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).

Rationale

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).