Italy: Hyper-Regulation of Abortion Care

Congratulations and thanks to Dr. Elena Caruso, whose article on “The Hyper-Regulation of Abortion Care in Italy” was recently published in the International Journal of Gynecology and Obstetrics‘ “Ethical and Legal Issues in Reproductive Health” section, edited by Professors Rebecca J. Cook, Bernard M. Dickens and Charles G. Ngwena. The author, Elena Caruso, is an Italian legal scholar who completed a doctorate in Law at Kent University and who now holds an AMTD Waterloo Global Talent Postdoctoral Fellowship at the University of Waterloo in Ontario, Canada. We are pleased to circulate the following abstract of this article, which is now fully available online in both English and Italian:

The Hyper-Regulation of Abortion Care in Italy, by Elena Caruso in International Journal of Gynecology and Obstetrics 163.3 (December 2023):1036-1042.  PDF at Wiley Online.  Italian translation.

ABSTRACT: This paper argues that the current abortion regulation by Law 194/1978 is an inadequate basis for the provision of good quality abortion care and must be reformed. First, the paper explains why Law 194/1978 creates a hyper-regulatory regime that is inconsistent with the best clinical evidence and practices in the field as well as relevant international human rights law, as outlined in the World Health Organization’s (WHO) 2022 Abortion Care Guideline. Second, it highlights gaps between what the law says and what happens in practice, pointing out how the everyday life of Law 194/1978, especially in the practices of gynecologists, is far removed from international standards of quality abortion care and has yet to comply with international human rights law. Third, it sets out some alternative routes to abortion access “outside” Law 194/1978. Finally, it concludes with some suggestions for a change in the practice of gynecology and a call for the reform of Law 194/1978, in favor of a bodily autonomy model of regulation grounded on decriminalization, demedicalization, dehospitalization, and self-management to ensure compliance with the WHO standards and international human rights law.

The entire paper is now freely available in English and Italian: English article PDF.  Italian translation.

RELEVANT RESOURCES:

Law 194 of 1978: an English translation of this Italian law is online here.

The WHO Abortion Care Guideline: Law and Policy–Past, Present and Future,” by Joanna N. Erdman, in International Journal of Gynecology and Obstetrics162.3 (Sept 2023): 1119–1124.   PDF at Wiley Online. 

Abortion Law Decisions webpages, now updated in English and in Spanish.

Ethical and Legal Issues in Reproductive Health – more than 110 other concise articles are online here.
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Contributed by: The International Reproductive and Sexual Health Law Program, reprohealth*law at utoronto.ca.   See Program website for our Publications,  Research resources, and Reprohealthlaw Commentaries Series.  TO JOIN THE REPROHEALTHLAW BLOG: enter your email address in the upper right corner of this blog, then check your email to confirm the subscription.

WHO Abortion Care Guideline: Past, Present and Future

Congratulations to Professor Joanna N. Erdman, MacBain Chair in Health Law and Policy at the Schulich School of Law in Dalhousie University, who served as a technical advisor with the WHO’s Department of Reproductive Health and Research and as a member of the Law and Policy Evidence and Recommendation Review Group, and the Guideline Development Group for the 2022 Abortion Care Guidelines. Her article on WHO’s new guideline was recently published in the Ethical and Legal Issues in Reproductive Health section of the International Journal of Gynecology and Obstetrics. We are pleased to circulate the abstract of her article, which is freely accessible online. 

Joanna N. Erdman, “The WHO Abortion Care Guideline: Law and Policy–Past, Present and Future,” in International Journal of Gynecology and Obstetrics, 162.3 (Sept 2023): 1119–1124. Abstract and Article. 

Abstract: In the 2022 Abortion Care Guideline, the World Health Organization (WHO) undertook systematic evidence reviews of seven law and policy interventions to assess their health and social impacts. Distinct recommendations were formulated for each. The present article highlights how the Guideline reconceptualizes abortion regulation as a complex structural intervention that shapes clinical care and service delivery and distributes risks and resources within these systems and in the care relations that define them. It then presents the Guideline recommendations and summarizes their evidence base, drawing on recent legal and policy developments to emphasize their real-world significance. The article concludes by anticipating the future of abortion law and policy, focusing on service delivery innovations and diverse care models, drug regulation and the supply of abortion pills, and protective interventions crafted in the context of political crisis and immediate need that serve policy objectives and take regulatory forms different from the past.

RELATED RESOURCES:

World Health Organization, Abortion Care Guideline, 2022. Online here.

See also: “Self managed abortion:  aligning law and policy with medical evidence,” by Patty Skuster, Heidi Moseson and Jamila Perritt, International Journal of Gynecology and Obstetrics 160.2 (February 2023): 720-725. . PDF at Wiley Online.  

Ethical and Legal Issues in Reproductive Health, more than 110 concise articles are online here.
__________________________________________________________________________
Contributed by: the International Reproductive and Sexual Health Law Program, reprohealth*law at utoronto.ca.   See Program website for our Publications,  Research resources, and Reprohealthlaw Commentaries Series.  TO JOIN THE REPROHEALTHLAW BLOG: enter your email address in the upper right corner of our blog, then check your email to confirm the subscription.

Access to knowledge and the Global Abortion Policies Database

Congratulations to Joanna N. Erdman and Brooke R. Johnson Jr., who recently published an article in the Ethical and Legal Issues section of the International Journal of Gynecology and Obstetrics.  Prof. Joanna Erdman teaches Law at Dalhousie University and Brooke R. Johnson the World Health Organization’s Department of Health and Research and manages the WHO’s Global Abortion Policies Database.

“Access to knowledge and the Global Abortion Policies Database,”  by Joanna Erdman, Brooke Ronald Johnson.  International Journal of Gynecology and Obstetrics  2018; 142: 120–124   PDF at Wiley online.   Submitted text online at SSRN.

Research shows that women, healthcare providers, and even policy makers worldwide have limited or inaccurate knowledge of the abortion law and policies in their country. These knowledge gaps sometimes stem from the vague and broad terms of the law, which breed uncertainty and even conflict when unaccompanied by accessible regulation or guidelines. Inconsistency across national law and policy further impedes safe and evidence‐based practice. This lack of transparency creates a crisis of accountability. Those seeking care cannot know their legal entitlements, service providers cannot practice with legal protection, and governments can escape legal responsibility for the adverse effects of their laws. This is the context for the newly launched Global Abortion Policies Database—an open‐access repository that seeks to promote transparency and state accountability by providing clear and comprehensive information about national laws, policies, health standards, and guidelines, and by creating the capacity for comparative analysis and cross‐referencing to health indicators, WHO recommendations, and human rights standards.

The published article  can temporarily be downloaded in PDF at Wiley online.
Full text, as submitted, is online at SSRN.
Ethical and Legal Issues in Reproductive Health: 85+ concise articles.

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Compiled by the Coordinator of the International Reproductive and Sexual Health Law Program, reprohealth*law at utoronto.ca For Program publications and resources, see our website, online here. TO JOIN THIS BLOG: enter your email address in upper right corner of this webpage, then check your email to confirm the subscription.

Mandatory Waiting Periods and Biased Abortion Counseling in Central and Eastern Europe

Congratulations to Leah Hoctor and Adriana Lamačková of the Centre for Reproductive Rights, whose article has just been published in the Ethical and Legal Issues section of the International Journal of Gynecology and Obstetrics.  The article addresses the recent retrogressive introduction of mandatory waiting periods and biased counseling and information requirements prior to abortion in Central and Eastern Europe.

Leah Hoctor and Adriana Lamačková,  Mandatory Waiting Periods and Biased Abortion Counseling in Central and Eastern Europe (2017). International Journal of Gynecology and Obstetrics, 139 (Nov. 2017): 253–258. 
PDF at Wiley Online Library.    Submitted text online at SSRN.

A number of Central and Eastern European countries have recently enacted retrogressive laws and policies introducing new pre-conditions that women must fulfill before they can obtain legal abortion services. Mandatory waiting periods and biased counseling and information requirements are particularly common examples of these new prerequisites. This article considers these requirements in light of international human rights standards and public health guidelines, and outlines the manner in which, by imposing regressive barriers on women’s access to legal abortion services, these new laws and policies undermine women’s health and well-being, fail to respect women’s human rights, and reinforce harmful gender stereotypes and abortion stigma.

Key words: Abortion; Abortion counseling; Central and Eastern Europe; Discrimination; Human rights; Informed consent; Waiting periods

The published article is online in PDF at Wiley Library.
Full text, as submitted, is online at SSRN.
Ethical and Legal Issues in Reproductive Health: 80 other concise articles.

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Compiled by the Coordinator of the International Reproductive and Sexual Health Law Program, reprohealth*law at utoronto.ca For Program publications and resources, see our website, online here. TO JOIN THIS BLOG: enter your email address in upper right corner of this webpage, then check your email to confirm the subscription.

Human Rights and African Abortion Laws: A Handbook for Judges

Congratulations to Prof. Charles Ngwena and the Ipas Africa Alliance upon the publication of this concise guide, Human Rights and African Abortion Laws which judges can use to interpret and apply domestic abortion laws, taking into account global and regional human rights standards.   The Table of Contents, reproduced below, provides a more detailed overview of this useful resource:

by Prof. Charles Ngwena  (Nairobi, Kenya:  Ipas Africa Alliance, 2014) 85 pages, online here.  Direct link to PDF

I   INTRODUCING THE HANDBOOK
1.1      Introduction
1.2      Purpose of the handbook
1.3      Role of the courts
1.4      Women’s rights in the age of constitutionalism and human rights
1.5      Structure of the handbook

II.   THE BURDEN OF PREVENTABLE UNSAFE ABORTION IN THE SUB-SAHARAN REGION
2.1     Introduction
2.2    Scale and health consequences of unsafe abortion
2.3   Costs of unsafe abortion

III.   HISTORICAL DEVELOPMENT OF DOMESTIC LAWS IN AFRICA
3.1 Historical development
3.2 Abortion law in European colonies in Africa (non- British colonies)
3.3 Abortion law in British colonies in Africa
3.4 Section 58 of the Offences Against the Person Act of 1861 and the Bourne case
3.5 The significance of the Bourne case

IV.     CURRENT DOMESTIC ABORTION LAWS IN AFRICA
4.1    Introduction
4.2    Sources of abortion law
4.3    Overview of current abortion laws
4.4    Abortion and the constitution
——–4.4.1    Uganda and Zimbabwe
——–4.4.2    Swaziland and Kenya
4.5  Untested abortion laws
4.6  Linking abortion laws with unsafe abortion
4.7  Abortions laws as barriers

V.     APPLYING HUMAN RIGHTS TO FRAME, INTERPRET AND APPLY DOMESTIC ABORTION LAWS
5.1  Introduction
5.2  Global developments
——–5.2.1    Global consensus statements
——–5.2.2    Treaty-monitoring bodies and special rapporteurs of the United Nations
——–5.2.3    Decisions of treaty monitoring bodies under optional protocols
——–5.2.4    World Health Organization: Technical and policy Guidance
5.3  Regional developments
——–5.3.1    African regional developments
——–5.3.2    Human rights developments in the European and the Inter-American regions 

VI.    ABORTION AND COMPARATIVE LAW
6.1    Introduction
6.2    Interpreting the life ground
6.3    Interpreting the health ground
6.4    Foetal rights
6.5    Criminalisation of abortion
6.6    Spousal consent requirements
6.7    Parental consent requirements
6.8    Conscientious objection by auxiliary workers
6.9    Conscientious objection by judges

VII.       CASE STUDIES: STATE OBLIGATIONS TO RESPECT, PROTECT AND FULFIL WOMEN’S RIGHTS TO ABORTION
7.1    Introduction
7.2    Case study 1: Abortion law reform with human rights principles
——–7.2.1 Introduction
7.3 Case study 2: A challenge to a restrictive abortion law
——–7.3.1    Introduction        

BIBLIOGRAPHY

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Human Rights and African Abortion Laws: A Handbook for Judges (85 pages): is online here.  Direct link to PDF.