10 1016@j Bpobgyn 2019 05 004

Best Practice & Research Clinical Obstetrics and Gynaecology xxx (xxxx) xxx
Contents lists available at ScienceDirect
Best Practice & Research Clinical

Obstetrics and Gynaecology
journal homepage: www.elsevier.com/locate/bpobgyn
Decriminalization of abortion e A human rights

imperative
Joanna N. Erdman, B.A., LL.M., Associate Professor and the
MacBain Chair a,
Rebecca J. Cook, A.B., M.P.A., J.D., J.S.D., Professor Emerita,
Co-Director b, c, *
a
Health Law and Policy in the Schulich School of Law, Dalhousie University, Halifax, Canada
b
The Faculty of Law, the Faculty of Medicine and the Joint Centre for Bioethics, University of Toronto,
Toronto, Canada
c
International Reproductive and Sexual Health Law Program, Faculty of Law, University of Toronto, Toronto,
Canada
a b s t r a c t
Keywords:
Abortion This chapter reviews the evolving consensus in international
Penalization human rights law, first supporting the liberalization of criminal
Criminalization abortion laws to improve access to care and now supporting their
Decriminalization repeal or decriminalization as a human rights imperative to pro-
Proportionality tect the health, equality, and dignity of people. This consensus is
Human rights
based on human rights standards or the authoritative in-
terpretations of U.N. and regional human rights treaties in general
comments and recommendations, individual communications and
inquiry reports of treaty monitoring bodies, and in the thematic
reports of special rapporteurs and working groups of the U.N. and
regional human rights systems. This chapter explores the reach
and influence of human rights standards, especially how high
courts in many countries reference these standards to hold gov-
ernments accountable for the reform and repeal of criminal
abortion laws.
© 2019 Published by Elsevier Ltd.
* Corresponding author. Faculty of Law, University of Toronto, Toronto, M5S 2C5, Ontario, Canada.
E-mail address: rebecca.cook@utoronto.ca (R.J. Cook).
https://doi.org/10.1016/j.bpobgyn.2019.05.004
1521-6934/© 2019 Published by Elsevier Ltd.
Please cite this article as: Erdman JN, Cook RJ, Decriminalization of abortion e A human rights imperative,
Best Practice & Research Clinical Obstetrics and Gynaecology, https://doi.org/10.1016/
j.bpobgyn.2019.05.004
2 J.N. Erdman, R.J. Cook / Best Practice & Research Clinical Obstetrics and Gynaecology xxx (xxxx) xxx
Introduction
At the 1994 International Conference on Population and Development, governments agreed that the
devastating public health impact of unsafe abortion was a global priority, but that otherwise, abortion
was a matter “only [to] be determined at the national or local level” [1]. This compromise was softened
one year later at the Fourth World Conference on Women, where governments agreed to “review laws
containing punitive measures against women who have undergone illegal abortions.” [2]. The inter-
national consensus on abortion laws has continued to evolve, first supporting the liberalization of
criminal abortion laws to improve access to care, and now supporting their repeal or decriminalization
as a human rights imperative [3]. Nonetheless, abortion remains governed within criminal or penal
codes in most countries worldwide [4].
This chapter reviews the evolution of international human rights law on the criminalization of
abortion, specifically a progressive consensus to
depenalize or withdraw punitive measures on abortion;

liberalize abortion on specified grounds and provide procedural protections to ensure effective
access on those grounds; and now to
decriminalize abortion to reduce unsafe abortion and to protect the health, equality, and dignity of
people.
This consensus is based on human rights standards or the formal and authoritative interpretations
of U.N. and regional human rights treaties in general comments and recommendations, individual
communications and inquiry reports of treaty monitoring bodies, and in the thematic reports of special
procedures (special rapporteurs and working groups) of the U.N. and regional systems. Human rights
treaties, as legal texts, are written in broad and open language and, rarely if ever, make specific textual
reference to abortion, or even reproduction. Human rights standards explain what any general pro-
vision of a human rights treaty means as applied to a specific issue, in this case, criminal abortion laws.
These standards “are particularly important for providing interpretive guidance in areas where human
rights remain unprotected as is the case with … safe abortion care.” [5].
The chapter also seeks to show the reach and influence of human standards on abortion decrimi-
nalization. The World Health Organization (hereinafter WHO) has incorporated these standards into its
Safe Abortion: Technical and Policy Guidance for Health Systems [6] (hereinafter WHO Safe Abortion
Guidance), to illustrate the ways in which they can inform concrete actions of health care providers and
policy makers to improve the health and lives of people. The chapter further identifies how high courts
in countries of Africa [7], Asia [8], Europe [9], and Latin America [10] increasingly reference human
rights standards in their review of national abortion laws [11]. The chapter seeks overall to show how
these standards are used to support efforts to reform or repeal criminal abortion laws, to protect
against retrogressive measures of recriminalization, and to remedy and redress the harms of abortion
criminalization as a human rights imperative.
Depenalization or withdrawal of punitive measures
Early international human rights standards called for the depenalization of abortion, specifically the
removal of criminal penalties related to abortion offenses. For example, in 1999, an early standard
under the Convention on the Elimination of All Forms of Discrimination against Women (hereinafter
the CEDAW Convention) advised that “[w]hen possible, legislation criminalizing abortion could be
amended to remove punitive provisions imposed on women who undergo abortion.” [12, ¶31c]. Later
articulations of these standards also emphasize that criminal abortion sanctions should not be applied
against women undergoing abortion [13]. In 2018, the UN Special Rapporteur on the Right to Health
acknowledged that criminal abortion laws contribute to women's imprisonment, and it has cautioned
that “[k]eeping women out of the criminal justice system in the first place by, for example, repealing
laws criminalizing access to … sexual and reproductive health-care services … is critical to protecting
the right to health.” [14, ¶78]. These standards also reflect the injustices of grossly disproportionate and
j.bpobgyn.2019.05.004
J.N. Erdman, R.J. Cook / Best Practice & Research Clinical Obstetrics and Gynaecology xxx (xxxx) xxx 3
discriminatorily applied criminal penalties for abortion in, for example, El Salvador [15] and Nicaragua
[16].
National-level abortion reforms reflect human rights standards on depenalization. In the Isle of
Man, for example, a provision in the new law clarifies that “a relevant professional or pharmacist
treating a woman” is not required to notify the authorities that the woman “has taken a relevant
product with a view to terminating her pregnancy.” [17]. A position statement of the American College
of Obstetricians and Gynecologists specifies that a woman who attempts to or successfully self-induces
abortion should not be criminalized [18]. The threat of arrest and imprisonment remains real in the
United States, where a few states have explicit bans on self-induced abortion and where prosecutors in
other states have used different types of laws to criminalize women who have ended their pregnancies
outside the formal medical system [19].
Human rights standards, promulgated by, for example, the Committee on Economic, Social and
Cultural Rights [20, ¶¶34; 21, ¶28] and the Committee on the Elimination of Discrimination against
Women [22, ¶18], have also long protected against de facto punitive measures for criminal abortion,
specifically abuse and mistreatment, and the withholding or conditioning of care within health set-
tings. The UN Special Rapporteur on Torture [23, ¶¶42, 46, 47, 70(k)] and the UN Working Group on
Discrimination against Women condemned the degrading treatment in healthcare facilities. The UN
Working Group has explained that “Women face a disproportionate risk of being subjected to
humiliating and degrading treatment in health-care facilities, especially during pregnancy … in the
name of morality or religion, as a way of punishing what is considered ‘immoral’ behavior.” [24, ¶17]
These standards, variously articulated by treaty monitoring bodies such as the Human Rights Com-
mittee [13], the Committee on the Elimination of Discrimination against Women [25], and the Com-
mittee on the Rights of the Child [26] and in reports of UN Special Rapporteurs such as on Health [27,
¶¶21e36; 28] and Torture [23, ¶72(bed)], guarantee every person immediate, confidential, and un-
conditional care for management of complications, regardless of the law on abortion. Moreover, they
specifically state that health care cannot be withheld for purposes of punishment, nor used to elicit
confession or as evidence in any criminal proceedings, or otherwise conditioned on a person's coop-
eration in a criminal prosecution [27, ¶¶30; 23, ¶44].
In accordance with these standards, the WHO advises that “the provision of care for complications is
always legal” [29] and to “provide timely treatment for abortion complications regardless of the law on
induced abortion, to protect a woman's life or health.” [6, p.89]. In other words, treatment of abortion
complications should not be conditioned on assessment of the lawfulness of the abortion. Human
rights standards such as those articulated by the Human Rights Committee [30, ¶20] and the Special
Rapporteurs on Torture [31, ¶¶46, 50,90] and Health [14, ¶75] recognize extraction of confessions or
denunciations, and the mandatory reporting of suspected illegal abortion as a condition of care,
whether by legal duty or feared repercussion (“aiding and abetting”), as a form of inhuman and
degrading treatment and a violation of the right to privacy.
By retaining abortion as a crime, although unpunished, depenalization cannot protect the health
and human rights of people [24, ¶¶79e83]. When abortion remains a crime, information and services
cannot be offered openly in public facilities, nor can public health information of safe abortion be
promoted. The continued criminalization of providers and others who assist in abortion provision also
maintains conditions for unsafe practice. Overall depenalization does not allow for providers and
others to act openly and freely, or for the enactment of positive policy on abortion, to protect the health
and lives of people.
Criminal abortion law liberalization
Human rights standards recognize that criminal abortion laws can serve legitimate ends, including
the protection of morals, of which the protection of unborn life as a public interest may be one aspect.
Given, however, that criminal law represents the most onerous, intrusive, and punitive power of the
state, many courts including the Supreme Court of Brazil [32] have required that criminal law only be
used as the last resort. Moreover, international human rights law also sets limits on the state power to
criminalize abortion because state action on abortion impacts the human rights and freedoms of those
who are pregnant [33].
j.bpobgyn.2019.05.004
These limits are rooted in principles of non-arbitrariness and proportionality [34]. Under interna-
tional human rights law, criminal laws must be rational and proportionate to the ends they seek to
achieve. Human rights standards define a law as arbitrary if it inflicts harm without need or reason, or if
its prohibitions bear no connection to or undermine its aims, however legitimate [35]. The WHO Safe
Abortion Guidance, for example, explains that criminal abortion laws do not decrease the rate or
number of abortions, a stated objective of many government policies, but perversely tend only to in-
crease illegal and unsafe abortion [[6], p.90]. Human rights standards define a criminal law as
disproportionate if the harms it inflicts are disproportionate to its aims; a fair balance must be struck
among competing interests [36].
Abortion liberalization through legal grounds
Absolute criminal prohibitions on abortion run afoul of these principles, constituting an arbitrary
deprivation of the rights to life and health in their absolute negation of these rights through the denial
of life-saving care [37]. Human rights standards thus require the repeal of laws that criminalize all
forms of abortion or their reform through the introduction or broadening of legal grounds for abortion
[38]. Legal grounds describe the “circumstances under which abortion is lawful, that is, allowed or not
contrary to law, or explicitly permitted or specified by law” against an otherwise general prohibition on
abortion [39].
Human rights standards require the decriminalization of abortion, at a minimum, on three grounds:
where pregnancy presents a risk to the life or health of the pregnant person, where pregnancy results
from sexual crime (i.e., rape, sexual assault, or incest), and where there is a risk of serious fetal
impairment [28; 23, ¶72b]. The Protocol to the African Charter on Human and Peoples’ Rights on the Rights
of Women in Africa (hereinafter the Maputo Protocol) explicitly requires the decriminalization of and
lawful access to abortion on these grounds in the text of the treaty [40]. Criminalization of abortion in
these circumstances is considered arbitrary and/or disproportionate because it fails to give due
consideration to the hardships of those who seek to end their pregnancies in such circumstances with
risks to health, integrity, and well-being.
Human rights standards require the decriminalization of abortion in cases of risk to life or health as
an entitlement of human rights to life, health, and equality. Any law likely to result in bodily harm,
unnecessary morbidity, or preventable mortality including through the denial of health care consti-
tutes a violation of rights to life [30, ¶10] and health [20, ¶¶49e50], [21, ¶¶10e11]; [13, 27, ¶31] and any
law that criminalizes or otherwise restricts access to care disproportionately needed by women,
constitutes discrimination, and violates the right to equality [12, ¶¶11; 20, ¶¶34; 41]. The Rapporteur on
the Rights of Women of the Inter-American Commission on Human Rights recognized that “thera-
peutic abortion has been internationally recognized as a … health service for women, its ultimate
purpose being to save the life of the mother when threatened during pregnancy.” [42] Health services
denials risking death and ill health are regarded as disproportionate harms to the achievement of any
legitimate end in the criminal regulation of abortion.
Human rights standards against inhuman and degrading treatment require the decriminalization of
abortion on grounds where pregnancy results from sexual crime to protect against the infliction of
emotional harm [30, ¶11; 43; 44, ¶¶8.7, 8.18, 9.2; 27, ¶¶36; 45; 13], as well as social harms of rejection or
banishment from community or family life due to the stigma of sexual violence [46; 23, ¶51]. This legal
ground has been recognized as critical for indigenous girls who may face the risk of sexual violence
during long journeys to school [47]. Given the increased risk of sexual violence including systematic
rape as a tool of political repression, the Committee on the Elimination of Discrimination against
Women [48], the Committee on Economic, Social and Cultural Rights [21, ¶30], and the UN Special
Rapporteur on Health [49] have recognized the rape ground as critical for those living during and after
conflict.
The UN Special Rapporteur on Health reported that for women who have suffered from sexual
violence, it is unacceptable that they should suffer again from the denial of health care necessary to
promote and protect their mental health [50]. Under this ground, human rights standards explicitly
characterize abortion services as a form of mental health care [51]. These rationales for decriminal-
ization based on rights to health and to be free from inhuman and degrading treatment are distinct
j.bpobgyn.2019.05.004
from invoking sexual crime as a mitigating or exculpatory factor to preserve a woman's sexual virtue or
honor. In L.C. v. Peru, the state was required to provide a remedial human rights measure to “review its
legislation with a view to decriminalizing abortion when the pregnancy results from rape or sexual
abuse” as an entitlement of the right to health [44, ¶¶8, 18]. Various parts of the UN, including the
Committee on the Elimination of Discrimination against Women [52] and the UN Office on Drugs and
Crime, recognize that lawful abortion is a remedial measure to address the harms to health and well-
being from gender-based violence including sexual violence [53].
Human rights standards require the decriminalization of abortion in circumstances where there is a
risk of serious, including fatal, fetal impairment given foreseeable risks of mental distress and suffering
[54], with the criminalization of abortion denying a critical form of health care and social support [55].
Criminal prohibitions on abortion that require the continuation of non-viable pregnancies to mis-
carriages or stillbirths further constitute violations of the right against inhuman and degrading
treatment by forcing the endurance of pregnancies with the knowledge that they will end in death
rather than life [56]. This infliction of harm is arbitrary because no countervailing state interest in the
protection of prenatal life justifies it. These standards have been reaffirmed under the International
Covenant on Civil and Political Rights in the communications of K.L. v. Peru [54], Mellet v. Ireland
[57],and Whelan v. Ireland. [58] The Inter-American Court of Human Rights ordered El Salvador to take
appropriate humane measures for a woman pregnant with an anencephalic fetus [59].
The prohibition of abortion in circumstances of serious fetal impairment constitutes an arbitrary
and unreasonable interference with a person's physical and psychological integrity and their decisional
autonomy on how best to cope with a non-viable pregnancy. In a joint statement, the Committee on the
Elimination of Discrimination against Women and the Committee on the Rights of Persons with Dis-
abilities explicitly clarified that the use of disability rights to restrict or prohibit women's access to safe
and legal abortion of fetuses with disabilities constitutes a misinterpretation of the Convention on the
Rights of Persons with Disabilities [60]. Disability rights and gender equality are two components of the
same human rights standard that cannot be construed as conflicting.
Abortion liberalization through the addition or expansion of legal grounds is well reflected at the
national level. In Latin America, the Supreme Court of Justice in Argentina cited human rights standards
in a favorable interpretation of the penal code that decriminalized abortion in all cases of rape [61]. The
Constitutional Court in Colombia held that an absolute prohibition on abortion was unconstitutional
and recognized rights to lawful abortion on grounds of threat to life and health, sexual crime, and fatal
fetal malformation [62]. The Constitutional Court of Chile applied similar reasoning to allow for
abortion on grounds of threat to the pregnant women's life, in cases of rape and fatal fetal anomaly
[63]. The Supreme Court of Brazil held that decriminalization on grounds of fatal fetal anomaly is
constitutionally required to avoid inhuman and degrading treatment and to protect physical and
mental health [32, 64]. In its holding, the Court referenced the K.L. decision and emphasized the mental
health component of care [64], relying on the WHO definition of health as “a state of complete physical,
mental and social well-being, and not only the absence of disease or infirmity.” [65].
In Europe, the United Kingdom (UK) Supreme Court reasoned that the current law applied in
Northern Ireland that limits abortion to save life and health of the woman is disproportionate with
women's rights to private and family life because it does not allow abortion in cases of sexual crimes
and fatal fetal anomaly [66]. Even though the Court dismissed the case on procedural grounds, a
majority of the Court felt compelled to explain that the restrictive Northern Irish law is incompatible
with the UK's human rights obligations [66].
Abortion liberalization through procedural protections
Abortion liberalization worldwide has shown that progressive legal grounds alone provide little
guarantee of effective access to services. This is a consequence of laws written in vague terms, breeding
uncertainty, and conflict over what the law allows, resulting in delayed or denied access to lawful
services [67]. Criminal laws with specified grounds for abortion often grant doctors wide discretion to
interpret and apply them. In what is referred to as the “chilling effect,” doctors often refuse services on
a cautious interpretation of vague law, reasonably fearing prosecution under conditions of uncertainty.
j.bpobgyn.2019.05.004
When influenced by bias and prejudice, doctors have been known to create their own informal re-
strictions to intentionally frustrate access [68].
Human rights standards therefore require affirmative legal and policy measures to protect against
arbitrary denials of lawful care and to ensure access to services under legal grounds. These measures
include legal frameworks that articulate clear entitlements to care under lawful grounds or what has
been termed “transparency” in abortion laws [69]. National ministerial guidelines, such as in Peru [70],
are a key example of such measures. In addition to guidelines, social mobilization strategies include
initiatives, as in Colombia [71], where women's health advocates, with expertise on the multiple legal
rules affecting access to abortion, work to ensure actual access.
Human rights standards also require certain procedural protections to protect these entitlements to
lawful care, including measures that
guarantee timely access to information of the circumstances of pregnancy and grounds for its
possible termination
require written reasons for denials of care; and
establish mechanisms of appeal and review of denials with an opportunity for persons seeking
abortions to be heard and to have their views considered [37, ¶103].
Human rights standards on procedural protections often reference the WHO Safe Abortion
Guidance to identify a variety of policy and practical measures available to ensure access to lawful
care [72]. These protections are recognized as particularly important for socially vulnerable and
disadvantaged groups [54; 44; 73, ¶9.2e3]. The Committee on the Rights of the Child, for example,
has urged states to ensure that the views of pregnant adolescents are always heard and respected in
abortion decisions [74].
Human rights standards on procedural protections apply to all legal grounds including risk to life
[36] or health [44,75], sexual crime [73,76], and risk of serious or fatal fetal impairment [54,57,58].
Requirements to exhaust all alternative interventions before an abortion can be provided to protect life
or health, for example, are contrary to human rights standards [44; 37,¶95]. Such an onerous
requirement not only creates unnecessary delay in care [77] but also withholds care and coercively
requires consent to alternative interventions [52, ¶24m; 78]. A lawful abortion cannot be withheld on
the basis of a person's refusal to consent to an alternative medical intervention (e.g., fetal surgery, live
delivery). For these reasons, denials or obstructions of lawful care constitute violations of the right to be
free from inhuman and degrading treatment [73]. Procedural protections for lawful abortion in cases of
risk to life or health therefore include robust clinical governance and professional standards to ensure
health professionals are secure in delivering time-critical care and patients are aware of their care
entitlements [79].
Human rights standards on procedural protections have been particularly articulated and applied in
the European human rights system [67]. In Tysia˛ c v. Poland, the European Court of Human Rights
recognized that the “legal prohibition on abortion, taken together with the risk of their incurring
criminal responsibility … can well have a chilling effect on doctors when deciding whether the re-
quirements of legal abortion are met in an individual case. The provisions regulating the availability of
lawful abortion should be formulated in such a way as to alleviate this effect. Once the legislature
decides to allow abortion, it must not structure its legal framework in a way which would limit real
possibilities to obtain it.” [75, ¶116].
Procedural human rights standards are particularly strong to ensure access to abortion care in cases
of sexual crime. Particular protections include timely access to services on the basis of a complaint
rather than forensic evidence or police examination, or a commitment to commence legal proceedings
[73, ¶¶9.2e11; 13]. Human rights standards also recognize the importance of protecting the right to
dignity and privacy in access to abortion and other care in cases of sexual violence [20, ¶3; 21, ¶29];
[12,¶22; 80, ¶76]. The WHO Safe Abortion Guidance advises that “standards and guidelines for provision
of abortion in such cases should be elaborated, and appropriate training given to health-care providers
and police,” ideally as part of comprehensive care standards and guidelines for treating sexual violence
[6, p.69].
j.bpobgyn.2019.05.004
Affirmative measures undertaken at the regional and national levels to alleviate harms of denial of
access to abortion in cases of sexual crime are exemplary. The Inter-American Commission on Human
Rights recognized the gravity of this emotional harm for adolescent girls who had been raped in
granting precautionary measures to provide appropriate health services for rape victims from
Colombia [81], Nicaragua [82], and Paraguay [83]. Under the Inter-American Commission's negotiated
Friendly Settlement scheme, Mexico agreed that it had violated the rights of an adolescent girl who
gave birth to a child resulting from rape [84] and paid reparations. The Constitutional Court of Bolivia
followed the recommendations of the Inter-American Commission on Human Rights to repeal criminal
provisions that require prior medical or forensic evidence, judicial authorization or criminal investi-
gation, and criminal reporting or proceedings for access to lawful abortion in cases of rape [80, ¶116(9)]
to invalidate provisions requiring rape victims to obtain judicial authorization and to provide a criminal
report to access legal abortion services [85].
In cases of fetal impairment, procedural protections extend to a right to the information and
support necessary for free and informed decision-making, specifically the right to access timely
prenatal screening to diagnose fetal impairment and to access lawful care [86]. The European
Court of Human Rights again explained that “the State is under a positive obligation to create a
procedural framework enabling a pregnant woman to exercise her right of access to lawful
abortion … In other words, if the domestic law allows for abortion in cases of foetal malformation,
there must be an adequate legal and procedural framework to guarantee that relevant, full and
reliable information on the foetus’ health is available to pregnant women” [86, ¶¶197, 200]. The
WHO Safe Abortion Guidance reflects this standard in affirming that “prenatal tests and other
medical diagnostic services cannot legally be refused because the woman may decide to terminate
her pregnancy. A woman is entitled to know the status of her pregnancy and to act on this in-
formation.” [6, p.93].
The Malawi Law Reform Commission has recommended reform of its national abortion law [87].
Pending such reform, the government of Malawi has been reminded of the need to provide procedural
protections to ensure prompt access to existing legal grounds for abortion, especially given its obli-
gations under the Maputo Protocol and the CEDAW Convention [88]. The African Commission on
Human and Peoples’ Rights has formulated authoritative interpretive guidance through a general
comment to assist governments, especially their ministries of health [89], to design and apply abortion
laws in a balanced, transparent, fair, and nonarbitrary manner [5]. Significantly, particular African
countries such as Ethiopia have implemented guidance to ensure transparent access to lawful in-
dications for abortion, including in cases of rape and incest [90].
Abortion decriminalization
With a growing acceptance of the deep and enduring dysfunctions of criminal abortion laws, no
matter how liberal or with what procedural protections, the international human rights consensus has
moved toward the decriminalization of abortion, that is, the repeal of criminal abortion laws and,
generally, the removal of abortion as a legitimate subject of criminal law [91].
This consensus is supported by an increased recognition of the inherent, diverse, and complex
harms of abortion criminalization [92]. As recognized by the UN Special Rapporteur on the Right to
Health, “[c]riminal laws and other legal restrictions may … directly outlaw a particular service, such as
abortion.… In practice, these laws affect a wide range of individuals, including women who attempt to
undergo abortions …; friends or family members who assist women to access abortions; practitioners
providing abortions; [and] … human rights defenders advocating for sexual and reproductive health
rights …. ” [27,¶14] Acknowledging the full reach and impact of criminal abortion laws in jeopardizing
peoples’ health and lives, subjecting them to physical and mental pain and suffering, inviting all
manner of arbitrary state interference and indignity into their lives, and creating gross social injustice
in the exercise and enjoyment of sexual and reproductive rights, the Special Rapporteur counsels their
repeal. He recommends that States “Decriminalize abortion, including related laws, such as those
concerning abetment of abortion.” [[27,¶65h]].
j.bpobgyn.2019.05.004
Criminalization and safe abortion
Criminalization has long been recognized as a key factor in the prevalence of unsafe abortion, which
carries risks for the lives, health, and well-being of people. Human rights standards support decrim-
inalization on this basis, namely, that criminal laws increase peoples’ resort to unsafe abortion in
violation of the right to life and health. This right requires making efforts to achieve the contrasting
effect, that is, to ensure that people “do not have to undergo life-threatening clandestine abortions”
[[30,¶10]; [27,¶35]; [37,¶¶92,93,102]]. The WHO Safe Abortion Guidance captures this public health and
human rights rationale for decriminalization, explaining that restrictive laws are “likely to increase the
number of women seeking illegal and unsafe abortions, leading to increased morbidity and mortality.”
[6, p.90]. There are strong national case studies to support these standards. In Romania, after abortion
was made illegal under the Ceausescu pronatalist regime, abortion-related mortality increased to rates
ten times higher than those in other European countries [93]. Currently, the overwhelming majority of
unsafe abortions occur in countries where abortion is strictly criminalized [94].
Human rights standards are evolving from an exclusive focus on saving women from unsafe
abortion to recognizing the broader social effects of criminalization that endanger them [13]. By
focusing on the criminal law as a social determinant of health, these human rights standards shift
attention away from the simple criminal prohibition of the cause of harm toward the broader social
effects of criminalization that endanger health and well-being.
Criminalization and health protection
Human rights standards guarantee to all “a system of health protection which provides equality of
opportunity for people to enjoy the highest attainable level of health.” [20,¶8]. Abortion criminalization
creates and perpetuates unsafe conditions through a myriad of institutional effects that structure
vulnerability and risk by limiting access to information, available facilities and trained providers, and
distribution of medicines [27,¶¶17,18,21,26]. The UN special rapporteur on the right to health reports
that “provision of health-care goods and services that are of poor quality is a major problem arising
from legal regimes criminalizing abortion.” [27,¶32].
Abortion criminalization censors or obstructs health information not only on entitlements to lawful
abortion within formal health care systems [27,¶¶26,31,33,65l] but also on safer self-managed abortion
in informal settings [95]. Criminalization restricts the circumstances in which any individual may
provide information about abortion [58,¶¶7.6.9]. People are deterred from taking steps to protect their
health, including by asking questions and sharing experiences, as well as by seeking treatment for
complications to avoid liability and in fear of stigma [14,¶¶14,19b,72,75,78,98]. In health worker
guidance for safe abortion care, the WHO recognizes that “[w]omen themselves have a role to play in
managing their own health … [including in abortion] self-assessment and self-management ap-
proaches in contexts where the woman has access to appropriate information and to health services
should she need or want them at any stage of the process” [29,¶11]. Such opportunity for self-care
cannot be realized in criminalized contexts. The right to heath, however, extends to underlying de-
terminants of health, such as access to health-related information and includes the right to seek,
receive, and impart information and ideas concerning health issues [20,¶¶11,12,34,36,37].
Moreover, the information deficits due to criminalization distort public understanding and per-
ceptions of abortion. Criminalization generates a chilling effect on data collection, hence causing
substantial underreporting and the open exchange of information [27,¶19]. The WHO Safe Abortion
Guidance recognizes that “[i]t is particularly important to include the perspectives on services from
users and potential users,” in policy development, “as they are the main source of identifying barriers
to service use,” yet criminalization often prohibits their participation.[6, p.81] Criminal abortion laws
serve to stigmatize those associated with abortion inhibiting their constructive participation in policy
development [96]. Criminalization generates and perpetuates abortion stigma, which then reinforces
continued criminalization of abortion [[27,¶¶24,34,35]; [24,¶¶76,80]]. A law or a policy that censors
information “distorts the balance of care, seeking to silence those who wish to speak frankly and
competently about, or wish to advocate for, legal and safe abortion while giving an advantage to those
who wish to organize in opposition to abortion.” [97].
j.bpobgyn.2019.05.004
Abortion criminalization and the associated stigma interfere with health system planning and
management and provide a rationale for the exceptional and arbitrary treatment of abortion in all
manner of health policies and practices. Criminalization, for example, impedes the integration of
abortion care into the health system as legitimate health services and interferes with the training and
work of health care providers by requiring their adherence to practices that are not evidence-based.
Where abortion is prohibited, public health and safety regulations such as provisions for the
training and licensing of healthcare workers cannot exist or create strong incentives for providers to
avoid training and the provision of information of abortion [27,¶¶26,28,32].
Many criminal laws “overmedicalize” abortion through highly restrictive requirements for pro-
viders and facilities, which needlessly limit the provision of abortion care, restricting the availability
of services to higher level settings and concentrating distribution of services within urban areas
contrary to guarantee under the right to health [[21,¶46]; [24,¶¶74-5]; [20,¶12]]. The harms of
abortion travel in response to criminal restrictions that deny people care within familiar environ-
ments of their own country, separated from the support of family and without the comfort of trusted
and known health professionals, constitute a human rights violation [57,¶¶7.2,7.4,7.8; 58,¶¶7.5,7.11].
The WHO Safe Abortion Guidance advises that abortion laws “should be evidence-based to protect
against over-medicalized, arbitrary or otherwise unreasonable requirements” in service delivery [6,
p.96]. Criminal abortion laws, however, prevent safer community-based services accessible to rural
women and women with disabilities and others who are underserved by formal health facilities
[12,¶¶37,39]. Human rights standards require that accessibility to health services be ensured for all
[21,¶16].
Criminal laws also often result in restrictions in the national registration and distribution of
mifepristone and misoprostol for medical abortion, contrary to human rights standards to ensure that
“access to essential medicines … is based purely on health needs and evidence and not restricted on
account of extraneous non-health considerations” [98; 21,¶¶38,49]. Criminal abortion laws further
provide a rationale for the exclusion or revocation of public funding or foreign assistance for abortion,
again contrary to human rights standards that require benefits packages to be responsive to the health
needs of the full population served [99; 21,¶¶38,41]. User or “informal” fees for abortion care increase
the risk of exploitation and resort to substandard services [24,¶90].
Criminalization and social equality
Human rights standards support decriminalization to promote social equality because health-
related risks and harms of criminal abortion laws are unjustly distributed [100]. Criminal abortion
laws are also recognized as inherently discriminatory because of the sex and gender bias inscribed into
their structure and purpose [31,¶¶37,46; 101]. Human rights standards therefore recognize abortion
criminalization as discriminatory for a variety of reasons, including that these laws
criminalize health care needed only by women and result in the disproportionate impact on the
health of disadvantaged women and their disproportionate detention [12,¶14],
punish women for transgressions of gender stereotypes of dedicated motherhood [27,¶16], and
constitute a form of gender-based violence [22,¶¶18,29].
Human rights standards condemn intersecting social inequalities and the disproportionate burdens
of criminal abortion laws on socially marginalized and disadvantaged women. The UN Working Group
Report observed that “safe termination of pregnancy is a privilege of the rich, while women with
limited resources have little choice but to resort to unsafe providers and practices.” [24,¶80].
Marginalized women are disproportionately affected by arbitrary denials of legal services, as well as
higher prosecution rates and heavier penalties due to lack of competent legal representation [102]. In
calling for decriminalization, courts in Nepal [103] and Brazil [104] have recognized the dispropor-
tionate impact on disadvantaged women. The Supreme Court of Nepal called for the decriminalization
of abortion to ensure equitable provision of services to all women irrespective of gender, poverty, and
rural location. In ordering the release of providers charged with criminal abortion from pretrial
j.bpobgyn.2019.05.004
detention, the Supreme Court of Brazil referenced the disproportionate impact on disadvantaged
women as a reason for its call for decriminalizing abortion.
Human rights standards require measures to address and eliminate discriminatory stereotypes and
norms concerning sexuality and reproduction that underlie criminal abortion laws [21,¶35]. In L.C. v.
Peru, the demeaning prejudices and stereotypes inherent in criminal abortion laws were cited as a
reason for decriminalization as a necessary measure to ensure women's equality [44].
Criminalization and human dignity
Criminalization of abortion inherently limits a person's right to decide whether and when to
reproduce, a right that human rights standards recognize as integral to physical and mental integrity
and to human dignity and worth.
Abortion criminalization takes into consideration the “sexual life of a person” as a condition of their
human rights, and the scope and protection of those rights [30,¶20]. Human rights standards accept
that there can be no sexual freedom without the right to control one's health and body [20,¶8] and the
freedom to decide the direction of one's life [27,¶50]. Abortion criminalization “is one of the most
damaging ways of instrumentalizing and politicizing women's bodies and lives” [24,¶79], through the
state substituting its will for that of the individual [27,¶12]. Human rights require that individuals are
free to make decisions without interference from the State, especially in their sexual and reproductive
lives [105]. To gestate and to birth a child is a profound human act, enlisting the whole of a person and
their full faculties of mind and body. It is an act that carries serious lifelong consequences for a person,
hence reflecting and influencing the way they think about themselves and their relationships with
family, community, and society. Criminal abortion laws thus inflict mental or physical suffering,
constitute violence against women, and amount to torture and cruel, inhuman, and degrading treat-
ment, but the severity of these harms is realized in the affront to dignity and personhood that they
represent. Abortion criminalization constitutes a profound violation of respect for human dignity,
which is fundamental to the realization of all human rights.
Among the greatest reflection of respect for these standards in national law is the adoption of state
measures on abortion that are designed to acknowledge and to support the decisional autonomy, the
dignity, and personhood of people when pregnant. In upholding a law allowing abortion without re-
striction early in pregnancy, the Constitutional Court of Portugal explained that dignity-enhancing
measures of sex education, access to contraception, and social policies to support wanted mother-
hood and family life are constitutional because they respect decisional autonomy and support women's
own initiatives to determine their reproductive futures [106]. The Constitutional Courts of Croatia [107]
and Slovakia [108] have upheld their respective progressive abortion laws by reference to human rights
standards on the rights to reproductive self-determination.
With these measures, human rights standards have captured the substantive core of reproductive
rights in abortion, that is, the basic right to decide the number, spacing, and timing of children and to
have the information and means to do so.
Summary
International human rights standards on abortion have evolved from the withdrawal of punitive
measures imposed on women for undergoing abortion to the expansion of grounds for lawful abortion
and procedural protections to ensure actual access on those grounds and ultimately to the decrimi-
nalization of abortion as a human rights imperative. Human rights standards require access to abortion,
at a minimum, on grounds of life and health, rape or sexual crime, and fetal impairment. Procedural
protections to safeguard entitlements to lawful care include measures that guarantee timely access to
information of the circumstances of pregnancy and grounds for its possible termination, written
reasons for denials of care, and mechanisms of appeal and review of denials with an opportunity for
persons seeking abortions to be heard and to have their views considered.
Even with the liberalization of grounds for abortion with specific procedural protections, crimi-
nalization continues to contribute to deep and enduring dysfunctions: (i) it is a key factor in the
prevalence of unsafe abortion, (ii) it increases vulnerability and risk to poor health outcomes by
j.bpobgyn.2019.05.004
limiting access to information, quality health services, including trained providers and appropriate
medicines, and (iii) treaty monitoring bodies and courts have found that it violates the right to life,
health, and dignity, including the right to private life and to be free from inhuman and degrading
treatment, and to equality, especially of disadvantaged women and girls. As a result of these dys-
functions, the human rights consensus has moved toward the decriminalization of abortion, that is, the
repeal of criminal abortion laws and generally, the removal of abortion as a legitimate subject of
criminal law.
Practice points
Human rights standards require that clinical practice ensures that every person is entitled to
immediate, confidential, and unconditional care for management of complications regard-
less of the law on abortion, and health care cannot be withheld for purposes of punishment or
used to elicit confession or as evidence in any criminal proceedings, or otherwise condi-
tioned on a person's cooperation in a criminal prosecution.
Human rights standards require that clinical practice and procedures articulate clear enti-
tlements to care under legal grounds for abortion and provide procedural protections,
including written reasons for denials of care, and mechanisms of appeal and review of de-
nials with an opportunity for persons seeking abortions to be heard and to have their views
considered to ensure and protect these entitlements to care.
Human rights standards require that clinical practice acknowledge and support the decisional
autonomy, dignity, and personhood of all those seeking information or services related to
abortion to uphold their rights to life, health, dignity, and equality.
Research agenda
Research is necessary to identify how criminalization of abortion is a factor in the cause,

distribution, and prevention of poor physical and mental health outcomes.
Research is needed to determine whether governments are applying their abortion laws
equitably across their respective countries, or in subsections of their countries, so that all
women and girls, irrespective of their circumstances, can access abortion services according
to their health care needs and in a dignified manner.
Research is necessary to help identify specific and practical interventions for effective
decriminalization of abortion in health policy and practice.
Conflicts of interest statement
The authors have no conflicts of interest.
References
[1] United Nations. Programme of action of the United Nations international conference on population and development.
New York: United Nations. 1994¶8.25.
[2] United Nations. Beijing declaration and platform for action: fourth world conference on women. New York: United
Nations. 1995¶106(k).
[3] Erdman JN. Abortion in international human rights law. In: Rowlands S, editor. Abortion care. Cambridge: Cambridge
University Press; 2014. p. 244e50.
[4] Johnson BR, Mishra V, Lavelanet AF, Khosla R, Ganatra B. A global database of abortion laws, policies, health standards,
and guidelines. Bull World Health Organ 2017;95:542e4.
j.bpobgyn.2019.05.004
[5] Ngwena CG, Brookman-Amissah E, Skuster P. Human rights advances in women's reproductive health in Africa. Int J
Gynecol Obstet 2015;129:184e7.
*[6] World Health Organization. Safe abortion: technical and policy guidance for health systems. second ed. Geneva:
World Health Organization; 2012.
*[7] Ngwena CG. Inscribing abortion as a human right: the significance of the protocol on the rights of women in Africa.
Hum Rights Q 2010;32:783e864.
[8] Upreti M. Toward transformative equality in Nepal: the Lakshimi Dhikta decision. In: Cook RJ, Erdman JN, Dickens BM,
editors. Abortion in transnational perspective: cases and controversies. Philadelphia: University of Pennsylvania
Press; 2014. p. 278e300.
[9] Zampas C. Legal and political discourses on women's rights to abortion. In: de Zordo S, Mishtal J, Anton L, editors.
A fragmented landscape: abortion governance and protest logics in Europe, New York: Berghahn; 2017. p. 23e45.
[10] Bergallo P, Michel AR. Constitutional developments in Latin American abortion law. Int J Gynecol Obstet 2016;135:
228e31.
[11] Fine JB, Mayall K, Sepúlveda L. The role of international human rights norms in the liberalization of abortion laws
globally. Health Hum Rights 2017;19(1):69e79.
[12] The UN Committee on the Elimination of Discrimination against Women. General recommendation no. 24. A/54/38/
Rev. 1. 1999¶31(c).
[13] The UN Human Rights Committee. General comment no. 36. CCPR/C/GC/36. 2018¶8.
[14] Pu ras D. Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard
of physical and mental health. A/HRC/38/36. 2018¶78.
[15] Zureick A, Khan A, Chen A, Reyes A. Physicians' challenges under El Salvador's criminal abortion prohibition. Int J
Gynecol Obstet 2018;143(1):121e6.
[16] Amnesty International. The total abortion ban in Nicaragua: women's lives and health endangered, medical pro-
fessionals criminalized. London: Amnesty International; 2009.
[17] Isle of Man. Abortion Reform Act 2019 2019;14(3). Isle of Man.
[18] The American College of Obstetricians and Gynecologists. Decriminalization of self induced abortion: position
statement. December 2017. Available at: https://www.acog.org/Clinical-Guidance-and-Publications/Position-
Statements/Decriminalization-of-Self-Induced-Abortion. [Accessed 26 March 2019].
*[19] Amnesty International. Body politics: a primer on criminalization of sexuality and reproduction. London: Amnesty
International; 2018. p. 185.
[20] The UN Committee on Economic, Social and Cultural Rights. General comment no. 14. E/C.12/2000/4. 2000¶34.
[21] The UN Committee on Economic, Social and Cultural Rights. General comment no. 22. E/C.12/GC/22. 2016¶28.
[22] The UN Committee on the Elimination of Discrimination against Women. General recommendation no. 35. CEDAW/C/
GC/35. 2017¶18.
[23] Me ndez JE. Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or pun-
ishment. A/HRC/31/57. Geneva: United Nations. 2016. ¶¶42, 46, 47, 70(k).
[24] The UN Working Group on Discrimination against Women. Report of the working group on the issue of discrimination
against women in law and in practice. A/HRC/32/44. Geneva: United Nations. 2016¶17.
GR/34. 2016¶39.
[26] The UN Committee on the Rights of the Child. General comment no. 15. CRC/C/GC/15. 2013¶70.
[27] Grover A. The Report of the Special Rapporteur on the Right of everyone to the enjoyment of the highest attainable
standard of physical and mental health. A/66/254. Geneva: United Nations. 2011. ¶¶21-36.
[28] Pu ras D. The Report of the Special Rapporteur on the Right of everyone to the enjoyment of the highest attainable
standard of physical and mental health. A/HRC/32/32. Geneva: United Nations. 2016¶92.
[29] World Health Organization. Health worker roles in providing safe abortion care and post-abortion contraception.
London: World Health Organization; 2015. p. 4.
[30] The UN Human Rights Committee. General comment no. 28. CCPR/C/21/Rev.1/Add. 10. 2000¶20.
[31] Me ndez JE. Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or pun-
ishment. A/HRC/22/53. Geneva: United Nations. 2013. ¶¶46, 50, 90.
[32] Supreme Court of Brazil. Sentence. Claim of non compliance with fundamental Precept no.54. Judge-rapporteur:
justice Marco Aure lio. Vote: justice Rosa Weber. Brasília, DF. April 30 2013. p. 169.
[33] European Court of Human Rights. Vo v. France, Application No. 53924/00.40 E.H.R.R. 12, Eur. Ct. H.R. (2004), ¶80.
*[34] Undurraga V. Proportionality in the constitutional review of abortion law. In: Cook RJ, Erdman JN, Dickens BM, editors.
Abortion law in transnational perspective: cases and controversies. Philadelphia: University of Pennsylvania Press;
2014. p. 77e97.
[35] The UN Human Rights Committee. General comment no. 16. CCPR/C/GC/16. 1988.
[36] European Court of Human Rights. A, B, and C v. Ireland, ECHR. 16 Dec 2010¶229.
[37] Callamard A. Report of the Special Rapporteur on extrajudicial, summary or arbitrary executions on a gender-sensitive
approach to arbitrary killings. A/HRC/35/23. Geneva: United Nations. 2017. ¶94. ¶¶24. 93.
[38] Zampas C, Gher JM. Abortion as a human right e international and regional standards. Hum Rights Law Rev 2008;8:
249e94.
[39] Lavelanet AF, Schlitt S, Johnson Jr BR, Ganatra B. Global abortion policies database: a descriptive analysis of the legal
categories of lawful abortion. BMC Int Health Hum Right 2018;18:44.
[40] African Commission on Human and Peoples’ Rights. Protocol to the African charter on human and peoples' rights on
the rights of women in Africa (the Maputo Protocol). AHG/Res, 240 (XXXI). African union. 2003. Art. 14(2)(c).
[41] The UN Committee on Economic, Social and Cultural Rights. General comment no. 16. E/C.12/2005/4. 2005¶29.
[42] Inter-American Commission on Human Rights, letter to Nicaragua's minister of foreign Affairs. HE Norman Calderas
Cardenal; 10 November 2006.
[43] General comment no. 2. CAT/C/GC/2 The UN committee against torture. 2008¶22.
j.bpobgyn.2019.05.004
[44] The UN Committee on the Elimination of Discrimination against Women. L.C. v. Peru, Communication No. 22/2009, U.
N. Doc. CEDAW/C/50/D/22/2009. 2011. ¶¶8.7, 8.18, 9.2.
[45] The United Nations. Pathways to, conditions and consequences of incarceration for women. A/68/340. 2013¶13.
Geneva: United Nations.
[46] Nowak M. Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or pun-
ishment. A/HRC/7/3. 2008¶36. Geneva: United Nations.
[47] Corpuz VT. A/HRC/30/41. Report of the Special Rapporteur on the rights of indigenous peoples, vol. ¶¶28; 2015. p. 33.
Geneva: United Nations.
GR/30. 2013. p. 38. ¶¶36.
[49] Grover A. Right of everyone to the enjoyment of the highest attainable standard of physical and mental health. A/68/
297. Geneva: United Nations. 2013¶49.
[50] Pu ras D. Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard
of physical and mental health. A/HRC/35/21. 2017¶59. Geneva: United Nations.
[51] Cook RJ, Ortega-Ortiz A, Romans S, Ross LE. Legal abortion for mental health indications. Int J Gynecol Obstet 2006;95:
185e90.
[52] The UN Committee on the Elimination of Discrimination against Women. General recommendation no. 19. HRI/GEN/1/
Rev.9 (I). 2008. ¶¶1, 19, 24(k).
[53] The UN Office on Drugs and Crime. Strengthening crime prevention and criminal justice responses to violence against
women. Vienna: United Nations. 2014. Arts. 7(e-h), 8(d).
[54] The UN Human Rights Committee. K.L. V. Peru, Communication No. 1153/2003, U.N. Doc. CCPR/C/85/D/1153/2003.
2005.
[55] Cook RJ, Erdman JN, Hevia M, Dickens BM. Prenatal management of anencephaly. Int J Gynecol Obstet 2008;102:
304e6.
[56] Sifris R. Reproductive freedom, torture and international human rights: challenging the masculinisation of torture.
New York: Routledge. 2014. pp. 52, 69, 116, 151, 250.
[57] The UN Human Rights Committee. Mellet v. Ireland. CCPR/C/116/D/2324/2013. 2016. ¶¶7.6-7.8.
[58] The UN Human Rights Committee. Whelan v. Ireland. CCPR/C/119/D/2425/2014. 2017. ¶¶7.7, 7.9.
[59] Inter-American Court of Human Rights. Matter of B, provisional measures with regard to El Salvador. May 29 2013.
[60] The United Nations. Office of the High Commissioner for Human Rights, Stop regression on sexual and reproductive
rights of women and girls, UN experts urge. United Nations Human Rights: Office of the High Commissioner; 2018.
Available from: https://www.ohchr.org/en/NewsEvents/Pages/DisplayNews.aspx?NewsID¼23503&LangID¼E 5.
[Accessed 9 March 2019].
[61] National Supreme Court of Justice of Argentina. Corte Suprema de Justicia de la Nacio n, F, A. L. s/Medida Autosa-
tisfactiva, Expediente Letra “F”, N 259, Libro XLVI. 13 March 2012. ¶¶3, 6, 7, 10-13, 15, 16, 24, 26.
[62] Constitutional Court of Colombia. Sentencia C-355/06, Part VI. 2006. Section VI, 6, 7, 8.4, 10.11.
[63] Constitutional Court of Chile. STC Rol N 3729(3751)-17 CPT. 2017.
[64] Machado M, Cook RJ. Constitutionalizing abortion in Brazil. Revista de Investigaco €es Constitucionais 2019;5(3):
185e231.
[65] World Health Organization. Constitution of the World Health Organization. 1946.
[66] Supreme Court of the United Kingdom. In: The matter of an application by the northern Ireland human rights
commission for judicial review (Northern Ireland); 2018. UKSC 27.
*[67] Erdman JN. The procedural turn: abortion at the European court of human rights. In: Cook RJ, Erdman JN, Dickens BM,
editors. Abortion law in transnational perspective: cases and controversies. Philadelphia: University of Pennsylvania
Press; 2014. p. 121e42.
[68] Bergallo P. The struggle against informal rules on abortion in Argentina. In: Cook RJ, Erdman JN, Dickens BM, editors.
Abortion in transnational perspective: cases and controversies. Philadelphia: University of Pennsylvania Press; 2014.
p. 143e65.
*[69] Ngwena CG. Reforming African abortion laws and practice: the place of transparency. In: Cook RJ, Erdman JN,
Dickens BM, editors. Abortion law in transnational perspective: cases and controversies. Philadelphia: University of
Pennsylvania Press; 2014. p. 166e86.
[70] Government of Peru. National technical guidance for the standardization of the process for comprehensive care for
pregnant women during the voluntary interruption of pregnancy for theraperutic purposes under 22 weeks of
gestation with informed consent under Article 119 of the penal code). Ministerial Resolution No. 486/2014/MINSA.
June 27, 2014 (translation of the Spanish title).
[71] Gonz lez AC, Jaramillo IC. Legal knowledge as a tool for social change: La mesa por la vida y la salud de las
alez Ve
mujeres as an expert on Colombian abortion law. Health Hum Rights 2017;19(1):109e18.
*[72] Center for Reproductive Rights. Breaking ground 2018: treaty monitoring bodies on reproductive rights. New York:
Centre for Reproductive Rights; 2018. p. 33.
[73] The UN Human Rights Committee. L.M.R. V. Argentina. Communication No. 1608/2007. CCPR/C/101/D/1608/2007.
2011. ¶¶9.2., 9.3.
[74] The UN Committee on the Rights of the Child. General comment no. 20. CRC/C/GC/20. 2016¶65.
[75] European Court of Human Rights. Tysia˛ c v. Poland. Application no. 5410/03, 45. ECHR; 2007.
[76] European Court of Human Rights. P. And S. V. Poland. Application no. 57375/08. ECHR; 2012.
[77] Ireland Health Services Executive. The final report of the Health Services Executive investigation of Incident 50278
from the time of the patient's self referral to hospital on 21st of October 2012 to the patient's death on the 28th
October 2012. Ireland Health Services Executive. June 2013 (Sabaratnam Arulkumaran (chair)), Available from: https://
www.lenus.ie/handle/10147/293964. [Accessed 7 March 2019].
[78] Grover A. Report of the UN Special Rapporteur on the right of everyone to the enjoyment of the highest attainable
standard of physical and mental health. A/64/272. Geneva: United Nations, vol. ¶¶9; 2009. p. 54.
j.bpobgyn.2019.05.004
[79] IPPF/WHR. Legal abortion: a comparative analysis of health regulations. New York: IPPF/WHR; 2012.
[80] Inter-American Commission on Human Rights. Access to information on reproductive health from a human rights
perspective, 2011. OAS/Ser.L/V/II., doc. 61. 2011¶76.
[81] Inter-American Commission on Human Rights. X and XX, precautionary measure 270/09 (Colombia). IACHR; 2009.
[82] Inter-American Commission on Human Rights. Amalia, precautionary measure 43-10 (Nicaragua). IACHR; 2010.
[83] Inter-American Commission on Human Rights. Nin ~ a mainumby, precautionary measure 178/15 (Paraguay). IACHR;
2015.
[84] Inter-American Commission on Human Rights, Paulina Ramirez V. Mexico. Case 161-02. Report No. 21/07. IACHR.
Friendly settlement. 2007.
[85] Constitutional Court of Bolivia. Sentencia constitucional Plurinacional 0206/2014, Part III, x 8.8. 2014. Section III, 8.8.
[86] European Court of Human Rights. R.R. V. Poland, Application No. 27617/04. ECHR; 2011.
[87] Malawi Law Commission. Report of the law commission on the review of the law on abortion (penal code CAP.7:01 of
the laws of Malawi). Lilongwe: Malawi Law Commission; 2015.
[88] Kangaude GD, Chisale Mhango C. The duty to make abortion law transparent: a Malawi case study. Int J Gynecol
Obstet 2018;143(3):409e13.
[89] African Commission on Human and Peoples’ Rights. General comment No 2 on article 14 (1) (a), (b), (c) and (f) and
article 14 (2) (a) and (c) of the Protocol to the African charter on human and peoples' rights on the rights of women in
Africa, adopted by the African commission on November 28. 2014.
[90] Mavundla S, Ngwena CG. Access to legal abortion for rape as a reproductive health right: a commentary on the
abortion regimes of Swaziland and Ethiopia. In: Ngwena CG, Durojaye E, editors. Strengthening the protection of
sexual and reproductive health and rights in the African region through human rights. Pretoria: University of Pretoria
Law Press; 2014. p. 61e78.
*[91] The UN Committee on the Elimination of Discrimination against Women. Report of the inquiry concerning the United
Kingdom of Great Britain and Northern Ireland under article 8 of the optional Protocol to the convention on the
elimination of all forms of discrimination against women. CEDAW/C/OP.8/GBR/1. 2018¶58.
[92] Erdman JN. Harm production: an argument for decriminalization. In: Miller A, Roseman M, editors. Beyond virtue and
vice - rethinking human rights and criminal law. Philadelphia: University of Pennsylvania Press; 2019. p. 249.
[93] Hord C, David HP, Donnay F, Wolf M. Reproductive health in Romania: reversing the Ceausescu legacy. Stud Fam Plann
1991;22(4):231e40.
[94] Ganatra B, Gerdts C, Rossier C, Johnson BR, Tunçalp O, Assifi A, et al. Global, regional, and subregional classification of
abortions by safety, 2010e14: estimates from a Bayesian hierarchical model. Lancet 2017;390:2372e81.
[95] Erdman JN. Harm reduction, human rights and access to information on safer abortion. Int J Gynecol Obstet 2012;118:
83e6.
[96] Cook RJ. Stigmatized meanings of criminal abortion law. In: Cook RJ, Erdman JN, Dickens CM, editors. Abortion law in
transnational perspective: cases and controversies. Philadelphia: University of Pennsylvania Press; 2014. p. 347e69.
[97] Callamard A. Report of the UN special rapporteur on extrajudicial, summary or arbitrary executions: note by the
secretary-general. A/73/314. Geneva: United Nations. 2018¶79.
[98] Grover A. Report of the special rapporteur on the right of everyone to the enjoyment of the highest attainable
standard of physical and mental health. A/HRC/23/42 Geneva, United Nations; ¶¶40, 45, 73(b).
[99] Grover A. The Interim Report of the Special Rapporteur on the Right of everyone to the enjoyment of the highest
attainable standard of physical and mental health. A/67/302. Geneva, United Nations. 2012¶44.
*[100] Cook RJ, Howard S. Accommodating women's differences under the Women's Anti-Discrimination Convention. Emory
Law J 2007;56:1039e91.
[101] The Committee on the Elimination of Discrimination against Women. General recommendation no. 33. CEDAW/C/GC/
33. 2015. p. 49e51. ¶¶47.
*[102] Kane G, Galli B, Skuster P. When abortion is a crime: the threat to vulnerable women in Latin America. third ed. Chapel
Hill, NC: Ipas; 2013.
[103] Supreme Court of Nepal, Lakshmi Dhikta V. Government of Nepal, Writ no. 0757. 2009.
[104] Supreme Court of Brazil. Writ of Habeas corpus 124.306 Rio de Janeiro state. November 29, 2016.
[105] European Commission on Human Rights. Brüggemann and scheuten v. Federal Republic of Germany, Application No.
6959/75. 1981. 3 E.H.R.R. 244, ¶¶54-55.
[106] Constitutional Tribunal of Portugal. Aco rd~
ao Nº 75. 2010.
[107] Constitutional Court of the Republic of Croatia. Decision No. U-I-60/1991. 20 March 2017.
[108] Constitutional Court of Slovakia. PL. ÚS 12/01-297, Collection of Laws of the Slovak Republic. No. 14/2008, vol. 8 at II.A
Pt (3,4). December 4, 2007.
j.bpobgyn.2019.05.004

10 1016@j Bpobgyn 2019 05 004

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

10 1016@j Bpobgyn 2019 05 004

Uploaded by

Copyright:

Available Formats

Best Practice & Research Clinical Obstetrics and Gynaecology xxx (xxxx) xxx

Contents lists available at ScienceDirect

Best Practice & Research Clinical

Decriminalization of abortion e A human rights

depenalize or withdraw punitive measures on abortion;

Depenalization or withdrawal of punitive measures

Criminal abortion law liberalization

Abortion liberalization through legal grounds

Abortion liberalization through procedural protections

Criminalization and safe abortion

Criminalization and health protection

Criminalization and social equality

Criminalization and human dignity

Research is necessary to identify how criminalization of abortion is a factor in the cause,

Conﬂicts of interest statement

The authors have no conﬂicts of interest.

You might also like