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Comparative Study
. 2018 Jun 13;15(1):107.
doi: 10.1186/s12978-018-0548-x.

Access to abortion under the heath exception: a comparative analysis in three countries

Stephanie A Küng  1 , Blair G Darney  2   3 , Biani Saavedra-Avendaño  4 , Patricia A Lohr  5 , Laura Gil  6
Affiliations
Comparative Study

Access to abortion under the heath exception: a comparative analysis in three countries

Stephanie A Küng et al. Reprod Health. .

Abstract
in English, Spanish

Background: Despite Britain, Colombia, and some Mexican states sharing a health exception within their abortion laws, access to abortion under the health exception varies widely. This study examines factors that result in heterogeneous application of similar health exception laws and consequences for access to legal abortion. Our research adds to previous literature by comparing implementation of similar abortion laws across countries to identify strategies for full implementation of the health exception.

Methods: We conducted a cross-country comparative descriptive study synthesizing data from document and literature review, official abortion statistics, and interviews with key informants. We gathered information on the use and interpretation of the health exception in the three countries from peer-reviewed literature, court documents, and grey literature. We next extracted public and private abortion statistics to understand the application of the law in each setting. We used a matrix to synthesize information and identify key factors in the use of the law. We conducted in-depth interviews with doctors and experts familiar with the health exception laws in each country and analyzed the qualitative data based on the previously identified factors.

Results: The health exception is used broadly in Britain, somewhat in Colombia, and very rarely in Mexican states. We identified five factors as particularly salient to application of the health exception in each setting: 1) comprehensiveness of the law including explicit mention of mental health, 2) a strong public health sector that funds abortion, 3) knowledge of and attitudes toward the health exception law, including guidelines for physicians in providing abortion, 4) dissemination of information about the health exception law, and 5) a history of court cases that protect women and clarify the health exception law.

Conclusions: The health exception is a valuable tool for expanding access to legal abortion. Differences in the use of the health exception as an indication for legal abortion result in wide access for women in Britain to nearly no access in Mexican states. Our findings highlight the difference between theoretical and real access to legal abortion. The interpretation and application of the health exception law are pivotal to expanding real access to abortion.

Propósito: A pesar de que Gran Bretaña, Colombia y algunos estados mexicanos comparten una causal salud dentro de sus leyes de aborto, el acceso al aborto bajo la causal varía ampliamente. Este estudio examina los factores que resultan en la aplicación heterogénea de leyes similares y las consecuencias para el acceso al aborto legal. Nuestra investigación se suma a la literatura anterior comparando la implementación de leyes entre países para dilucidar estrategias para la implementación total.

Métodos: Realizamos un estudio descriptivo comparativo entre países que sintetizó datos de la revisión de documentos, estadísticas oficiales, y entrevistas con informantes claves. Recopilamos información sobre el uso y la interpretación de la causal salud en los tres países haciendo referencia a literatura revisada por pares, documentos judiciales, y literatura gris. Extraemos estadísticas públicos y privados para comprender la aplicación de la ley en cada entorno. Usamos una matriz para sintetizar información e identificar factores clave en el uso de la causal salud. Realizamos entrevistas en profundidad con médicos y expertos familiarizados con las leyes y analizamos los datos cualitativos en función de los factores previamente identificados.

Resultados: La causal salud se usa ampliamente en Gran Bretaña, a veces en Colombia, y casi nunca en los estados mexicanos. Identificamos cinco factores relevantes para la aplicación de la causal salud: 1) la exhaustividad de la ley, incluyendo la mención explícita de la salud mental, 2) un fuerte sector de salud pública que financia el aborto, 3) conocimiento y actitudes hacia la ley, incluyendo directrices para los médicos, 4) difusión de información sobre la causal salud, y 5) un historial de casos judiciales que protegen a las mujeres y clarifican la ley.

Conclusiones: La causal salud es una herramienta valiosa para ampliar el acceso al aborto legal. Las diferencias en el uso de la causal dan como resultado un amplio acceso para mujeres en Gran Bretaña a casi ningún acceso en los estados mexicanos. Nuestros hallazgos resaltan la diferencia entre el acceso teórico y real al aborto legal. La interpretación y la aplicación de la causal salud son cruciales para expandir el acceso real al aborto.

Keywords: Abortion; Causal Salud; Family planning; Great Britain; Health exception; Law and policy; Mexico; Colombia; Public health.

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Conflict of interest statement

Ethics approval and consent to participate

The research team received oral consent to participate from all key informants. This study was approved by the Comité de Ética (IRB) of the Instituto Nacional de Salud Pública in Cuernavaca, Mexico.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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