Identifying data for the empirical assessment of law (IDEAL): a realist approach to research gaps on the health effects of abortion law

Reproductive rights have been the focus of United Nations consensus documents, a priority for agencies like the WHO, and the subject of judgments issued by national and international courts. Human rights approaches have galvanised abortion law reform across numerous countries, but human rights analysis is not designed to empirically assess how legal provisions regulating abortion shape the actual delivery of abortion services and outcomes. Reliable empirical measurement of the health and social effects of abortion regulation is vital input for policymakers and public health guidance for abortion policy and practice, but research focused explicitly on assessing the health effects of abortion law and policy is limited at the global level. This paper describes a method for Identifying Data for the Empirical Assessment of Law (IDEAL), to assess potential health effects of abortion regulations. The approach was applied to six critical legal interventions: mandatory waiting periods, third-party authorisation, gestational limits, criminalisation, provider restrictions and conscientious objection. The IDEAL process allowed researchers to link legal interventions and processes that have not been investigated fully in empirical research to processes and outcomes that have been more thoroughly studied. To the extent these links are both transparent and plausible, using IDEAL to make them explicit allows both researchers and policy stakeholders to make better informed assessments and guidance related to abortion law. The IDEAL method also identifies gaps in scientific research. Given the importance of law to public health generally, the utility of IDEAL is not limited to abortion law.