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Veldhuis S, Sánchez-Ramírez G, Darney BG. "That is when I understood everything": Ideological trajectories of pro-choice female doctors in Mexico. Contraception 2024; 136:110473. [PMID: 38670303 DOI: 10.1016/j.contraception.2024.110473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024]
Abstract
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.
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Affiliation(s)
- Suzanne Veldhuis
- El Colegio de la Frontera Sur (ECOSUR), Department of Health, Carretera Panamericana y Periférico Sur s/n. Barrio de María Auxiliadora, San Cristóbal de las Casas, México.
| | - Georgina Sánchez-Ramírez
- El Colegio de la Frontera Sur (ECOSUR), Department of Health, Carretera Panamericana y Periférico Sur s/n. Barrio de María Auxiliadora, San Cristóbal de las Casas, México.
| | - Blair G Darney
- Oregon Health & Science University, Department of Obstetrics & Gynecology, Portland, OR, United States; Centro de Investigación en Salud Poblacional (CISP), Instituto Nacional de Salud Pública (INSP), Cuernavaca, Mexico.
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Atienzo EE, Cruz V, Garduño S, Lomelí S, Meza M, Zurbriggen R, Carbone SL, Wollum A. Safe abortion in Latin America: a look at abortion accompaniment collectives from the perspective of their activists. CULTURE, HEALTH & SEXUALITY 2024; 26:588-604. [PMID: 37504892 DOI: 10.1080/13691058.2023.2233589] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 07/03/2023] [Indexed: 07/29/2023]
Abstract
Over the last decade, activists in Latin America have expanded access to safe abortion through processes of accompaniment. Abortion accompaniment is characterised by activism and community-based strategies to facilitate access to, and safe use of, medication abortion, mainly outside clinical contexts. Drawing on findings from a survey of 515 activists who were part of Accompaniment Collectives in Latin America, this study describes the organisation of these collectives, barriers and facilitators to their activism, and how accompaniers perceive the impact and future of abortion accompaniment. Accompaniment Collectives are organised and flexible and operate in diverse social and legal contexts. The main goals of accompaniment are the normalisation and social decriminalisation of abortion culturally (84%); the social construction of autonomy (79%); and the protection of people's freedom (73%), life (71%) and health (67%). Activists in legally restrictive settings identified limited access to abortion medication (73%) and restrictive laws (71%) as the main barriers to accompaniment, while health care personnel objecting to abortion provision on grounds of conscience was most common in legally permissive settings (64%). Collectives have developed strategies to overcome such barriers to and expanding access to abortion care. Activists expect accompaniment to continue regardless of the legal status of abortion.
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Affiliation(s)
| | | | - Sofía Garduño
- Fondo de Aborto para la Justicia Social MARIA, Ciudad de México, México
| | - Stephanie Lomelí
- Fondo de Aborto para la Justicia Social MARIA, Ciudad de México, México
| | - Milena Meza
- Con las Amigas y en la Casa, Santiago, Chile
| | - Ruth Zurbriggen
- Colectiva Feminista La Revuelta en Socorristas en Red, Neuquén, Argentina
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Erhardt-Ohren B, Pier E, Arroyo D, Cole W, Hilliard M, Otero-Gonzalez A, Hidalgo-Mora O, Ospina-Henao S, Rochat R, Newton-Levinson A. Extra-legal abortion and post-abortion care knowledge, attitudes, and practices among obstetrician-gynecologist clinicians and medical residents in San José, Costa Rica: a qualitative study. BMC Womens Health 2023; 23:503. [PMID: 37735400 PMCID: PMC10512472 DOI: 10.1186/s12905-023-02639-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Induced abortion in Costa Rica is illegal in all cases except to save the life of the pregnant person. Despite severe restrictions to legal abortion, individuals in Costa Rica still induce abortions outside of the formal healthcare system. These individuals and those with spontaneous abortions, also known as miscarriages, occasionally need medical care for complications. In Costa Rica, an estimated 41% of unintended pregnancies end in abortion, yet there is very little published literature exploring the perspectives of healthcare providers on abortion in Costa Rica. METHODS We interviewed ten obstetrician-gynecologist clinicians and five obstetrician-gynecologist medical residents in San José, Costa Rica about their beliefs and practices related to extra-legal abortion and post-abortion care (PAC) using a Spanish language in-depth semi-structured interview guide. After transcription and translation into English, analysis team pairs used a combination of deductive and inductive coding to identify themes and sub-themes within the data. RESULTS Obstetrician-gynecologist clinicians and medical residents were aware of the presence of extra-legal abortion, and particularly, medication abortion, in their communities, but less familiar with dosing for induction. They expressed the desire to provide non-judgmental care and support their patients through extra-legal abortion and PAC journeys. Study participants were most familiar with providing care to individuals with spontaneous abortions. When discussing PAC, they often spoke about a policy of reporting individuals who seek PAC following an extra-legal abortion, without commenting on whether or not they followed the guidance. CONCLUSIONS This study contributes to a gap in research about the knowledge, attitudes, and practices of Costa Rican obstetrician-gynecologist clinicians and medical residents around extra-legal abortion and PAC. The results reveal an opportunity to train these healthcare providers as harm reduction experts, who are able to accurately counsel individuals who are seeking abortion services outside of the healthcare system, and to provide training to improve care for individuals needing PAC.
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Affiliation(s)
| | - Ellyn Pier
- Rollins School of Public Health, Emory University, Atlanta, USA
| | - Daniel Arroyo
- Faculty of Medicine, Universidad de Ciencias Médicas, San José, Costa Rica
| | - Whitney Cole
- Rollins School of Public Health, Emory University, Atlanta, USA
| | | | | | - Oscar Hidalgo-Mora
- Faculty of Medicine, Universidad de Ciencias Médicas, San José, Costa Rica
| | | | - Roger Rochat
- Rollins School of Public Health, Emory University, Atlanta, USA
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Veldhuis S, Sánchez-Ramírez G, Darney BG. “Sigue siendo un sistema precario”. Barreras de acceso a abortos clínicos: la experiencia de acompañantes en tres regiones mexicanas. CAD SAUDE PUBLICA 2022; 38:ES124221. [DOI: 10.1590/0102-311xes124221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 12/27/2021] [Indexed: 11/21/2022] Open
Abstract
El objetivo de esta investigación fue la identificación de las barreras más recurrentes de acceso a abortos en contextos clínicos (clandestinos o legales), desde la perspectiva de acompañantes, activistas feministas que acompañan a mujeres que optaron por abortos autogestionados con medicamentos. Realizamos 14 entrevistas semiestructuradas con acompañantes en tres regiones mexicanas: Baja California y Chiapas, ambos contextos restrictivos, y la Ciudad de México, donde el aborto por voluntad es legal hasta las 12 semanas. Identificamos cuatro categorías en las cuales se entretejen las vulnerabilidades sociales de las mujeres que deciden abortar, la falta de información, persistencia de estigma, y la influencia del marco legal, los fallos en la atención del aborto, incluso en las clínicas de interrupción legal de embarazo (en la Ciudad de México), y mala calidad de los servicios prestados -maltrato, objeción de conciencia y denuncia de los proveedores de salud-, y, por último, los grupos anti-derechos y sus estrategias. En las tres regiones, el acceso a abortos clínicos sigue siendo un privilegio reservado para las mujeres que cuentan con los recursos económicos, logísticos y sociales indispensables para realizarlo en esos espacios. La existencia de un programa Interrupción Legal de Embarazo en solamente una entidad denota la existencia de una desigualdad jurídica y sanitaria. Los hallazgos de este estudio sobre mujeres acompañantes de abortos aportan elementos para que el Estado mexicano mejore el acceso a abortos seguros para todas las mujeres, sobre todo ahora que la Suprema Corte de la Justicia de la Nación decretó la despenalización, y la legalización inminente en todo el país.
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Affiliation(s)
| | | | - Blair G. Darney
- Oregon Health & Science University, USA; Instituto Nacional de Salud Publica, Mexico
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Veldhuis S, Sánchez-Ramírez G, Darney BG. "Becoming the woman she wishes you to be": a qualitative study exploring the experiences of medication abortion acompañantes in thre regions in Mexico. Contraception 2021; 106:39-44. [PMID: 34742716 DOI: 10.1016/j.contraception.2021.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 10/24/2021] [Accepted: 10/27/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Acompañantes are activists who accompany women who have medication abortions outside of clinical settings. We describe models of accompaniment across three states in Mexico with diverse abortion laws, access, and acompañantes, and describe how acompañantes conceptualize the benefits and challenges of their work. STUDY DESIGN In this exploratory, qualitative study, we conducted semi-structured interviews with 14 participants about their experiences as acompañantes, in two states with restrictive abortion legislation (Baja-California, Chiapas) at the time of research and Mexico City, where abortion is legal upon request in the first trimester. We used a feminist ethnography approach and analyzed data using a priori categories which included perceived benefits of and challenges of the accompaniment model. RESULTS Participants described similar steps and general characteristics of the accompaniment process regardless of the setting, supporting the concept of an overarching definition of the holistic accompaniment model for these acompañantes. Holistic accompaniment is a horizontal model that involves trusting women, not asking for the reasons for their abortion, preventing criminalization, economic support, respecting autonomy, emotional accompaniment, and being flexible. Participants described perceived advantages, including safety, even in settings otherwise unsafe, such as where women may be stigmatized and / or criminalized. Participants described benefits of autonomous abortion compared to in-clinic medication abortion or surgical abortion, and benefits specifically related to accompaniment, such as the potential to make the abortion a positive experience. CONCLUSIONS We describe components of a holistic accompaniment model in Mexico which has specific characteristics that may benefit women who opt for out-of-clinic abortion.
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Affiliation(s)
- Suzanne Veldhuis
- El Colegio de la Frontera Sur (ECOSUR), Carretera Panamericana y Periférico Sur s/n. Barrio de María Auxiliadora, San Cristóbal de las Casas, México C.P. 29230.
| | - Georgina Sánchez-Ramírez
- El Colegio de la Frontera Sur (ECOSUR), Carretera Panamericana y Periférico Sur s/n. Barrio de María Auxiliadora, San Cristóbal de las Casas, México C.P. 29230
| | - Blair G Darney
- Oregon Health & Science University, Portland, Oregon, USA; Centro de Investigación en Salud Poblacional (CISP), Instituto Nacional de Salud Pública (INSP), Cuernavaca, México
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