Attitudes of Medical and Health Sciences Students towards Abortion in Jordan

Osteopathic Medical Students' Concerns About the Future of Abortion Education and Training Post-Roe v. Wade

Background In the United States, new regulations on access to abortion and, in some cases, penalization of physicians who provide abortions, have been established on a state-by-state basis. The American College of Obstetricians and Gynecologists recommends that medical schools include abortion training in their curriculum. It is still unknown if the Dobbs decision will limit medical students' abortion training and/or discourage them from pursuing a career in obstetrics. The goal of this study was to investigate the attitudes of medical students toward abortion following the Dobbs decision and their beliefs about its possible effect on future medical education and practice. Methods This cross-sectional, observational study collected data from students enrolled in a Florida, United States osteopathic medical school using an anonymous online questionnaire from February to March 2023. The questionnaire contained 35 items that addressed medical students' attitudes towards a range of potential implications on medical training due to the new abortion restrictions. Hypothesis testing was performed using Spearman's rho correlation and multivariate linear regression to explore the relationship between the predictor variables (concerns about future practice regarding abortion, religiosity, and acceptability of abortion based on gestation age) and the predicted variable (attitudes about abortion). Data were analyzed using Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 28.0, Armonk, NY). Results In total, 158 participants completed the questionnaire; 91 (57.6%) were women. The mean age was 25.8 (range 21-37 years). Using a stepwise regression analysis, only the variables shown to be statistically associated (per Spearman's rho bivariate correlation) with the predicted variable (abortion attitudes) were entered into the model (i.e., concerns about abortion education and future practice, religiosity, and abortion acceptability based on gestational age). A significant regression equation was found (F(3,134) = 205.750, p < 0.001, R2 = 0.822, R2 adjusted = 0.818). The percentage of variance in the scores accounted for by the model was 82%. Higher levels of feeling that the abortion ban would negatively affect their training and future practice, greater religiosity, and acceptability of abortion at later gestation ages were statistically significant predictors of more positive attitudes toward abortion in this sample of osteopathic medical students. Conclusions The results suggest that the attitudes of medical students toward abortion are related to multiple factors, including concerns about future abortion training, religiosity, and the week of pregnancy acceptable for a woman to have an abortion. Findings also highlight the attitudes of medical students in response to more restrictive abortion legislation, emphasizing their desire for possible curricular enhancements to safeguard their training and education.

Attitudes towards induced abortion among gynecologists in Kurdistan region of Iraq

BACKGROUND

Unsafe abortion is a major contributor to maternal morbidity and mortality in countries where induced abortion is restricted. In Kurdistan Region of Iraq, induced abortion is strictly forbidden except for life-threatening situations, increasing the risk of seeking unsafe abortions. Attitudes among healthcare professionals who directly encounter cases and consequences of induced abortion can be studied to improve women's access to safe abortion. This study aimed to examine attitudes towards induced abortion among gynecologists in Kurdistan Region of Iraq.

METHODS

This cross-sectional facility-based study was conducted in the first quarter of 2022 in Kurdistan Region of Iraq in the cities of Erbil, Sulaymaniyah, and Duhok. Convenient sampling was used to invite 330 gynecologists to participate, with 171 ultimately completing the questionnaire, giving a response rate of 53%. Questionaries using the Taylor and Whitehead abortion attitude scale were sent in person or digitally. The data was then analyzed using Chi-square and Fisher's exact tests to determine the independence of attitudes and associations between attitudes and sociodemographic factors.

RESULTS

Among 171 gynecologists, 25% of the gynecologists agreed that induced abortion is unacceptable under any circumstances. Most (71%) disagreed that a woman has the right to choose to have an induced abortion. Around 51% considered induced abortion murder, and 41% agreed that induced abortion goes against all morals. Around 57% disagreed with the legalization of induced abortion, while 43% agreed. Gynecologists who were unmarried (P = 0.025), under the age of 40 (P = 0.044), and with less than 10 years of clinical experience (P = 0.043) were more likely to support the legalization of induced abortion in Kurdistan Region. None of the variables was found to be independently associated with attitudes towards abortion legalization.

CONCLUSIONS

Despite some younger gynecologists having more favorable attitudes towards induced abortion, most gynecologists in Kurdistan Region had less favorable views. Most gynecologists were willing to provide post-abortion care regardless of their legal status. We recommend conducting more studies to investigate the consequences of current abortion legislation among women in need of induced abortion in Kurdistan Region of Iraq.

A narrative review of challenges related to healthcare worker rights, roles and responsibilities in the provision of sexual and reproductive services in health facilities

INTRODUCTION

This paper identifies and summarises tensions and challenges related to healthcare worker rights and responsibilities and describes how they affect healthcare worker roles in the provision of sexual and reproductive health (SRH) care in health facilities.

METHOD

The review was undertaken in a two-phase process, namely: (1) development of a list of core constructs and concepts relating to healthcare worker rights, roles and responsibilities to guide the review and (2) literature review.

RESULT

A total of 110 papers addressing a variety of SRH areas and geographical locations met our inclusion criteria. These papers addressed challenges to healthcare worker rights, roles and responsibilities, including conflicting laws, policies and guidelines; pressure to achieve coverage and quality; violations of the rights and professionalism of healthcare workers, undercutting their ability and motivation to fulfil their responsibilities; inadequate stewardship of the private sector; competing paradigms for decision-making-such as religious beliefs-that are inconsistent with professional responsibilities; donor conditionalities and fragmentation; and, the persistence of embedded practical norms that are at odds with healthcare worker rights and responsibilities. The tensions lead to a host of undesirable outcomes, ranging from professional frustration to the provision of a narrower range of services or of poor-quality services.

CONCLUSION

Social mores relating to gender and sexuality and other contested domains that relate to social norms, provider religious identity and other deeply held beliefs complicate the terrain for SRH in particular. Despite the particularities of SRH, a whole of systems response may be best suited to address embedded challenges.

Predictors of Abortion Attitudes in Medical Students After the Reversal of Roe v. Wade

Background On June 24, 2022, the United States (U.S.) Supreme Court ruled in Dobbs v. Jackson Women's Health that the Constitution does not grant women the right to abortion. This new ruling may have a profound impact on not only the attitudes of medical trainees but the nature in which they are trained when it comes to abortion practices, indications, or procedures. Some clinics where medical schools provide first-hand abortion experience have closed. As a surge of extreme restrictions on abortion has been seen in certain states in the U.S., medical schools and residency programs need to address these issues to ensure future physicians are adequately prepared. The purpose of this study was to assess factors that influence medical students' attitudes toward abortion, specifically knowledge about abortion, religiosity, and philosophical group affiliation regarding abortion (i.e., "pro-choice vs. "pro-life"). Methodology This cross-sectional study collected data from a convenience sample of 413 medical students between October and December 2022 via an online, anonymous questionnaire. Major study variables as depicted in the published literature led to the development of the Abortion Attitudes Questionnaire (AAQ) for medical students. The AAQ contained validated scales to assess the contribution of levels of abortion knowledge and religiosity as well as sample characteristics on attitudes about abortion in medical students. Speakman rank correlation and linear multivariate regression were used for hypothesis testing to explore the contributions of the dependent variables to attitudes about abortion in medical students. Results The mean age of the participants was 25.8 years (SD = 2.96; range = 21-45 years). Linear regression modeling indicated that religiosity, abortion knowledge, being a woman, and group affiliation regarding abortion ("pro-choice" or "pro-life") explained a significant amount of the variance (60%) in abortion attitudes scores in medical students. A significant regression equation was found, F(6,373) = 83.570, p < 0.0001, R² = 0.603, R² adjusted = 0.611). Less religiosity, greater abortion knowledge, being a woman, and identifying as "pro-choice" significantly contributed to more positive attitudes toward abortion in this sample of medical students. Interestingly, while moderately correlated with abortion attitudes (r = 0.436,p < 0.01), the single item regarding the importance of religion in one's life did not contribute to the model. Conclusions The present study is the first, to our knowledge, to identify medical student characteristics (i.e., sex, "pro-choice" vs. "pro-life" group affiliation, level of knowledge about abortion, and religiosity) as indicators of abortion attitudes. With the reversal of Roe v. Wade, attention must be given to the possible change in medical students' attitudes toward abortion (as well as any newly developed constraints on clinical training) and to ensure the provision of comprehensive education as U.S. states will determine the limits of these practices and procedures. While further research in this area is needed, findings from this study can help assess students' attitudes about abortion and guide medical education efforts to better prepare tomorrow's obstetrics and gynecology physicians.