Costa Rica’s Therapeutic Abortion Law: A Qualitative Study of Public Health Implications Open Access

O'Bannon, Amari (Spring 2022)

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Background: Since the 1970s, Costa Rica has permitted abortion in the case of imminent risk to women’s life or health due to pregnancy. In 2019, the Costa Rican Ministry of Health released the Technical Norm for therapeutic abortion in an attempt to clarify the protocols for approving the procedure. However, there are minimal data about therapeutic abortion making it difficult to ascertain implications of the law on the realization of the human right to life, health, privacy, freedom from discrimination, and freedom from cruel, inhumane, and degrading treatment.Objectives: This study aims to determine the human rights implications Article 121 of the Penal Code and the Technical Norm for therapeutic abortion by assessing the perceptions of abortion availability, accessibility, acceptability, and quality (AAAQ) among key stakeholders. 

Methods: We conducted 22 in-depth interviews. Eight interviews were conducted with community stakeholders from a range of legislative, social activism, and research backgrounds. Thirteen interviews were completed with clinicians —10 experienced physicians and 3 medical residents. 

Results: Across groups participants described barriers to therapeutic and illegal abortion care availability, accessibility, acceptability, and quality. Participants reported religious and cultural influences on the acceptability, availability, and quality of abortion care. Clinicians felt limitations in their training and subsequent abilities to administer abortion care due to the ambiguity of the Technical Norm and restrictions caused by criminalization of abortion. All participants addressed the ways abortion acceptability, availability, and quality intersect with the dimensions of care accessibility (financial, physical, and informational) for people seeking abortion services. 

Conclusion: The current therapeutic abortion law and Technical Norm introduce and maintain barriers to therapeutic and illegal abortion care across the components of the AAAQ framework. The maintenance of the therapeutic abortion law through the Technical Norm has not improved clarity about or access to therapeutic abortion. In alignment with human rights based approaches, our findings suggest that decriminalization and legal allowances for rape, incest, and fetal anomly are necessary to mitigate the barriers to informational, financial, physical, and non-discriminatory accessibility to abortion care.

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Chapter 1: Introduction ________________________________________________________1                              

Chapter 2: Review of the Literature_______________________________________________5    

Table 1: The AAAQ Framework Sources (Jensen et al., 2014)____________________17    

Figure 1: Map of Therapeutic Abortion Procedures by Facility 1997-2017__________ 25

Chapter 3: Methods____________________________________________________________32        

Chapter 4: Results_____________________________________________________________39     

Table 2: Participant Group Demographics____________________________________ 39    

4.1: Availability_________________________________________________________40         

4.2: Accessibility________________________________________________________48   

4.3: Acceptability_______________________________________________________ 53         

4.4: Quality____________________________________________________________57

Chapter 5: Discussion__________________________________________________________61         

Chapter 6: Public Health Implications/Recommendations______________________________70   

Chapter 7: References __________________________________________________________76

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