Table 1

Causal pathways linking legal regulations of abortion to plausibly related outcomes and relevant research

Legal interventionSelect causal pathwaysPlausibly related outcomesExamples of relevant research identified
Law requires parental involvement or notification for abortion
  • Minor complies with law and involves parent

  • Minor does not involve parent

  • Minor invokes legal exception or judicial bypass

  • Intrafamilial conflict

  • Continued pregnancy

  • Lawful abortion

  • Legally prohibited abortion

  • Unintended Childbirth

  • Delayed abortion

  • Increased costs

  • Henshaw SK, Kost K. Parental involvement in minors' abortion decisions. Fam Plann Perspect 1992 Sep-Oct;24(5):196–207, 213.

  • Hasselbacher LA, Dekleva A, Tristan S, Gilliam ML. Factors influencing parental involvement among minors seeking an abortion: a qualitative study. Am J Public Health. 2014;104(11):2207–2211.

  • Coleman-Minahan K, Stevenson AJ, Obront E, Hays S. Adolescents obtaining abortion without parental consent: Their reasons and experiences of social support. Perspect Sex Reprod Health. 2020;52(1):15–22.

Law requires spousal notification/consent for abortion
  • Individual notifies spouse and obtains consent

  • Non-compliance with spousal consent

  • Individual invokes legal exception

  • Lawful abortion

  • Continues pregnancy

  • Unintended childbirth

  • Legally prohibited abortion

  • IPV or marital disharmony

  • Delayed abortion

  • Increased costs

  • Altshuler, Nguyen et al., Male Partners' Involvement in Abortion Care: A Mixed-Methods Systematic Review, Perspect Sex Reprod Health. 2016 Dec; 48:209–219.

  • Hall M, Chappell LC, Parnell BL, Seed PT, & Bewley S. Associations between intimate partner violence and termination of pregnancy: a systematic review and meta-analysis. PLoS medicine 2014;11(1):e1001581.

Additional authorisation (AA) required for abortion in cases of sexual assault
  • Pregnant individual complies with AA law and obtains authorisation

  • Pregnant individual is denied authorisation

  • Non-compliance with AA law

  • Lawful abortion

  • Secondary rape victimisation

  • Legally prohibited abortion

  • Unintended childbirth

  • Delayed abortion

  • Increased costs

  • Maier SL.“I have heard horrible stories …": rape victim advocates' perceptions of the revictimization of rape victims by the police and medical system. Violence against women 2008; 14(7):786–808.

  • Blake M, Drezett J, et al. Factors associated with the delay in seeking legal abortion for pregnancy resulting from rape. International Archives of Medicine 2015;8. doi:10.3823/1628.

Law requires a mandatory waiting period between clinical encounter and abortion
  • Non-compliance with waiting period

  • Individual eligible for legal exception to waiting period

  • Compliance with waiting period

  • Unintended childbirth

  • Legally prohibited abortion

  • Lawful abortion

  • Delayed abortion

  • Increased costs

  • Karasek, D., Roberts, S. C., & Weitz, T. A. (2016). Abortion Patients Experience and Perceptions of Waiting Periods: Survey Evidence before Arizona’s Two-visit 24-hour Mandatory Waiting Period Law. Womens Health Issues, 26(1), 60–66. doi:10.1016/j.whi.2015.10.004

  • Bartlett, L.A., et al., Risk factors for legal induced abortion-related mortality in the United States. Obstet Gynecol, 2004. 103(4): p. 729–37.

Law sets gestational age limits for obtaining abortion
  • Pregnancy deemed to exceed legal limits

  • Pregnancy deemed within legal limits

  • Individual eligible for legal exception to gestational limit

  • Legally prohibited abortion

  • Unintended childbirth

  • Lawful abortion

  • Delayed abortion

  • Increased costs

  • Upadhyay, U.D., Weitz, T.A., Jones, R.K., Barar, R.E., & Greene Foster, D. Denial of Abortion Because of Provider Gestational Age Limits in the United States, 104 Am J Public Health,1687–1694 (2014)

  • Henshaw, S.K. & Finer, L. The Accessibility of Abortion Services in the United States, 2001. Perspectives on Sexual and Reproductive Health, Guttmacher Institute, 2003 Jan. –Feb.; 35(1): 16–24.

Law limits the types of healthcare professionals authorised to perform abortions
  • Availability and accessibility of abortion services

  • Changes in health workforce training and services infrastructure

  • Lawful abortion

  • Legally prohibited abortion

  • Delayed abortion

  • Increased costs

  • Unintended childbirth

  • Grimes DA. Clinicians who provide abortions: the thinning ranks. Obstet Gynecol. 1992 Oct;80(4):719–23. PMID: 1 407 901.

  • Joffe C, Yanow S. Advanced practice clinicians as abortion providers: current developments in the United States. Reprod Health Matters. 2004;12(Suppl):198–206. doi: 10.1016/S0968-8080(04)24008-.

Law criminalises some or all abortions
  • Availability and accessibility of abortion services

  • Changes in health workforce training and services infrastructure

  • Arrest and prosecution of individuals obtaining abortion outside formal health system

  • Lawful abortion

  • Legally prohibited abortion

  • Delayed abortion

  • Increased costs

  • Unintended childbirth

  • Increased abortion stigma

  • Harm to the confidentiality of patient-provider relationships

  • Baum, S., DePiñeres, T., & Grossman, D. (2015). Delays and barriers to care in Colombia among women obtaining legal first- and second-trimester abortion. International journal of gynaecology and obstetrics, 131(3), 285–288.

  • Hanschmidt, F., Linde, K., Hilbert, A., Riedel-Heller, S. G., & Kersting, A. (2016). Abortion Stigma: A Systematic Review. Perspectives on sexual and reproductive health, 48(4), 169–177.

Law allows medical provider or facility to refuse to perform an abortion due to conscientious objection
  • Availability and accessibility of abortion services

  • Changes in health workforce training and services infrastructure

  • Provider referral behaviour

  • Lawful abortion

  • Legally prohibited abortion

  • Unintended childbirth

  • Delayed abortion

  • Increased costs

  • Awoonor-Williams, J. K., Baffoe, P., Aboba, M., Ayivor, P., Nartey, H., Felker, B., Van der Tak, D., & Biney, A. (2020). Exploring Conscientious Objection to Abortion Among Health Providers in Ghana. International perspectives on sexual and reproductive health, 46, 51–59.

  • Turner, K. L., Pearson, E., George, A., & Andersen, K. L. (2018). Values clarification workshops to improve abortion knowledge, attitudes and intentions: a pre-post assessment in 12 countries. Reproductive health, 15(1), 40.