“Ethics surrounding the provision of abortion care”

"That is when I understood everything": Ideological trajectories of pro-choice female doctors in Mexico

OBJECTIVES

There is little evidence about how physicians become abortion clinicians or advocates. We describe the ideological trajectories of pro-choice female Mexican doctors and the factors that made them pro-choice.

STUDY DESIGN

In this qualitative study, we conducted semistructured interviews with members of the Mexican Network of Female Pro-choice Physicians. Participants came from eight diverse states. We used a feminist epistemology approach and analyzed data using inductive coding as well as a priori categories (becoming pro-choice, trajectories, and training).

RESULTS

We included 24 female pro-choice physicians. We identified five intersecting factors that influenced becoming pro-choice: feminism, personal experiences, confrontation with the inequalities and violence that women experience, role models, and routine exposure to abortion care. Participants described three ideological trajectories: being pro-choice before studying medicine, not having a specific opinion, and changing from "pro-life" to "pro-choice." Participants described the absence of abortion training in medical schools, stigmatizing training, and the use of alternative training sources.

CONCLUSIONS

In the absence of training on abortion during medical education, a combination of intersecting personal as well as work-related experience may turn doctors into pro-choice abortion clinicians and/or advocates. The findings of this study may be used to develop comprehensive medical curricula as well as strategies directed at doctors who have never received training on abortion care, such as promoting interactions with nonmedical abortion providers, education on inequalities and violence against women, moving beyond public health to a human rights and gender perspective, and exposure to routine safe abortion care.

IMPLICATIONS

Mexican female doctors become pro-choice clinicians who provide abortion care and/or advocates in spite of their medical education.

Considerations in Limiting Abortion: The Texas Heartbeat Act

ABSTRACT

In May 2021, Texas passed Senate Bill Eight, the Texas Heartbeat Act. The act bans physicians from performing an abortion after a fetal heartbeat is detected and bans nonmedical people from aiding or abetting an abortion in such situations. The act has significant social, economic, political, and ethical impacts for women with unintended pregnancies, for the state of Texas, and for nurses and other providers. A Christian perspective is offered regarding life, abortion, and the need to provide special care and support for women in crisis pregnancies.

Characteristics and Indications of Legal Abortion among the Pregnant Women in Lorestan Province of Iran during 2017–2019

Background. Legal abortion is a challenge from the viewpoint of ethics and religion. The present study was conducted to investigate the frequency of fetal and maternal indications of legal abortion and also the maternal characteristics in Lorestan Province of Iran. Methods. As a descriptive cross-sectional study, all the cases with issued permits for legal abortion were selected by a census during 2017–2019. Descriptive data analysis was used to report the results. Event rates with Poisson 95% confidence intervals (CIs) were calculated based on the regional population. Results. A total of 305 cases were selected. The mean age of the mothers was 31.61 ± 7.48 years, and the mean of gestational age was 15.76 ± 2.80 weeks. Demographically, most cases were from Khorramabad city (101 cases) followed by Borujerd (51 cases) and Doroud (46 cases). The overall event rate was 1.732 per 10,000 individuals (95% CI: 1.543–1.938) of the general population of the region per 3 years. Fetal disturbance of the brain and spine was the most prevalent reason of abortion (24.92%, 95% CI: 19.63%–31.19%) followed by Down syndrome (19.34%, 95% CI: 14.73%–24.95), hydrops fetalis (12.79%, 95% CI: 9.09%–17.48%), and anencephaly (12.79%, 95% CI: 9.09%–17.48%). Conclusion. From each 10,000 individuals of the population, one to two cases of legal abortion were screened per 3 years. More than 90% of cases had fetal indication. In cities with lower event rates, we should plan for better screening.

Legal abortion in Brazil: systematic review of the scientific production, 2008-2018

Previous reviews on the subject of abortion in Brazil have estimated one million procedures per year but did not address legal abortion. This systematic review sought to update knowledge regarding legal abortion in terms of service and women's profile, student and doctor knowledge, situations of anencephaly and severe malformations. We searched MEDLINE and LILACS for articles published in all languages between 2008 and 2018. Article quality was assessed using the Joanna Briggs Institute instruments. Search, selection, quality assessment and data extraction were carried out independently by two researchers. We selected 20 articles, 11 on the knowledge and opinion of medical professionals (4 articles) and students (7 articles) revealing a less-than-ideal level of knowledge and a high degree of objection of conscience. Six studies on women who use legal abortion services found that they are young, single and that the main demand was for pregnancy resulting from rape. When women were younger and single and when the aggressor was someone close to them, there were delays in seeking care. Three studies on severe malformation found around 40% of court authorizations. In cases for which no authorization was given, the evolution of pregnancies was complicated and deliveries were done through cesarean sections. Only one article addressed legal abortion services, showing that 37 of the 68 that had been registered were active, lack of services in seven states and concentration in capitals. Knowledge regarding legal abortion is still scarce, the demand for the procedure is repressed and medical training is deficient with regard to this subject.

Availability, accessibility and utilization of post-abortion care in Sub-Saharan Africa: A systematic review

At the 1994 ICPD, sub-Saharan African (SSA) states pledged, inter alia, to guarantee quality post-abortion care (PAC) services. We synthesized existing research on PAC services provision, utilization and access in SSA since the 1994 ICPD. Generally, evidence on PAC is only available in a few countries in the sub-region. The available evidence however suggests that PAC constitutes a significant financial burden on public health systems in SSA; that accessibility, utilization and availability of PAC services have expanded during the period; and that worrying inequities characterize PAC services. Manual and electrical vacuum aspiration and medication abortion drugs are increasingly common PAC methods in SSA, but poor-quality treatment methods persist in many contexts. Complex socio-economic, infrastructural, cultural and political factors mediate the availability, accessibility and utilization of PAC services in SSA. Interventions that have been implemented to improve different aspects of PAC in the sub-region have had variable levels of success. Underexplored themes in the existing literature include the individual and household level costs of PAC; the quality of PAC services; the provision of non-abortion reproductive health services in the context of PAC; and health care provider-community partnerships.

Perspectives of healthcare workers on the morality of abortion: a multicenter study in seven Brazilian public hospitals

We used the questionnaire "Mosaic of Opinions on Induced Abortion" to conduct a multi-centered study to evaluate the perspectives of physicians, nurses, social workers, psychologists and pharmacists on the morality of abortion. In all, 254 participants constituted the sample. The inadequate knowledge on Brazilian abortion laws was the only determinant negatively associated with the construct "Sexual and Reproductive Rights", corroborating the hypothesis that a better understanding of abortion legislation could mitigate the opposition of some professionals to the ethical perspective that access to safe abortion should be seen as a sexual and reproductive right.

Measurement properties of the questionnaire "Mosaic of opinions on induced abortion": a multicenter study in seven Brazilian hospitals

OBJECTIVE

In Brasil, abortion is legal in cases of rape, when there is a risk of maternal death, and in cases of fetal anencephaly. However, the literature reports that some doctors refuse to care for women with such demands or come to perform it in a discriminatory manner. Pretest, test and evaluate the measurement properties of the "Mosaic of Opinions on Induced Abortion," a questionnaire developed to investigate the perspectives of Brazilian healthcare professionals about the morality of abortion.

METHODS

Firstly, the questionnaire was pretested in an intentional sample of specialists. Secondly, it was tested in a randomized sample of 32 healthcare professionals. Finally, we conducted a multi-center study in seven university hospitals to evaluate the measurement properties of the questionnaire.

RESULTS

Combined samples of the three phases totalized 430 individuals. In pretest and test, all the evaluated aspects obtained satisfactory results. In the multicenter phase, confirmatory factorial analysis led to an important reduction of the questionnaire, which also obtained good indicators of reliability, beyond the validation of construct and criteria.

CONCLUSION

Questionnaire has been validated and is suitable for use in other surveys in Brasil.