy tools
(see Next Steps).
Important Documents
To complete Section 1, you will need to identify and access documents related to
existing abortion laws and policies. In describing the legal situation, it is important
to list the specific source (e.g., the criminal code, public health code) and text
supporting your answer.
The laws and policies governing abortion are located in a variety of places, such
as the criminal code, public health or medical ethics codes, the constitution, and
court decisions. Special provisions that clarify how to interpret an abortion law or
impose additional conditions can often be found in administrative regulations or in
the guidelines of professional associations and facilities that provide abortions or
educate health care providers. Additionally, government ministries and
professional associations (e.g., Ministry of Health, Medical Council) often have
national protocols and guidelines addressing abortion.
associations, retired judges), government, and human rights who can provide
documentation and help you to better understand laws and policies. Members
of legal, human rights, and advocacy organizations, as well as health care
providers can also provide useful information that will help you understand the
larger practical and political environment surrounding abortion. Take care to
ensure interviewees reflect varying geographic, economic, gender, and age
groups’ perspectives.
Note: If you are conducting this scan in a place with highly restrictive
abortion laws and high levels of stigma surrounding abortion, you
may need to be cautious when approaching key informants.
Tracking Answers
Your answers to the questions below should not be just “yes” or “no.” Your
answers should thoughtfully discuss the context for abortion. Blank space is
provided for evidence and examples. However, additional sheets of paper,
flipcharts, or a computer will likely be necessary to track your answers,
particularly those obtained during key informant interviews.
Important Terms and Definitions
Before beginning your scan, you should be familiar with the following terms
and definitions:
Key Informant Interviews
advocacy
To complete this scan, you will need to conduct key informant interviews. These
interviews can also help you make important connections and build alliances. You
can use this tool as an interview guide. You should interview representatives from
government (parliament, ministries of health, justice, education), businesses, or
other institutions to find out about programs, plans, and regulations that make up
abortion policy. You should also contact experts in law (e.g., women’s lawyers
When we talk about advocacy, we do not mean information, education, and
communication (IEC) activities. Advocacy is not about changing specific
practices or even building community awareness or support for an issue or
abortion policy scan for advocacy | pathfinder international | www.pathfinder.org
Advocacy is a strategy to influence policymakers to make policy change (e.g.,
create supportive policies, reform or remove harmful policies, ensure the funding
and implementation of supportive policies).
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practice. Rather, advocacy is intended to change opinion about a policy—
specifically, policymakers’ opinions—and achieve a particular policy change.
It is often necessary to conduct opinion change activities with the media,
community members, religious leaders, and health care providers before
conducting advocacy activities. However, these efforts are only considered
advocacy activities if the target groups then put pressure on the policymaking
process. Additionally, efforts to persuade government offices/ministries/etc.
to give funding to your organization’s programs are not advocacy.
policy
A policy can be: a plan, strategy, or agenda; program or course of action;
human rights instrument; budget decision; or piece of legislation, regulations,
or protocols/guidance issued by a government, multinational entity, or
institution.
policymakers
Policymakers are typically government officials or people with formal political
power (e.g., parliamentarians, ministers or agency officials, and their staff).
lobbying
Next Steps
After completing this scan, you should move on to the three advocacy tools in
Pathfinder’s Straight to the Point Series.* These tools will guide you through the
process of developing your advocacy initiative.
1.
The first tool, Setting Advocacy Priorities, will help you select specific
abortion-related issues for advocacy based on your findings in this scan.
2.
After identifying your issues, you can begin the Assessing the Political
Environment for Advocacy tool, which will help you better understand the
environment you are working in and who your potential allies and
opponents are.
3.
The information you gather in the second tool is necessary to complete the
final tool, Mapping an Advocacy Strategy, which will help you plan a
concrete strategy for achieving your advocacy goal, including determining
your specific activities.
* Pathfinder’s Straight to the Point Advocacy tools (available in French, English, and
Portuguese) can be found here: http://www.pathfinder.org/publications-tools/publicationseries/Straight-to-the-Point-Advocacy.html
Generally, lobbying is defined as the work of influencing a specific piece of
legislation. So, while lobbying can be part of an advocacy strategy, advocacy
work does not necessarily involve lobbying. For example, holding a meeting
with a policymaker explaining the benefits of permitting community health
workers to administer injectable contraceptives is not lobbying. Encouraging
that same policymaker to sign a piece of legislation permitting this is lobbying.
Often, limitations are placed on NGOs’ lobbying activities. Before considering
lobbying as part of your advocacy strategy, review your country’s laws and
policies governing NGO lobbying and advocacy.
abortion policy scan for advocacy | pathfinder international | www.pathfinder.org
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Section 1. Abortion Law vs. Practice
1.1 Abortion Access
The circumstances under which a woman can legally obtain an abortion
by law
in practice
In which of the following cases is abortion permitted?
When continuing the pregnancy endangers the woman’s life
To protect a woman’s physical health
(please specify conditions)
To preserve a woman’s mental health
(please specify conditions)
In cases when a woman is HIV positive
In cases of fetal impairment
(please specify conditions)
In cases of rape
In cases of incest
For reasons related to capacity to care for a child
(e.g., age of pregnant woman/girl, disability)
For socioeconomic reasons
(please specify reasons)
Abortion is available upon request, regardless of reason
Other
Are there any places where the laws concerning abortion are unclear?
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1.2 Abortion-related Communications
The information about abortion and abortion services that people (health care providers, educators, public officials, etc.) can give women
by law
in practice
Are there restrictions on providing women with information
about how to obtain a safe, legal abortion?
When abortion is legal under certain restricted cases
(e.g., to protect the woman’s health), are there restrictions
on providing women with information about how to obtain a
safe abortion?
Are there restrictions on providing information on the safe
use of misoprostol to induce abortion?
Are there restrictions on providing information on the public
heath impact of unsafe abortion?
Are there restrictions on advocating for expanding the legal
criteria for abortion?
Are there restrictions on the types of communication
(e.g., leaflets, radio announcements, speeches) that can be
used to share information about abortion?
Other
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1.3 Abortion Penalties
Legal consequences for obtaining, giving, or otherwise participating in an abortion
by law
in practice
What are the punitive measures (e.g., prison sentence, fines, suspension from practicing medicine) for the following offences?
Woman who has an illegal abortion
Health professional who performs an illegal abortion
Individual who helps a woman get an illegal abortion
Woman who self-induces an abortion
Individual who supplies abortion-inducing materials
Individual who provides restricted information on abortion
Other
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1.4 Abortion Approvals
Whose approval or permission is required for a woman to have an abortion
by law
in practice
Which of the following approvals is a woman required to obtain before undergoing an abortion?
Medical approval
(describe the process for gaining approval)
Judicial approval
(describe the process for gaining approval)
Spousal approval
(describe the process for gaining approval)
Parental/guardian approval
(describe the process for gaining approval)
Other
Are there ever exceptions to having to get
any of the above approvals?
abortion policy scan for advocacy | pathfinder international | www.pathfinder.org
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1.5 Waiting Periods
The time between a woman’s request for an abortion and receiving the abortion
by law
in practice
How long must a woman wait to have an abortion between
her initial request and the abortion procedure?
Are there ever exceptions to waiting periods?
1.6 Special Requirements
The documents or procedures a woman has to produce or go through in order to obtain an abortion
by law
in practice
If abortion is legal on criminal grounds (e.g., rape), are there
any special requirements for a woman to obtain an abortion
(e.g., a medical certificate proving a crime occurred, police
report, or court case)?
If abortion is legal on socioeconomic grounds, what evidence
(e.g., proof of income) must a woman produce in order to
have a legal abortion?
In general, are there any other special requirements or
processes a woman must undergo to obtain an abortion?
abortion policy scan for advocacy | pathfinder international | www.pathfinder.org
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1.7 Conscientious Objection
When a provider refuses to give abortion care because of his/her personal beliefs or opinions
by law
in practice
Who can claim conscientious objection (e.g., health care
institutions, medical doctors)?
Are there circumstances when conscientious objection
cannot be claimed (e.g., in a medical emergency, if the
mission of the health services would be compromised,
providing information on abortion or referrals)?
Are there requirements when claiming conscientious
objection (e.g., provider must be certified as a conscientious
objector, a referral must be made)?
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1.8 Performing Institutions and Personnel
Where abortions can be performed and by whom (according to abortion type and gestational age)
by law
in practice
Which of the following types of facilities perform safe abortions?
Government hospital
Government clinic
Private hospital
Private clinic
Other
Are there exceptions regarding gestational age
or abortion method?
Which of the following types of health professionals safely perform abortions?
OB/GYN
General practitioner
Nurse/midwife
Other
Are there exceptions regarding gestational age
or abortion method?
abortion policy scan for advocacy | pathfinder international | www.pathfinder.org
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1.9 Time Limits
The maximum length of time when abortion is permitted (i.e., how many months the woman has been pregnant)
by law
in practice
What is the time limit (gestational age in weeks) in which a
woman can access a safe abortion?
(Specify if it varies by reason or circumstance.)
Are there ever exceptions?
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1.10 Abortion Methods
The kinds of surgical and medical abortion that are legal and available
by law
in practice
Which of the following methods are used to perform safe abortions?
Medication abortion
Manual vacuum aspiration (MVA)
Electric vacuum aspiration (EVA)
Dilation and curettage (D&C)
Dilation and evacuation (D&E)
Other
Which of the following drugs are registered in your country and for what purposes? (Please include all purposes.)
Mifepristone (RU486)
Misoprostol (Cytotec)
Methotrexate
Gemeprost
Other
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1.11 Abortion Protocols
Written government documents and international agreements addressing abortion
Has the government signed and ratified key international treaties and agreements related to abortion
(e.g., the Maputo Protocol, ICPD, African Ministers’ Agreement of 2013)?
To what extent is the government actually implementing the above international agreements and treaties it has signed?
Is there a written government strategy addressing maternal and/or reproductive health? If yes, does it explicitly address unsafe abortion?
Is there a written government strategy addressing abortion?
Are there any legislative efforts in progress in your country to reduce restrictions on abortion? (This may help you identify potential allies.)
Are there any legislative efforts in progress in your country to increase restrictions on abortion? (This may help you identify potential opponents.)
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1.11 Abortion Protocols (continued)
The kinds of surgical and medical abortion that are legal and available
by law
in practice
Which of the following abortion methods are addressed through official protocols or guidelines?
Medication abortion
Manual vacuum aspiration (MVA)
Electric vacuum aspiration (EVA)
Dilation and curettage (D&C)
Dilation and evacuation (D&E)
Which of the following abortion-related activities are addressed through official protocols or guidelines?
Youth-friendly abortion services
Postabortion care
Integration of abortion and broader reproductive health
services
Pre-abortion counseling
Postabortion counseling
Postabortion contraceptive counseling and provision
Other
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1.12 Consent and Confidentiality
Procedures to ensure the woman willingly gives her permission and that her privacy is protected
by law
in practice
How is a woman’s consent for an abortion obtained?
What special procedures are in place to obtain the
consent of a woman deemed unable to provide consent
(e.g., a minor, woman with a mental disability)?
Are health professionals required to report abortion
services to the authorities or government?
What mechanisms exist to ensure patient confidentiality
when reporting services?
abortion policy scan for advocacy | pathfinder international | www.pathfinder.org
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1.13 Counseling Requirements
What providers should include in pre- and postabortion counseling
by law
in practice
by law
in practice
What materials or information is a woman given before
her procedure?
What is included in postabortion counseling?
What is included in a woman’s follow-up care?
1.14 Cost
Fees associated with getting an abortion
What are the associated costs for a woman seeking an
abortion (e.g., ultrasound, misoprostol, provider fee,
medications, other)?
abortion policy scan for advocacy | pathfinder international | www.pathfinder.org
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Section 2. Opportunities for Advocacy
Based on Section 1, in what ways is the law being over-interpreted, or are services not being provided to the fullest extent permitted?
Based on Section 1, what are the significant legal barriers to women accessing safe abortion that you are interested in addressing in the short term?
Based on Section 1, what are the significant legal barriers to women accessing safe abortion that you are interested in addressing in the long term?
Based on Section 1, what are the significant in practice barriers to women accessing safe abortion that you are interested in addressing in the short term?
Based on Section 1, what are the significant in practice barriers to women accessing safe abortion that you are interested in addressing in the long term?
Now you are ready to take the next steps in planning your advocacy initiative to increase access to abortion. Download Pathfinder’s Straight to the Point Advocacy
package here: http://www.pathfinder.org/publications-tools/publication-series/Straight-to-the-Point-Advocacy.html
abortion policy scan for advocacy | pathfinder international | www.pathfinder.org
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