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Examining implementation of health exception laws in six countries.

Exceptions to abortion restrictions on the grounds of protecting life or health enable essential care for pregnancy complications but are often underutilized or inconsistently applied. Through a narrative study, Global Doctors for Choice (GDC) aimed to identify barriers and facilitators to implement...

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Published in:African Journal of Reproductive Health Vol. 30; no. 9; pp. 26 - 46
Main Authors: Fortman, Emily C., Stratis, Catherine R., Berchmans-Uwimana, Jean, Sepúlveda, Lilian, Chavkin, Wendy, Shaw, Dorothy, Awoonor-Williams, Koku
Format: research tables/charts Journal Article
Published: Women's Health & Action Research Centre May2026
Online Access:View this record in EBSCOhost
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      jtl: African Journal of Reproductive Health
      issn: 11184841
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    pubinfo:
      dt: May2026
      vid: 30
      iid: 9
      pid: 12182
      pub: Women's Health & Action Research Centre
      place: Benin City Edostate 234, <Blank>
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        194237316
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        10.29063/ajrh2026/v30i9.3
        194237316
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      tig:
        atl: Examining implementation of health exception laws in six countries.
      aug:
        au:
          Fortman, Emily C.
          Stratis, Catherine R.
          Berchmans-Uwimana, Jean
          Sepúlveda, Lilian
          Chavkin, Wendy
          Shaw, Dorothy
          Awoonor-Williams, Koku
        affil: Global Doctors for Choice, New York, USA
      sug:
        subj:
          Abortion, Induced Legislation and Jurisprudence
          Implementation Science
          Health Services Accessibility
          Health Policy
          Quality Improvement
          Human
          Africa
          Colombia
          Ghana
          Ireland
          Rwanda
          South Korea
          Qualitative Studies
          Semi-Structured Interview
          Thematic Analysis
          Snowball Sample
          Private Sector
          Physicians
          Reproductive Health
          Maternal Health Services
          Stigma
          Patient Advocacy
          Empowerment
          Diversity, Equity, Inclusion
      ab:
        Exceptions to abortion restrictions on the grounds of protecting life or health enable essential care for pregnancy complications but are often underutilized or inconsistently applied. Through a narrative study, Global Doctors for Choice (GDC) aimed to identify barriers and facilitators to implementing these exceptions. We conducted literature and desk reviews and 15 semi-structured interviews (May-August 2025) with physicians, lawyers, and advocates from six countries: Colombia, Ghana, Ireland, Peru, Rwanda, and South Korea. Interviews were transcribed, de-identified, and analyzed for common themes. Implementation depended on disparate, often narrow or incorrect, interpretations by clinicians and institutions. Barriers included lack of training, geographic obstacles, personnel and supply constraints, stigma, and logistical delays, which push patients toward unsafe abortion. Facilitators involved comprehensive training with values clarification, patient awareness campaigns, unambiguous guidelines, and committed advocacy. Ultimately, clear legal frameworks, provider education, advocacy, and patient empowerment could improve access in diverse clinical and legal settings.
        Les exceptions aux restrictions légales de l'avortement fondées sur la protection de la vie ou de la santé permettent de fournir des soins essentiels en cas de complications liées à la grossesse, mais elles demeurent souvent sous-utilisées ou appliquées de manière inégale. À travers une étude narrative, Global Doctors for Choice (GDC) a cherché à identifier les obstacles et les facteurs facilitant la mise en œuvre de ces exceptions. Nous avons réalisé une revue de la littérature et une analyse documentaire, ainsi que quinze entretiens semi-structurés (mai--août 2025) avec des médecins, des juristes et des acteurs du plaidoyer issus de six pays : Colombie, Ghana, Irlande, Pérou, Rwanda et Corée du Sud. Les entretiens ont été retranscrits, anonymisés et analysés afin d'identifier des thèmes récurrents. La mise en œuvre dépendait d'interprétations divergentes, souvent restrictives ou erronées, de la part des cliniciens et des institutions. Les obstacles identifiés comprennent notamment le manque de formation, les contraintes géographiques, les limitations en personnel et en ressources, la stigmatisation sociale ainsi que des retards logistiques, qui peuvent orienter les patientes vers des avortements non sécurisés. Les facteurs facilitants incluent des programmes de formation complets intégrant des démarches de clarification des valeurs, des campagnes de sensibilisation destinées aux patientes, des directives claires et sans ambiguïté, ainsi qu'un plaidoyer soutenu. En définitive, l'existence de cadres juridiques explicites, le renforcement des capacités des prestataires, le plaidoyer et l'autonomisation des femmes pourraient améliorer l'accès aux soins d'avortement dans des contextes juridiques et cliniques variés.
      pubtype: Academic Journal
      doctype:
        research
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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