Chapter 3. Recommendations and best practice statements across the continuum of abortion care
Law & policy Recommendation 6: Mandatory waiting periods (3.3.1)
3.3.1 Mandatory waiting periods imposed by States, health-care facilities or health workers
In a number of countries, health-care facilities or health workers require women to wait a specified amount of time between requesting and receiving an abortion. These imposed delays are known as mandatory waiting periods. In some cases, women must also receive (sometimes biased) counselling or advice (see section 3.2.1 and section 3.2.2), attend the facility at the start and end of the waiting period, and/or undergo mandated ultrasound during these waiting periods (see section 3.3.5, Recommendation 10 on pre-abortion ultrasound).
LAW & POLICY Recommendation 6: Mandatory waiting periods
Recommend against mandatory waiting periods for abortion.
Note on updating of the recommendation: This and other law and policy recommendations are not new recommendations. WHO’s 2012 Safe abortion guidance provided a composite recommendation related to law and policy (19); in this guideline, this has been developed into seven separate recommendations using GRADE methodology.
In order to identify the impacts of mandatory waiting periods on abortion seekers and health workers, a systematic review of studies published between 2010 and 2020 was undertaken, identifying 33 studies all conducted in the USA. A summary of the evidence from these studies is presented in Supplementary material 1, EtD framework on Mandatory waiting periods. The evidence reviewed showed that mandatory waiting periods delayed access to abortion, sometimes to the extent that women’s access to abortion or choice of abortion method was restricted in that setting.
The evidence also indicates that mandatory waiting periods increase the cost of abortion and they may make abortion unattainable, resulting in the continuation of pregnancy against the wishes of the abortion seeker, especially among women with fewer resources, adolescents, younger women, those from racial or ethnic minorities and those who need to travel further for an abortion.
Among those seeking an abortion, the studies showed that mandatory waiting periods were experienced negatively, as a restriction on their access to abortion. For some women, the logistical and economic challenges of completing a mandatory waiting period, such as the need for time off work or education, extra travel and/or childcare, meant that they were forced to disclose their pregnancy to others even though international human rights law requires States to ensure that SRH services are provided in a way that ensures privacy and confidentiality. The evidence did not establish any benefits of mandatory waiting periods for women.
For health-care facilities, mandatory waiting periods increase staffing costs and logistical difficulties, by mandating additional visits or interventions outside of standard clinical practice (e.g. unnecessary ultrasound, specific counselling that is not evidence-based).
KEY HUMAN RIGHTS CONSIDERATIONS RELEVANT TO MANDATORY WAITING PERIODS
- Availability, accessibility, acceptability and quality must be central to the regulation of sexual and reproductive health (SRH) services.
- States may not regulate abortion in a manner that forces women to resort to unsafe abortion.
- Everyone has a right to non-discrimination and equality in accessing SRH services.
- SRH services must be provided in a way that ensures privacy and confidentiality.