Decriminalization of abortion - A human rights imperative

This chapter reviews the evolving consensus in international human rights law, 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 to protect the health, equality, and dignity of people. This consensus is based on human rights standards or the 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 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 governments accountable for the reform and repeal of criminal abortion laws.

Exploring the relationship between lay theories of gender and attitudes to abortion in the context of a national referendum on abortion policy

The relationship between lay theories of gender and attitudes to abortion policy has received minimal empirical attention. An ongoing theoretical debate in the psychological essentialism literature queries whether biological attributions causally influence social attitudes or primarily function to justify existing attitudinal commitments. The current research used the context of a national referendum on abortion in Ireland to investigate whether endorsement of certain gender theories is contingent on their rhetorical construction as supporting particular attitudes to abortion. Two experimental studies were conducted online in the three weeks preceding the Irish abortion referendum. The studies tested whether participants would adapt their causal gender beliefs after reading that biological (Study 1; N = 348) or social (Study 2; N = 241) accounts of gender supported or conflicted with their intended vote in the referendum. Both studies showed the opposite effect: causal gender theories presented as conflicting with participants' voting intentions subsequently showed elevated support, relative to theories that purportedly aligned with participants' voting intentions. While results confirm that lay theories of gender are mutable, the direction of effects does not support the proposition that gender theories are selectively endorsed to support existing socio-political attitudes to abortion. Potential mechanisms for the results observed are discussed.

Political Institutions and the Comparative Medicalization of Abortion

Comparative-historical research on medicalization is rare and, perhaps for that reason, largely ignores political institutions, which tend to vary more across countries than within them. This article proposes a political-institutional theory of medicalization in which health care policy legacies, political decentralization, and constitutionalism shape the preferences, discourses, strategies, and influence of actors that seek or resist medicalization. The theory helps explain why abortion has been more medicalized in Britain than the United States. The analysis finds that the American medical profession, unlike its British counterpart, focused on defending private medicine rather than protecting its power to "diagnose" the medical necessity of abortions; that American political decentralization aided the establishment of abortion on request by encouraging strategic innovation and learning that shaped social movement strategies, medical issue avoidance, and the growth of nonhospital clinics; and finally, that constitutionalism promoted rights discourses that partially crowded out medical ones.

Notes from the field: political norm change for abortion in Pakistan

This commentary describes positive political norm change on abortion despite a restrictive abortion law. As we describe it, the approach in Pakistan has involved careful efforts to maintain government ownership, leadership, and accountability for safe abortion care and service delivery by Pakistani health authorities early and throughout, with technical support from civil society as requested. This commentary suggests that careful collaboration and mutual support by NGOs working on expanding access to abortion can have a lasting and efficient impact on improving political norms and government ownership over abortion care. In most restrictive settings, political norms may be extremely challenging to address due to the institutionalised nature of abortion stigma and resistance, and NGOs can spend many years of resources trying unsuccessfully to challenge and eliminate these barriers. The experience in Pakistan has been a nontraditional approach to political norm change, as it starts by centring the issue of unsafe abortion squarely within the authority and responsibility of the Pakistani government to avert maternal deaths, within the current legal parameters. Emphasis on the public health needs for safe abortion care and current government obligations in Pakistan, as we describe, has led to increased dialogue and discussion about the need for further reforms by government stakeholders who were previously less willing to meaningfully address this health topic. We believe this approach demonstrates significant promise for future progressive change, and we hope this information will be a valuable resource for others working in the field.

Zika and abortion in Brazilian newspapers: how a new outbreak revived an old debate on reproductive rights

Since the beginning of the Zika virus epidemic, the Brazilian Ministry of Health has reported over 2000 confirmed cases of microcephaly associated with Zika virus in Brazil, with the cases concentrated in the northeast states. The Zika epidemic reopened a debate in Brazil that has played out in the national newspapers about expanding the abortion law to provide autonomy and legal protection to women. The argument for expanding the abortion law to include microcephaly secondary to Zika virus infection called for autonomy for women and, more broadly, protection of reproductive rights. The argument against expanding the current abortion law was separated into two main moral veins: those citing eugenics and those citing religious beliefs. However, the debate on abortion in the case of microcephaly accomplished more than giving a voice to two different viewpoints; it exposed health disparities that exist in Brazil, which were magnified by Zika virus, and reopened the political arena for discussion of the abortion law.

Who Was Afraid of Pregnancy Tests? Gestational Information and Reproduction Policies in France (1920-50)

Though resulting from a long-term process, the need to manage pregnancies both medically and bureaucratically became a state concern, especially from the 1920s onwards. A woman's official obligation to notify the state of her pregnancy (and therefore to know it on time) goes beyond a matter of biopolicies and poses a range of contradictions. 'Pregnant or not?' - as an issue of knowledge - is a powerful tool for apprehending the tensions between individual freedom, privacy, institutional requirements and professional powers.In order to better understand the historical meaning of pregnancy diagnostics in mid-twentieth-century France, this paper combines three dimensions: uncertainty and its management; the informational asymmetry between institutional agents and women; and the diachronic dimension of gestation. Writing this history sheds more light on an apparent paradox: while knowing and notifying one's own pregnancy became a duty, the tools that could help women eliminate some doubt right from the first months of their pregnancy - in particular the innovation of laboratory diagnosis - was seen as a danger. When, in 1938, private laboratories began publishing advertisements for the laboratory test in the most widely-read newspapers, tending to reframe it as a commercial service, the anti-abortion crusade was increasing its propaganda and its political pressure. This crusade's legal victory proved incomplete, but for a long time some of the most conservative physicians recommended great parsimony in prescribing testing. Combined with reducing the legal time limit for notification, this conflict shows how the state injunctions towards women could look like a 'double bind'.

The Right to Know? The Politics of Information about Contraception in France (1950s-80s)

In 1920 in France, a law was passed prohibiting abortion, the sale of contraceptives and 'anti-conception propaganda'. While contraception was legalised in 1967 and abortion in 1975, 'anti-natalist propaganda' remained forbidden. This article takes seriously the aim of the French state to prevent the circulation of information for demographic reasons. Drawing from government archives, social movement archives and media coverage, the article focuses on the way the propaganda ban contributed to shaping the public debate on contraception as well as lastingly impacting the ability of the state to communicate on the subject. It first shows how birth control activists challenged the legal interdiction against communicating about contraception (1956-67) without questioning the natalist obligation. It then shows how, after 1968, communication on contraception became a power struggle carried out by various actors (sexologists and feminist and leftist activists) and how the dissemination of information about contraception was thought of as a way to challenge moral and social values. Finally, the article describes the change of state communication policies in the mid-1970s, leading to the first national campaign on contraception launched in 1981, which defined information as a task that women should take on.

Metrics of Survival: Post-Abortion Care and Reproductive Rights in Senegal

Drawing on ethnographic fieldwork conducted in Senegal between 2010 and 2011, I demonstrate how health professionals have deployed indicators such as number of women and abortion type treated in government hospitals to demonstrate commitment to global mandates on reproductive rights. These indicators obscure discrimination against women suspected of illegal abortion as health workers negotiate obstetric treatment with the abortion law. By measuring hospitals' capacity to keep women with abortion complications alive, post-abortion care (PAC) indicators have normalized survival as a state of reproductive well-being.

Abortion laws reform may reduce maternal mortality: an ecological study in 162 countries

BACKGROUND

Unsafe abortion is one of the commonest causes of maternal mortality. Abortion-related maternal deaths are higher in countries with the most restrictive abortion laws. We assess whether maternal mortality varies within and between countries over time according to the flexibility of abortion laws (the number of reasons a woman can have an abortion).

METHOD

We conducted an ecological study to assess the association between abortion laws and maternal mortality in 162 countries between 1985 and 2013. Aggregate-level data on abortion laws and maternal mortality were extracted from United Nations (UN), and World Health Organization's (WHO) database respectively. A flexibility score of abortion laws (Score 0-7) was calculated by summing the number of reasons for which abortion was legally allowed in each country. The outcome was maternal mortality ratio (MMR), which represented maternal deaths per 100,000 live births. MMR was modelled as a continuous variable and flexibility score as an ordinal ranked variable (categories 0-7 with 0 as the reference, and < 3 vs > = 3). We used fixed effects linear regression models to estimate the association between flexibility score and MMR, adjusting for gross domestic product per capita (GDP per capita), and time in five-year intervals.

RESULTS

Compared to when a country's flexibility score was < 3, maternal deaths were reduced by 45 per 100,000 live births (95% CI: -64, - 26) when the flexibility score increased ≥3, after adjusting for the GDP per capita and five-year time intervals. With the exception of a flexibility score 6, MMR was lower when higher than zero. This may indicate the role of other country- specific effects.

CONCLUSION

This study provides evidence that abortion law reform in countries with restricted abortion laws may reduce maternal mortality.

Expanding reproductive justice through a supportability reparative justice framework: the case of abortion in South Africa

Theoretical refinement of the concept of reproductive justice has been called for. In this paper, I propose the use of a supportability reparative justice approach. Drawing on intra-categorical intersectionality, the supportability aspect starts from the event of a pregnancy to unravel the interwoven embodied and social realities implicated in women experiencing pregnancy as personally supportable/unsupportable, and socially supported/unsupported. The reparative justice aspect highlights the need for social repair in the case of unsupportable pregnancies and relies on Ernesto Verdeja's critical theory of reparative justice in which he outlines four reparative dimensions. Using abortion within the South African context, I show how this framework may be put to use: (1) the facilitation of autonomous decision-making (individual material dimension) requires understanding women within context, and less emphasis on individual-driven 'choice'; (2) the provision of legal, safe state-sponsored healthcare resources (collective material dimension) demands political will and abortion service provision to be regarded as a moral as well as a healthcare priority; (3) overcoming stigma and the spoiled identities (collective symbolic dimension) requires significant feminist action to deconstruct negative discourses and to foreground positive narratives; and (4) understanding individual lived experiences (individual symbolic dimension) means deep listening within the social dynamics of particular contexts.

Queering abortion rights: notes from Argentina

In recent years, there have been calls in activist spaces to 'queer' abortion rights advocacy, to incorporate non-normative notions of gender identity and sexuality into abortion struggles and services. Argentina provides an interesting site in which to examine these developments, since there is a longstanding movement for abortion rights in a context of illegal abortion and a recent ground-breaking Gender Identity Law that recognises key trans rights. In this paper, we analyse public documents from the abortion rights movement's main coalition - the National Campaign for the Right to Legal, Safe and Free Abortion - alongside interviews with 19 Campaign activists to examine shifts and tensions in contemporary abortion rights activism. We trace the incorporation of trans-inclusive language into the newly proposed abortion rights bill and conclude by pointing to contextual factors that may limit or enhance the further queering of abortion rights.

Coercing Women's Behavior: How a Mandatory Viewing Law Changes Patients' Preabortion Ultrasound Viewing Practices

Over the past two decades, US states have enacted legislation regulating ultrasound scanning in abortion care, including mandating that abortion patients view their ultrasound image. Legal scholars have argued that, by constructing ultrasound viewing as a necessary part of patients' abortion decision making, these laws aim to control and constrain how women make personal decisions about their bodies and parenthood. To date, however, the discussion of the impact of ultrasound viewing laws on women's decisional autonomy has occurred in the abstract. Here, we examine the effect of Wisconsin's mandatory ultrasound viewing law on the viewing behavior of women seeking care at a high-volume abortion-providing facility. Drawing both on chart data from patients before and after the law went into effect and on in-depth interviews with women subject to the mandatory viewing law, we found that the presence of the law impacted patients' viewing decision making. Moreover, we documented a differential effect of the law by race, with larger impacts on the viewing behavior of black women compared with white women. Our findings call for renewed attention to the coercive power of laws regulating abortion on a macrolevel, investigating not only how they affect individuals' behavior and experience but also which individuals are impacted.