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. PATHFINDER INTERNATIONAL HEADQUARTERS 9 Galen Street, Suite 217, Watertown, MA 02472 August 2014 Photo: Mercedes Sayageus
Overview Section 1: Abortion Law vs. Practice This section will help you analyze the official policies and laws governing abortion care ( ) as compared with the actual situation in a given setting ( ). For example, abortion may be legal to protect the health of a woman, but 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. 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). 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. 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 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 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 2
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. Key Informant Interviews 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 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: advocacy 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). 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 3
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 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. 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 abortion policy scan for advocacy pathfinder international www.pathfinder.org 4
Section 1. Abortion Law vs. Practice 1.1 Abortion Access The circumstances under which a woman can legally obtain an abortion 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? abortion policy scan for advocacy pathfinder international www.pathfinder.org 5
1.2 Abortion-related Communications The information about abortion and abortion services that people (health care providers, educators, public officials, etc.) can give women 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 abortion policy scan for advocacy pathfinder international www.pathfinder.org 6
1.3 Abortion Penalties Legal consequences for obtaining, giving, or otherwise participating in an abortion 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 abortion policy scan for advocacy pathfinder international www.pathfinder.org 7
1.4 Abortion Approvals Whose approval or permission is required for a woman to have an abortion 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 8
1.5 Waiting Periods The time between a woman s request for an abortion and receiving the abortion 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 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 9
1.7 Conscientious Objection When a provider refuses to give abortion care because of his/her personal beliefs or opinions 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)? abortion policy scan for advocacy pathfinder international www.pathfinder.org 10
1.8 Performing Institutions and Personnel Where abortions can be performed and by whom (according to abortion type and gestational age) 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 11
1.9 Time Limits The maximum length of time when abortion is permitted (i.e., how many months the woman has been pregnant) 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? abortion policy scan for advocacy pathfinder international www.pathfinder.org 12
1.10 Abortion Methods The kinds of surgical and medical abortion that are legal and available 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 abortion policy scan for advocacy pathfinder international www.pathfinder.org 13
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.) abortion policy scan for advocacy pathfinder international www.pathfinder.org 14
1.11 Abortion Protocols (continued) The kinds of surgical and medical abortion that are legal and available 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 abortion policy scan for advocacy pathfinder international www.pathfinder.org 15
1.12 Consent and Confidentiality Procedures to ensure the woman willingly gives her permission and that her privacy is protected 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 16
1.13 Counseling Requirements What providers should include in pre- and postabortion counseling 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 17
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 barriers to women accessing safe abortion that you are interested in addressing in the short term? Based on Section 1, what are the significant 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 18