Chapter 3. Recommendations and best practice statements across the continuum of abortion care
Law & policy Recommendation 7: Third-party authorization (3.3.2)
3.3.2 Third-party authorization for abortion
Third-party authorization requirements exist where there is a requirement imposed by law or policy, or in practice, that a party other than the pregnant woman must authorize an abortion, even though other applicable legal requirements for lawful abortion have been met (e.g. grounds or gestational age limits, see sections 2.2.2 and 2.2.3). Common third parties required to provide authorization include a parent, guardian, spouse, partner, health worker, health authority or judicial authority. Third-party authorization requirements operate without regard to whether the person who seeks to end a pregnancy has capacity to consent to medical treatment.
Regardless of whether third-party authorization requirements apply, informed consent of the person availing of abortion is a prerequisite for the provision of abortion (refer to Chapter 1, section 1.3.1[v] for information on free and informed consent, and also Web annex A: Key international human rights standards on abortion).
LAW & POLICY Recommendation 7: Third-party authorization
Recommend that abortion be available on the request of the woman, girl or other pregnant person without the authorization of any other individual, body or institution.
- While parental or partner involvement in abortion decision-making can support and assist women, girls or other pregnant persons, this must be based on the values and preferences of the person availing of abortion and not imposed by third-party authorization requirements.
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 third-party authorization requirements on abortion seekers and health workers, systematic reviews of studies published between 2010 and 2019 were undertaken. A total of 32 studies were included, conducted in Hong Kong Special Administrative Region (China), Turkey and the USA. A summary of the evidence from these studies is presented in Supplementary material 1, EtD framework for Third-party authorization. The reviewed evidence showed that third-party authorization requirements were associated with delays to abortion. For minors, these delays were sometimes, although not always, reduced when judicial authorization was used to bypass parental authorization requirements. However, bypass can be burdensome and time-consuming, and minors from ethnic minorities or of lower socioeconomic status are significantly more likely to need to use it. The evidence showed that adolescents and women sought to bypass parental/spousal authorization requirements to avoid anticipated violence, reproductive coercion and family disharmony.
A number of studies described “parental notification” or “parental involvement” rather than using the term “parental authorization”. As these terms may encompass parental authorization requirements and mandate the disclosure of the fact that a minor is seeking an abortion, thus creating opportunities for parental veto, these studies were included within the evidence base for this topic. These studies reinforced the associations between mandated parental involvement (including authorization) and barriers to accessing abortion (including delay, continuation of pregnancy, anticipated interpersonal violence or exploitation, reproductive coercion, family disharmony and recourse to unsafe abortion).
Third-party authorization requirements are incompatible with international human rights law, which provides that States may not restrict women’s access to health services on the ground that they do not have the authorization of husbands, partners, parents or health authorities, because they are unmarried, or because they are women. Therefore, the evidence underlines the importance of the requirements stated in international human rights law that SRH services be provided in a way that respects and maintains women’s and girls’ privacy and confidentiality, that States protect women and girls seeking abortion, and that States recognize adolescents’ evolving capacity (see section 1.3.1[v], Box 1.2 and Web annex 1: Key international human rights standards on abortion).
KEY HUMAN RIGHTS CONSIDERATIONS RELEVANT TO THIRD-PARTY AUTHORIZATION
- States may not restrict women’s access to health services on the ground that they do not have the authorization of husbands, partners, parents or health authorities, because they are unmarried, or because they are women.
- Sexual and reproductive health (SRH) services must be provided in a way that ensures privacy and confidentiality.
- States may not regulate abortion in a manner that forces women to resort to unsafe abortion.
- States must take steps, including revising laws, to reduce maternal morbidity and mortality, and to effectively protect women and girls from the physical and mental risks associated with resorting to unsafe abortion.
- Everyone has a right to privacy and confidentiality in accessing SRH services.
- Availability, accessibility, acceptability and quality must be central to the regulation of SRH services.