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Jibat N, Tadele G, Haukanes H, Blystad A. "We need to confirm at least from two or three": Healthcare workers' discretion as gatekeepers in the context of the Ethiopian abortion law. Int J Equity Health 2024; 23:127. [PMID: 38907223 PMCID: PMC11193265 DOI: 10.1186/s12939-024-02203-6] [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: 02/18/2024] [Accepted: 05/28/2024] [Indexed: 06/23/2024] Open
Abstract
INTRODUCTION Women's access to legal and safe abortion is a vital means to reduce unsafe abortion, which in turn is known to reduce maternal morbidity and mortality. In 2005, Ethiopia enacted a relatively permissive abortion legislation. However, there is evidence that access to abortion care services may be challenging and controversial even if progressive abortion laws are in place. This article examines women's access to abortion services from the perspective of healthcare workers in a rural setting in Ethiopia. Drawing on Lipsky's theory of street-level bureaucrats, the article discusses healthcare workers' discretion and the substantial authority they hold as gatekeepers to safe abortion services. METHODS The study draws upon a qualitative, interpretative methodological approach, with in-depth semi-structured interviews with healthcare workers as the key method of data generation. The data was analyzed and interpreted thematically. Healthcare workers' perspectives were examined with reference to the national abortion legislation and guidelines. RESULTS The findings reveal that healthcare workers make decisions on behalf of the women who seek abortion, and they involve parents and partners in abortion-related decision-making processes. Moreover, they assess the social context of the pregnancy such as the marital and economic statuses of the abortion-seeking women in ways that restrict women's access to legally-endorsed abortion services. CONCLUSIONS Healthcare workers' practices in this rural area were found to challenge the basic provisions laid out in Ethiopia's abortion legislation. Their negative discretion of the legislation contributes to the substantial barriers Ethiopian abortion-seeking women face in gaining access to legal abortion services, despite the presence of a progressive legal framework and guidelines.
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Affiliation(s)
- Nega Jibat
- Department of Sociology, Jimma University, Addis Ababa University, Jimma, Ethiopia.
| | - Getnet Tadele
- Department of Sociology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Haldis Haukanes
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - Astrid Blystad
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Merner B, Haining CM, Willmott L, Savulescu J, Keogh LA. Health providers' reasons for participating in abortion care: A scoping review. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241233124. [PMID: 38426387 PMCID: PMC10908244 DOI: 10.1177/17455057241233124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 12/14/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND There is a global shortage of health providers in abortion care. Public discourse presents abortion providers as dangerous and greedy and links 'conscience' with refusal to participate. This may discourage provision. A scoping review of empirical evidence is needed to inform public perceptions of the reasons that health providers participate in abortion. OBJECTIVE The study aimed to identify what is known about health providers' reasons for participating in abortion provision. ELIGIBILITY CRITERIA Studies were eligible if they included health providers' reasons for participating in legal abortion provision. Only empirical studies were eligible for inclusion. SOURCES OF EVIDENCE We searched the following databases from January 2000 until January 2022: Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, ScienceDirect and Centre for Agricultural and Biosciences International Abstracts. Grey literature was also searched. METHODS Dual screening was conducted of both title/abstract and full-text articles. Health providers' reasons for provision were extracted and grouped into preliminary categories based on the existing research. These categories were revised by all authors until they sufficiently reflected the extracted data. RESULTS From 3251 records retrieved, 68 studies were included. In descending order, reasons for participating in abortion were as follows: supporting women's choices and advocating for women's rights (76%); being professionally committed to participating in abortion (50%); aligning with personal, religious or moral values (39%); finding provision satisfying and important (33%); being influenced by workplace exposure or support (19%); responding to the community needs for abortion services (14%) and participating for practical and lifestyle reasons (8%). CONCLUSION Abortion providers participated in abortion for a range of reasons. Reasons were mainly focused on supporting women's choices and rights; providing professional health care; and providing services that aligned with the provider's own personal, religious or moral values. The findings provided no evidence to support negative portrayals of abortion providers present in public discourse. Like conscientious objectors, abortion providers can also be motivated by conscience.
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Affiliation(s)
- Bronwen Merner
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Casey M Haining
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Lindy Willmott
- Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, Brisbane, QLD, Australia
| | - Julian Savulescu
- Oxford 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
- Murdoch Children’s Research Institute, Parkville, VIC, Australia
- University of Melbourne, Parkville, VIC, Australia
| | - Louise A Keogh
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
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Schaaf M, Lavelanet A, Codjia L, Nihlén Å, Rehnstrom Loi U. A narrative review of challenges related to healthcare worker rights, roles and responsibilities in the provision of sexual and reproductive services in health facilities. BMJ Glob Health 2023; 8:e012421. [PMID: 37918835 PMCID: PMC10626880 DOI: 10.1136/bmjgh-2023-012421] [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: 03/28/2023] [Accepted: 10/07/2023] [Indexed: 11/04/2023] Open
Abstract
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.
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Affiliation(s)
- Marta Schaaf
- Department of Sexual and Reproductive Health and Research and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Antonella Lavelanet
- Department of Sexual and Reproductive Health and Research and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Laurence Codjia
- Department of Health Workforce, World Health Organization, Geneva, Switzerland
| | - Åsa Nihlén
- Department of Sexual and Reproductive Health and Research and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Ulrika Rehnstrom Loi
- Department of Sexual and Reproductive Health and Research and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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Abayneh M, Rent S, Ubuane PO, Carter BS, Deribessa SJ, Kassa BB, Tekleab AM, Kukora SK. Perinatal palliative care in sub-Saharan Africa: recommendations for practice, future research, and guideline development. Front Pediatr 2023; 11:1217209. [PMID: 37435165 PMCID: PMC10331424 DOI: 10.3389/fped.2023.1217209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/13/2023] [Indexed: 07/13/2023] Open
Abstract
Worldwide, sub-Saharan Africa has the highest burden of global neonatal mortality (43%) and neonatal mortality rate (NMR): 27 deaths per 1,000 live births. The WHO recognizes palliative care (PC) as an integral, yet underutilized, component of perinatal care for pregnancies at risk of stillbirth or early neonatal death, and for neonates with severe prematurity, birth trauma or congenital anomalies. Despite bearing a disproportionate burden of neonatal mortality, many strategies to care for dying newborns and support their families employed in high-income countries (HICs) are not available in low-and-middle-income countries (LMICs). Many institutions and professional societies in LMICs lack guidelines or recommendations to standardize care, and existing guidelines may have limited adherence due to lack of space, equipment, supplies, trained professionals, and high patient load. In this narrative review, we compare perinatal/neonatal PC in HICs and LMICs in sub-Saharan Africa to identify key areas for future, research-informed, interventions that might be tailored to the local sociocultural contexts and propose actionable recommendations for these resource-deprived environments that may support clinical care and inform future professional guideline development.
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Affiliation(s)
- Mahlet Abayneh
- Department of Pediatrics and Child Health, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Sharla Rent
- Duke Department of Pediatrics, Duke School of Medicine, Durham, NC, United States
- Duke Global Health Institute, Durham, NC, United States
| | - Peter Odion Ubuane
- Department of Pediatrics, Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, Nigeria
| | - Brian S. Carter
- Division of Neonatology and Bioethics Center, Children’s Mercy Hospital, Kansas City, MO, United States
- Department of Pediatrics and Department of Medical Humanities and Bioethics, Universityof Missouri-Kansas City School of Medicine, Kansas City, MO, United States
| | - Solomie Jebessa Deribessa
- Department of Pediatrics and Child Health, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Betelehem B. Kassa
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Atnafu Mekonnen Tekleab
- Department of Pediatrics and Child Health, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Stephanie K. Kukora
- Division of Neonatology and Bioethics Center, Children’s Mercy Hospital, Kansas City, MO, United States
- Department of Pediatrics and Department of Medical Humanities and Bioethics, Universityof Missouri-Kansas City School of Medicine, Kansas City, MO, United States
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Maregn RT, Bourret K, Egal JA, Esse A, Mattison C, Klingberg-Allvin M. Qualitative study of the roles of midwives in the provision of sexual and reproductive healthcare services in the Somaliland health system. BMJ Open 2023; 13:e067315. [PMID: 36921954 PMCID: PMC10030797 DOI: 10.1136/bmjopen-2022-067315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVES To explore midwives' perspectives in providing sexual reproductive healthcare services in the Somaliland health system. METHODS An exploratory qualitative design using focus group discussions (n=6) was used. The study was conducted in the capital of Somaliland, Hargeisa, at six maternal and child healthcare centres that provide sexual and reproductive healthcare (SRH) services. Qualified midwives (n=44) who had been working in the maternal and child health centres for a minimum of 1 year were recruited to participate, and only one did not participate due to illness. RESULTS The results showed that Somaliland midwives face multiple challenges from a lack of formal arrangements, primarily written guidelines and policies, that explicitly define their role as healthcare professionals, which impact the quality of care they provide. They also reported feeling unsafe when practising according to their professional scope of practice due to challenging cultural norms, customary traditions and Somaliland's legal system. Finally, the midwives called for support, including training, institutional protection and psychological support, to enhance their ability and fulfil their role in SRH services in Somaliland. CONCLUSION Midwives are essential to the provision of equitable SRH services to women and girls, yet are not fully supported by policies, laws or institutions, often living in fear of the consequences of their behaviours. Our research highlights the importance of understanding the context of Somaliland midwifery in order to better support the development of the midwifery workforce, stronger governance structures and midwifery leadership. Appropriately addressing these challenges faced by midwives can better sustain the profession and help to improve the quality of care provided to women and girls and ultimately enhance their reproductive health outcomes.
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Affiliation(s)
| | - Kirsty Bourret
- Department of Women and Children's Health, Karolinska Institute, Stockholm, Sweden
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Jama Ali Egal
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Faculty of Nursing and Midwifery, College of Medicine and Health Sciences, University of Hargeisa, Hargeisa, Somalia
| | - Amina Esse
- Faculty of Nursing and Midwifery, College of Medicine and Health Sciences, University of Hargeisa, Hargeisa, Somalia
| | - Cristina Mattison
- Department of Women and Children's Health, Karolinska Institute, Stockholm, Sweden
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Marie Klingberg-Allvin
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Women and Children's Health, Karolinska Institute, Stockholm, Sweden
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Poolkumlung R, Rongkapich R, Sinthuchai N, Santibenchakul S, Meevasana V, Jaisamrarn U. Knowledge, attitude, and intended practice of abortion among medical students in Thailand after the amendment of the Thai abortion law. Contracept X 2023; 5:100091. [PMID: 37124455 PMCID: PMC10140783 DOI: 10.1016/j.conx.2023.100091] [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: 08/02/2022] [Revised: 03/03/2023] [Accepted: 03/10/2023] [Indexed: 05/02/2023] Open
Abstract
Objectives Following the amendment of the Thai abortion law in February 2021, the authors conducted an anonymous survey to assess knowledge, attitude, and intended practice toward abortion among fifth-year medical students at Chulalongkorn University. Study design The authors developed a self-administrated questionnaire consisting of three parts: knowledge of the recently amended Thai abortion law, attitude toward abortion, and intended practices. Pilot testing showed a high Cronbach's alpha and test-retest reliability coefficient. Results Of the 292 surveyed medical students, 70% completed the questionnaire. The mean ± standard deviation of the knowledge part was 6.9 ± 1.8, of which the maximum score was 10. Nearly half of the participants (45.6%) answered at least 80% of the knowledge statements correctly. Sixty-four percent of participants answered correctly on the gestational limit for first-trimester abortion. Around one-third of participants answered correctly on the gestational limit for second-trimester abortion. Most participants (86.8%) agreed that abortion is a woman's right. The most acceptable conditions for abortion were pregnancy as a result of rape (93%) and serious anomalies that cause a nonviable neonate (95.6%). Conclusions Participants exhibited a lack of understanding regarding the legal gestational limit, which is a key aspect of the amendment. The findings of this study urge medical schools to emphasize the revised Thai abortion law in the Obstetrics and Gynecology curriculum. Implications Our results show that encouraging medical students to have up-to-date knowledge regarding the amendment of Thai abortion law may support their future decision to provide safe abortion services.
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Affiliation(s)
- Rada Poolkumlung
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ratthapong Rongkapich
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Natchanika Sinthuchai
- Departments of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA
| | - Somsook Santibenchakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Obstetrics and Gynecology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Corresponding author.
| | | | - Unnop Jaisamrarn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Campo-Engelstein L, Andaya E. Clinicians' criteria for fetal moral status: viability and relationality, not sentience. JOURNAL OF MEDICAL ETHICS 2022:medethics-2022-108392. [PMID: 36347605 DOI: 10.1136/jme-2022-108392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
The antiabortion movement is increasingly using ostensibly scientific measurements such as 'fetal heartbeat' and 'fetal pain' to provide 'objective' evidence of the moral status of fetuses. However, there is little knowledge on how clinicians conceptualise and operationalise the moral status of fetuses. We interviewed obstetrician/gynaecologists and neonatologists on this topic since their practice regularly includes clinical management of entities of the same gestational age. Contrary to our expectations, there was consensus among clinicians about conceptions of moral status regardless of specialty. First, clinicians tended to take a gradualist approach to moral status during pregnancy as they developed and viewed viability, the ability to live outside of the uterus, as morally significant. Second, in contrast to 'fetal pain' laws and philosophical discussions about the ethical salience of sentience, the clinicians in our study did not consider the ability to feel pain as a morally relevant factor in moral status determinations. Third, during previability and perviability, clinicians viewed moral status as a personal value decision, which should be made by pregnant people and parents of neonates.
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Affiliation(s)
| | - Elise Andaya
- Department of Anthropology, University at Albany, Albany, New York, USA
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O'Connell KA, Kebede AT, Menna BM, Woldetensay MT, Fischer SE, Samandari G, Kassaw JK. Signs of a turning tide in social norms and attitudes toward abortion in Ethiopia: Findings from a qualitative study in four regions. Reprod Health 2022; 19:198. [PMID: 35698231 PMCID: PMC9195190 DOI: 10.1186/s12978-021-01240-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 12/01/2022] Open
Abstract
Background Despite the 2005 expansion in abortion legal indications in Ethiopia, which provided for abortions in cases of rape, incest, or fetal impairment and other circumstances, nearly half of abortions occurred outside health facilities in 2014. The purpose of this study is to explore and understand the social barriers women face in seeking and obtaining quality safe abortion care, as a means to generate evidence that could be used to improve access to and quality of abortion services. Methods Thirty-two focus group discussions with both men and women were held in four different regions of Ethiopia: Addis Ababa; Amhara; Oromia; and the Southern Nations, Nationalities, and Peoples’ Region. The study team recruited participants (n = 193) aged 18–55 in each region using a purposive sample with snowball recruitment techniques. We conducted discussions in Amharic or Afaan Oromo using a semi-structured guide and transcribed and translated them into English for analysis. We used deductive coding and analysis to categorize findings into emergent themes around stigma, barriers, and the changing nature of attitudes around abortion. Results Despite changes in abortion law, findings show that women with unwanted pregnancies and those seeking abortions are still heavily stigmatized and sanctioned in a number of communities across Ethiopia. Abortion was deemed unacceptable in most cases, though respondents were more tolerant in cases of risk to the mother’s life and of rape. We saw promising indications that changes are taking place in Ethiopian society’s view of abortion, and several participants indicated progress toward a more supportive environment overall for women seeking abortion care. Still, this progress may be limited by variable knowledge of abortion laws and tightly held gender-based social norms, particularly in rural areas. Most participants noted the importance of education and outreach to improve abortion attitudes and norms. Conclusion Policymakers should create further awareness in Ethiopia on the availability of quality abortion services in public health facilities and the indications for legal abortion. Such efforts should be based on principles of gender equality, as a means of ensuring enduring changes for women’s reproductive choice throughout the country. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01240-6. We conducted a study to explore and understand the social barriers women face in seeking and obtaining quality safe abortion care in Ethiopia. We implemented focus group discussions with both men and women in four different regions of Ethiopia. We analyzed our findings into themes around stigma, barriers, and the changing nature of attitudes around abortion. Our results show that women seeking abortions are still heavily stigmatized. We found that abortion was deemed unacceptable in most cases. However, we also saw promising indications that changes are taking place in Ethiopian society’s view of abortion, and several participants indicated progress toward a more supportive environment overall for women seeking abortion care. Still, this progress may be limited by variable knowledge of abortion laws. Most participants noted the importance of education and outreach to improve abortion attitudes and norms. We concluded that further awareness is needed in Ethiopia on the availability of quality abortion services in public health facilities and the indications for legal abortion. These efforts should consider gender equality to ensure enduring changes for women’s reproductive choice throughout the country.
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Affiliation(s)
- Kathryn A O'Connell
- EngenderHealth, District of Columbia, 505 Ninth Street NW, Suite 601, Washington, DC, 20004, USA.
| | - Addisalem T Kebede
- EngenderHealth Ethiopia, Djibouti Avenue, P.O. Box 156 code 1110, Addis Ababa, Ethiopia
| | - Bereket M Menna
- EngenderHealth Ethiopia, Djibouti Avenue, P.O. Box 156 code 1110, Addis Ababa, Ethiopia
| | | | - Sara E Fischer
- Georgetown University, 3700 O St. NW, Washington, DC, 20007, USA
| | | | - Jemal K Kassaw
- EngenderHealth Ethiopia, Djibouti Avenue, P.O. Box 156 code 1110, Addis Ababa, Ethiopia
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Munetsi D, Ugarte WJ. Intervening factors in health care professionals' attitudes and behaviours towards comprehensive abortion care in the workplace: a comparative case study of Tanzania and Ethiopia. EUR J CONTRACEP REPR 2022; 27:221-229. [PMID: 35238260 DOI: 10.1080/13625187.2022.2039910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE Health care professionals' attitudes and behaviours play a fundamental role in the provision of timely comprehensive abortion care as a maternal health intervention and save hundreds of thousands of women's lives, annually. This study explores underlying factors influencing Tanzanian and Ethiopian health care professionals' attitudes and behaviours towards comprehensive abortion care between 2015 and 2020. MATERIALS AND METHODS The study inductively explored Ethiopian and Tanzanian health care professionals' behaviours using a comparative case study design and a textual analytical approach. Published and unpublished literature, documents and newspapers were used as data sources. The two cases were selected because of their different approaches towards the governance of abortion care, one gradually legalising while the other persistently restricting. RESULTS Results demonstrated that there are both subjective (beliefs, attitudes, images, pre-dispositions) and objective (institutional incapacity) factors that impact the actions of health care professionals in the work environment. CONCLUSIONS The study concluded that the intervention of subjective factors results from the institutional failure to effectively bridge the divide between governance and accessibility of safe abortion care.
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Affiliation(s)
- Dennis Munetsi
- Department of Health and Welfare, Dalarna University, Falun, Sweden
| | - William J Ugarte
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Ewnetu DB, Thorsen VC, Solbakk JH, Magelssen M. Navigating abortion law dilemmas: experiences and attitudes among Ethiopian health care professionals. BMC Med Ethics 2021; 22:166. [PMID: 34922507 PMCID: PMC8684257 DOI: 10.1186/s12910-021-00735-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 12/08/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Ethiopia's 2005 abortion law improved access to legal abortion. In this study we examine the experiences of abortion providers with the revised abortion law, including how they view and resolve perceived moral challenges. METHODS Thirty healthcare professionals involved in abortion provisions in Addis Ababa were interviewed. Transcripts were analyzed using systematic text condensation, a qualitative analysis framework. RESULTS Most participants considered the 2005 abortion law a clear improvement-yet it does not solve all problems and has led to new dilemmas. As a main finding, the law appears to have opened a large space for professionals' individual interpretation and discretion concerning whether criteria for abortion are met or not. Regarding abortion for fetal abnormalities, participants support the woman's authority in deciding whether to choose abortion or not, although several saw these decisions as moral dilemmas. All thought that abortion was a justified choice when a diagnosis of fetal abnormality had been made. CONCLUSION Ethiopian practitioners experience moral dilemmas in connection with abortion. The law places significant authority, burden and responsibility on each practitioner.
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Affiliation(s)
- Demelash Bezabih Ewnetu
- Department of Physiology, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Viva Combs Thorsen
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Jan Helge Solbakk
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Morten Magelssen
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
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Allotey P, Ravindran TKS, Sathivelu V. Trends in Abortion Policies in Low- and Middle-Income Countries. Annu Rev Public Health 2021; 42:505-518. [PMID: 33138701 DOI: 10.1146/annurev-publhealth-082619-102442] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The decision to terminate a pregnancy is not one that is taken lightly. The need for an abortion reflects limited sexual autonomy, ineffective or lack of access to contraceptive options, or a health indication. Abortion is protected under human rights law. That notwithstanding, access to abortions continues to be contested in many parts of the world, with vested interests from politically and religiously conservative states, patriarchal societies, and cultural mores, not just within local contexts but also within a broader geopolitical context. Criminalization of a women's choice not to carry a pregnancy is a significant driver of unsafe procedures, and even where abortions are provided legally, the policies remain constrained by the practice or by a lack of coherence. This review outlines the trends in abortion policy in low- and middle-income countries and highlights priority areas to ensure that women are safe and able to exercise their reproductive rights.
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Affiliation(s)
- Pascale Allotey
- United Nations University-International Institute for Global Health (UNU-IIGH), 56000 Cheras, Kuala Lumpur, Malaysia; , ,
| | - T K Sundari Ravindran
- United Nations University-International Institute for Global Health (UNU-IIGH), 56000 Cheras, Kuala Lumpur, Malaysia; , ,
| | - Vithiya Sathivelu
- United Nations University-International Institute for Global Health (UNU-IIGH), 56000 Cheras, Kuala Lumpur, Malaysia; , ,
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