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Emmerich N. The provision of abortion in Australia: service delivery as a bioethical concern. Monash Bioeth Rev 2024:10.1007/s40592-024-00215-0. [PMID: 39245693 DOI: 10.1007/s40592-024-00215-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2024] [Indexed: 09/10/2024]
Abstract
Despite significant progress in the legalization and decriminalization of abortion in Australia over the past decade or more recent research and government reports have made it clear that problems with the provision of services remain. This essay examines such issues and sets forth the view that such issues can and should be seen as (bio)ethical concerns. Whilst conscientious objection-the right to opt-out of provision on the basis of clear ethical reservations-is a legally and morally permissible stance that healthcare professionals can adopt, this does not mean those working in healthcare can simply elect not to be providers absent a clear ethical rationale. Furthermore, simple non-provision would seem to contravene the basic tenants of medical professionalism as well as the oft raised claims of the healthcare professions to put the needs of patients first. Recognizing that much of the progress that has been made over the past three decades can be attributed to the efforts of dedicated healthcare professionals who have dedicated their careers to meeting the profession's collective responsibilities in this area of women's health and reproductive healthcare, this paper frames the matter as a collective ethical lapse on the part of healthcare professionals, the healthcare professions and those involved in the management of healthcare institutions. Whilst also acknowledging that a range of complex factors have led to the present situation, that a variety of steps need to be taken to ensure the proper delivery of services that are comprehensive, and that there has been an absence of critical commentary and analysis of this topic by bioethicists, I conclude that there is a need to (re)assess the provision of abortion in Australia at all levels of service delivery and for the healthcare professions and healthcare professionals to take lead in doing so. That this ought to be done is clearly implied by the healthcare profession's longstanding commitment to prioritizing the needs of patient over their own interests.
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Affiliation(s)
- Nathan Emmerich
- School of Medicine and Psychology, Australian National University, Canberra, Australia.
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2
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Dempsey B, Callaghan S, Higgins MF. Providers' experiences with abortion care: A scoping review. PLoS One 2024; 19:e0303601. [PMID: 38950040 PMCID: PMC11216598 DOI: 10.1371/journal.pone.0303601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 04/27/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND Induced abortion is one of the most common gynecological procedures in the world, with as many as three in every ten pregnancies ending in abortion. It, however, remains controversial. The objective of this scoping review was to explore and map existing literature on the experiences of those who provide abortion care. METHODS AND FINDINGS This exploratory review followed the Levac et al. guidelines and was reported in accordance with the PRISMA-ScR checklist. CINAHL, Cochrane, EMBASE, PsycInfo, PubMed, and Web of Science were used to identify peer-reviewed, original research articles published on providers' experience of abortion. We identified 106 relevant studies, which include a total sample of 4,250 providers from 28 countries and six continents. Most of the studies were qualitative (n = 83), though quantitative (n = 15) and mixed methods (n = 8) studies were also included. We identified two overarching themes: (1) Providers' experiences with abortion stigma and (2) Providers' reflections on their abortion work. Our findings suggest that providers from around the world experience challenges within society and their communities and workplaces which reinforce the stigmatization and marginalization of abortion and pose questions about the morality of this work. Most, however, are proud of their work, believe abortion care to be socially important and necessary, and remain committed to the provision of care. CONCLUSIONS The findings of this review provide a comprehensive overview on the known experiences of providing abortion care. It is a key point of reference for international providers, researchers, and advocates to further this area of research or discussion in their own territories. The findings of this review will inform future work on how to support providers against stigmatization and will offer providers the chance to reflect on their own experiences.
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Affiliation(s)
- B. Dempsey
- UCD Perinatal Research Centre, National Maternity Hospital, University College Dublin, Dublin, Ireland
| | - S. Callaghan
- UCD Perinatal Research Centre, National Maternity Hospital, University College Dublin, Dublin, Ireland
- National Maternity Hospital, Dublin, Ireland
| | - M. F. Higgins
- UCD Perinatal Research Centre, National Maternity Hospital, University College Dublin, Dublin, Ireland
- National Maternity Hospital, Dublin, Ireland
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Haining CM, Bowman-Smart H, O'Rourke A, de Crespigny L, Keogh LA, Savulescu J. The 'Institutional Lottery': Institutional variation in the processes involved in accessing late abortion in Victoria, Australia. WOMENS STUDIES INTERNATIONAL FORUM 2023; 101:102822. [PMID: 39077555 PMCID: PMC11285594 DOI: 10.1016/j.wsif.2023.102822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/06/2023] [Accepted: 08/26/2023] [Indexed: 07/31/2024]
Abstract
Despite abortion being decriminalised in Victoria, Australia, access remains difficult, especially at later gestations. Institutions (i.e. health services) place restrictions on the availability of late abortions and/or require additional requirements to be satisfied (e.g. Hospital Termination Review Committee approval), as a consequence of local regulation (i.e. policies and processes determined at the institutional level). This paper reports on the results of 27 interviews with Victorian health professionals about late abortion processes and the operation of Termination Review Committees in Victorian health services, which were analysed thematically. The results reveal the operation of an 'institutional lottery' whereby patients' experiences in seeking late abortion services were variable and largely shaped by the institution(s) they found themselves in.
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Affiliation(s)
- Casey Michelle Haining
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Hilary Bowman-Smart
- Australian Centre for Precision Health, University of South Australia, South Australia, Australia
- Murdoch Children's Research Institute, Victoria, Australia
- Monash Bioethics Centre, Monash University, Victoria, Australia
| | - Anne O'Rourke
- Monash Business School, Monash University, Victoria, Australia
| | - Lachlan de Crespigny
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Louise Anne Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Julian Savulescu
- Murdoch Children's Research Institute, Victoria, Australia
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Melbourne Law School, University of Melbourne, Victoria, Australia
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Bowman-Smart H, Keogh L, Haining CM, O'Rourke A, de Crespigny L, Savulescu J. 'The tabloid test': a qualitative interview study on the function and purpose of termination of pregnancy review committees in Victoria, Australia. Reprod Health 2023; 20:104. [PMID: 37464379 DOI: 10.1186/s12978-023-01624-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 05/17/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Termination of pregnancy (TOP) is not an uncommon procedure. Availability varies greatly between jurisdictions; however, additional institutional processes beyond legislation can also impact care and service delivery. This study serves to examine the role institutional processes can play in the delivery of TOP services, in a jurisdiction where TOP is lawful at all gestations (Victoria, Australia). As per the Abortion Law Reform Act 2008, TOPs post-24 weeks require the approval of two medical practitioners. However, in Victoria, hospitals that offer post-24 week TOPs generally require these cases to additionally go before a termination review committee for assessment prior to the service being provided. These committees are not stipulated in legislation. Information about these committees and how they operate is scarce and there is minimal information available to the public. METHODS To trace the history, function, and decision-making processes of these committees, we conducted a qualitative interview study. We interviewed 27 healthcare professionals involved with these committees. We used purposive sampling to gain perspectives from a range of professions across 10 hospitals. Interviews were transcribed verbatim, identifying details removed and inductive thematic analysis was performed. RESULTS Here, we report the three main functions of the committees as described by participants. The functions were to protect: (1) outward appearances; (2) inward functionality; and/or, (3) service users. Function (1) could mean protecting the hospital's reputation, with the "Herald Sun test"-whether the TOP would be acceptable to readers of the Herald Sun, a tabloid newspaper-used as a heuristic. Function (2) related to logistics within the hospital and protecting the psychological wellbeing and personal reputation of healthcare professionals. The final function (3) related to ensuring patients received a high standard of care. CONCLUSIONS The primary functions of these committees appear to be about protecting hospitals and clinicians within a context where these procedures are controversial and stigmatized. The results of this study provide further clarity on the processes involved in the provision of TOPs at later gestations from the perspectives of the healthcare professionals involved. Institutional processes beyond those required by legislation are put in place by hospitals. These findings highlight the additional challenges faced by patients and their providers when seeking TOP at later gestations.
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Affiliation(s)
- Hilary Bowman-Smart
- Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC, 3052, Australia
- Monash Bioethics Centre, Monash University, Clayton, VIC, Australia
- Ethox Centre, University of Oxford, Oxford, UK
- Australian Centre for Precision Health, University of South Australia, Adelaide, Australia
| | - Louise Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Casey M Haining
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Anne O'Rourke
- Monash Business School, Monash University, Clayton, VIC, Australia
| | - Lachlan de Crespigny
- Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Julian Savulescu
- Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC, 3052, Australia.
- Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK.
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Rosser S, Sekar R, Laporte J, Duncombe GJ, Bendall A, Lehner C, Portmann C, McGrath P, Lust K, Ganter P, Kumar S. Late termination of pregnancy at a major Queensland tertiary hospital, 2010–2020. Med J Aust 2022; 217:410-414. [DOI: 10.5694/mja2.51697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Renuka Sekar
- Royal Brisbane and Woman's Hospital Brisbane QLD
| | | | - Gregory J Duncombe
- Centre for Advanced Prenatal Care Royal Brisbane and Woman's Hospital Brisbane QLD
| | | | | | | | | | - Karin Lust
- Royal Brisbane and Woman's Hospital Brisbane QLD
| | - Peter Ganter
- Royal Brisbane and Woman's Hospital Brisbane QLD
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de Londras F, Cleeve A, Rodriguez MI, Lavelanet AF. The impact of 'grounds' on abortion-related outcomes: a synthesis of legal and health evidence. BMC Public Health 2022; 22:936. [PMID: 35538457 PMCID: PMC9092771 DOI: 10.1186/s12889-022-13247-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/14/2022] [Indexed: 01/13/2023] Open
Abstract
Where abortion is legal, it is often regulated through a grounds-based approach. A grounds-based approach to abortion provision occurs when law and policy provide that lawful abortion may be provided only where a person who wishes to have an abortion satisfies stipulated 'grounds', sometimes described as 'exceptions' or 'exceptional grounds'. Grounds-based approaches to abortion are, prima facie, restrictive as they limit access to abortion based on factors extraneous to the preferences of the pregnant person. International human rights law specifies that abortion must be available (and not 'merely' lawful) where the life or health of the pregnant woman or girl is at risk, or where carrying a pregnancy to term would cause her substantial pain or suffering, including but not limited to situations where the pregnancy is the result of rape or incest or the pregnancy is not viable. However, international human rights law does not specify a grounds-based approach as the way to give effect to this requirement. The aim of this review is to address knowledge gaps related to the health and non-health outcomes plausibly related to the effects of a grounds-based approach to abortion regulation. The evidence from this review shows that grounds have negative implications for access to quality abortion and for the human rights of pregnant people. Further, it shows that grounds-based approaches are insufficient to meet states' human rights obligations. The evidence presented in this review thus suggests that enabling access to abortion on request would be more rights-enhancing than grounds-based approaches to abortion regulation.
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Affiliation(s)
- Fiona de Londras
- grid.6572.60000 0004 1936 7486Birmingham Law School, University of Birmingham, Birmingham, B15 2TT UK
| | - Amanda Cleeve
- grid.4714.60000 0004 1937 0626Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden ,grid.3575.40000000121633745Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, World Health Organization, Geneva, Switzerland
| | - Maria I. Rodriguez
- grid.5288.70000 0000 9758 5690Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon USA
| | - Antonella F. Lavelanet
- grid.3575.40000000121633745Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, World Health Organization, Geneva, Switzerland
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O'Shea LE, Hawkins JE, Lord J, Schmidt-Hansen M, Hasler E, Cameron S, Cameron IT. Access to and sustainability of abortion services: a systematic review and meta-analysis for the National Institute of Health and Care Excellence-new clinical guidelines for England. Hum Reprod Update 2021; 26:886-903. [PMID: 32712660 DOI: 10.1093/humupd/dmaa026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/07/2020] [Accepted: 06/15/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Induced abortion is a common procedure. However, there is marked variation in accessibility of services across England. Accessing abortion services may be difficult, particularly for women who live in remote areas, are in the second trimester of pregnancy, have complex pre-existing conditions or have difficult social circumstances. OBJECTIVE AND RATIONALE This article presents a two-part review undertaken for a new National Institute of Health and Care Excellence guideline on abortion care, and aiming to determine: the factors that help or hinder accessibility and sustainability of abortion services in England (qualitative review), and strategies that improve these factors, and/or other factors identified by stakeholders (quantitative review). Economic modelling was undertaken to estimate cost savings associated with reducing waiting times. SEARCH METHODS Ovid Embase Classic and Embase, Ovid MEDLINE(R) Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R), PsycINFO, Cochrane Library via Wiley Online, Cinahl Plus and Web of Science Core Collection were searched for articles published up to November 2018. Studies were included if they were published in English after 2001, conducted in Organization for Economic Co-operation and Development (OECD) countries and were: qualitative studies reporting views of patients and/or staff on factors that help or hinder the accessibility and sustainability of a safe abortion service, or randomized or non-randomized studies that compared strategies to improve factors identified by the qualitative review and/or stakeholders. Studies were excluded if they were conducted in OECD countries where abortion is prohibited altogether or only performed to save the woman's life. One author assessed risk of bias of included studies using the following checklists: Critical Appraisal Skills Programme checklist for qualitative studies, Cochrane Collaboration quality checklist for randomized controlled trials, Newcastle-Ottawa scale for cohort studies, and Effective Practice and Organization of Care risk of bias tool for before-and-after studies.Qualitative evidence was combined using thematic analysis and overall quality of the evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE) Confidence in the Evidence from Reviews of Qualitative Research (CERQual). Quantitative evidence was analysed in Review Manager 5.3 and overall quality of evidence was assessed using GRADE. OUTCOMES Eight themes (service level barriers; financial barriers; logistical barriers; personal barriers; legal and policy barriers; privacy and confidentiality concerns; training and education; community prescribing and telemedicine introduce greater flexibility) and 18 subthemes were identified from 23 papers (n = 1016) included in the qualitative review. The quality of evidence ranged from very low to high, with evidence for one theme and seven subthemes rated as high quality. Nine studies (n = 7061) were included in the quantitative review which showed that satisfaction was better (low to high quality evidence) and women were seen sooner (very low quality evidence) when care was led by nurses or midwives compared with physician-led services, women were seen sooner when they could self-refer (very low quality evidence), and clinicians were more likely to provide abortions if training used an opt-out model (very low quality evidence). Economic modelling showed that even small reductions in waiting times could result in large cost savings for services. WIDER IMPLICATIONS Self-referral, funding for travel and accommodation, reducing waiting times, remote assessment, community services, maximizing the role of nurses and midwives and including practical experience of performing abortion in core curriculums, unless the trainee opts out, should improve access to and sustainability of abortion services.
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Affiliation(s)
- Laura E O'Shea
- National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London SE1 1SZ, UK
| | - James E Hawkins
- National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London SE1 1SZ, UK
| | - Jonathan Lord
- Department of Obstetrics & Gynaecology, Royal Cornwall Hospital, Truro TR1 3LQ, UK
| | - Mia Schmidt-Hansen
- National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London SE1 1SZ, UK
| | - Elise Hasler
- National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London SE1 1SZ, UK
| | - Sharon Cameron
- Sexual and Reproductive Health Services, NHS Lothian and University of Edinburgh, Edinburgh EH3 9EJ, UK
| | - Iain T Cameron
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
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Best E, Lokuge B, Dunlop A, Dunford A. Unmet need for postpartum long-acting reversible contraception in women with substance use disorders and/or socioeconomic disadvantage. Aust N Z J Obstet Gynaecol 2021; 61:304-309. [PMID: 33619725 DOI: 10.1111/ajo.13306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 12/13/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND In Australia, it is estimated that 30% of pregnancies are unintended and 25% of pregnancies end in abortion. Unintended pregnancy can be particularly problematic for women with substance use disorders (SUD) and/or socioeconomic disadvantage. Long-acting reversible contraception (LARC) including progestogen implants and intrauterine devices (IUD) are safe, affordable and extremely effective in decreasing rates of unintended pregnancy, yet are currently underutilised in Australia. AIMS To determine the current rate of unintended pregnancy, contraception counselling and postpartum LARC use in women who attend an antenatal clinic for SUD and/or socioeconomic disadvantage in pregnancy. We hypothesise that there is an unmet need for contraception in this population. MATERIALS AND METHODS We conducted a retrospective audit of women who birthed in a tertiary hospital in 2018 with SUD and/or additional social support needs. We recorded the rate of unintended pregnancy, the occurrence of antenatal and postpartum contraception counselling and the rate of immediate postpartum LARC uptake through review of our electronic medical database. RESULTS Of the 210 women in our study population, we identified a high proportion of unintended pregnancies (64%), a low rate of antenatal (11%) and postpartum (35%) contraception counselling, and a low uptake of immediate postpartum LARC use (3.3%), confirming an unmet need for contraception. CONCLUSIONS Further intervention is required to enhance the access to immediate postpartum LARC and reduce the risk and health burden of unintended pregnancy.
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Affiliation(s)
- Emanuelle Best
- Department of Maternity and Gynaecology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Buddhima Lokuge
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Adrian Dunlop
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Angela Dunford
- Department of Maternity and Gynaecology, John Hunter Hospital, Newcastle, New South Wales, Australia
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Baird B, Millar E. Abortion at the edges: Politics, practices, performances. WOMENS STUDIES INTERNATIONAL FORUM 2020; 80:102372. [PMID: 32346206 PMCID: PMC7186192 DOI: 10.1016/j.wsif.2020.102372] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 11/27/2022]
Abstract
This article provides a brief overview of the state of discourse, politics and provision of abortion in the Anglophone West, including developments in the wake of the COVID-19 pandemic. It then surveys three promising directions for feminist abortion scholarship. The first is work inspired by the Reproductive Justice Movement, that points to the intersectional axes of inequality that shape abortion discourse and position us in relation to reproductive choice and access issues. The second is work that examines the particularity of the constitution of the aborting body, reflecting the particularity of the pregnant body. This is a specific body, with a specific history; abortion discourse draws from and makes a significant contribution to the meaning and lived experience of this body. The third area of scholarship we highlight is that which seeks to amplify the meaning of abortion as a social good. Much abortion scholarship is attuned to a critique of negative aspects of abortion-from its representation in popular culture to restrictive law and access issues. This is critical work but/and the performative nature of abortion scholarship, like all discourse, means that it can amplify the association of negativity with abortion. The article concludes by introducing the articles contained in the special section of Women's Studies International Forum, 'Abortion at the edges: Politics, practices, performances'.
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Affiliation(s)
- Barbara Baird
- Women's Studies, Flinders University, GPO Box 2100, Adelaide, South Australia 5001, Australia
| | - Erica Millar
- Crime, Justice and Legal Studies, La Trobe University, Bundoora, Victoria 3086, Australia
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The prevalence and the reasons of issuing permission for therapeutic abortion in department of forensic medicine, Kermanshah, Iran, during 2005 to 2010. BMC Res Notes 2019; 12:574. [PMID: 31519224 PMCID: PMC6743142 DOI: 10.1186/s13104-019-4622-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 09/07/2019] [Indexed: 11/18/2022] Open
Abstract
Objective The present study aimed to investigate the prevalence and the reasons of issuing permission for therapeutic abortion in department of forensic medicine, Kermanshah-Iran. Results There were a total number of 428 applications for issuing permits. The most common reasons of issuing permit for therapeutic abortion were fetal and maternal problems, specifically cerebral abnormalities (70.8%), and anencephaly (30.3%). Furthermore, 354 (82/7%) out of 428 applications were able to get the legal permit and 17.3% of the applications did not receive permission, which was mainly due to “the lack of maternal indication”. Increased knowledge of physicians and clinical personnel on indications of therapeutic abortions and related regulations would lead to the implementation of strategies which prevent void referrals to the department of forensic medicine and a better execution of therapeutic abortion law. By improving the health condition of pregnant women who seek pregnancy termination, informing them about indications of therapeutic abortions, and developing proper strategies to make pregnant women more acquainted with legal cases of abortion, we can take a significant step towards helping pregnant women and promoting their health.
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Bateson DJ, Black KI, Sawleshwarkar S. The Guttmacher–
Lancet
Commission on sexual and reproductive health and rights: how does Australia measure up? Med J Aust 2019; 210:250-252.e1. [DOI: 10.5694/mja2.50058] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Kirsten I Black
- University of Sydney Sydney NSW
- Royal Prince Alfred Hospital Sydney NSW
| | - Shailendra Sawleshwarkar
- Westmead Clinical SchoolUniversity of Sydney Sydney NSW
- Western Sydney Sexual Health CentreWestmead Hospital Sydney NSW
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12
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Black KI, Bateson D. Medical abortion is fundamental to women's health care. Aust N Z J Obstet Gynaecol 2017; 57:245-247. [DOI: 10.1111/ajo.12642] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Kirsten I. Black
- Discipline of Obstetrics, Gynaecology and Neonatology; Central Clinical School, University of Sydney; Sydney New South Wales Australia
- Women's and Babies, Royal Prince Alfred Hospital; Camperdown New South Wales Australia
| | - Deborah Bateson
- Discipline of Obstetrics, Gynaecology and Neonatology; Central Clinical School, University of Sydney; Sydney New South Wales Australia
- Family Planning NSW; Sydney New South Wales Australia
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de Moel-Mandel C, Shelley JM. The legal and non-legal barriers to abortion access in Australia: a review of the evidence. EUR J CONTRACEP REPR 2017; 22:114-122. [DOI: 10.1080/13625187.2016.1276162] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Julia M. Shelley
- School of Health and Social Development, Deakin University, Melbourne, Australia
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Keogh LA, Newton D, Bayly C, McNamee K, Hardiman A, Webster A, Bismark M. Intended and unintended consequences of abortion law reform: perspectives of abortion experts in Victoria, Australia. ACTA ACUST UNITED AC 2016; 43:18-24. [PMID: 27913574 DOI: 10.1136/jfprhc-2016-101541] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/07/2016] [Accepted: 11/07/2016] [Indexed: 11/04/2022]
Abstract
INTRODUCTION In Victoria, Australia, abortion was decriminalised in October 2008, bringing the law in line with clinical practice and community attitudes. We describe how experts in abortion service provision perceived the intent and subsequent impact of the 2008 Victorian abortion law reform. METHODS Experts in abortion provision in Victoria were recruited for a qualitative semi-structured interview about the 2008 law reform and its perceived impact, until saturation was reached. Nineteen experts from a range of health care settings and geographic locations were interviewed in 2014/2015. Thematic analysis was conducted to summarise participants' views. RESULTS Abortion law reform, while a positive event, was perceived to have changed little about the provision of abortion. The views of participants can be categorised into: (1) goals that law reform was intended to address and that have been achieved; (2) intent or hopes of law reform that have not been achieved; (3) unintended consequences; (4) coincidences; and (5) unfinished business. All agreed that law reform had repositioned abortion as a health rather than legal issue, had shifted the power in decision making from doctors to women, and had increased clarity and safety for doctors. However, all described outstanding concerns; limited public provision of surgical abortion; reduced access to abortion after 20 weeks; ongoing stigma; lack of a state-wide strategy for equitable abortion provision; and an unsustainable workforce. CONCLUSION Law reform, while positive, has failed to address a number of significant issues in abortion service provision, and may have even resulted in a 'lull' in action.
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Affiliation(s)
- L A Keogh
- Associate Professor, Gender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - D Newton
- Research Fellow, Gender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - C Bayly
- Senior Clinical Adviser, Women's Health, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - K McNamee
- Medical Director, Family Planning Victoria, Melbourne, Victoria, Australia
| | - A Hardiman
- Manager, Pregnancy Advisory Service, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - A Webster
- Senior Policy and Health Promotion Officer, Women's Health Victoria, Melbourne, Victoria, Australia
| | - M Bismark
- Associate Professor of Law and Public Health, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Dickinson JE. Confusion, inequity and inconsistency: Abortion in Australia. Aust N Z J Obstet Gynaecol 2015; 55:103-4. [PMID: 25871348 DOI: 10.1111/ajo.12332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jan E Dickinson
- Australian and New Zealand Journal of Obstetrics and Gynaecology, School of Women's and Infants' Health, The University of Western Australia, Perth, Western Australia, Australia.
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