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1.
BMC Pregnancy Childbirth ; 24(1): 112, 2024 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-38321392

RESUMO

BACKGROUND: In many countries, abortions at 20 weeks and over for indications other than fetal or maternal medicine are difficult to access due to legal restrictions and limited availability of services. The Abortion and Contraception Service at the Royal Women's Hospital in Victoria, Australia is the only service in the state that provides this service. The views and experiences of these abortion providers can give insight into the experiences of staff and women and the abortion system accessibility. The aim of this study was to examine health providers' perceptions and experiences of providing abortion care at 20 weeks and over for indications other than fetal or maternal medicine, as well as enablers and barriers to this care and how quality of care could be improved in one hospital in Victoria, Australia. METHODS: A qualitative study was conducted at the Abortion and Contraception Service at the Royal Women's Hospital. Participants were recruited by convenience and purposive sampling. Semi-structured interviews were conducted one-on-one with participants either online or in-person. A reflexive thematic analysis was performed. RESULTS: In total, 17 healthcare providers from medicine, nursing, midwifery, social work and Aboriginal clinical health backgrounds participated in the study. Ultimately, three themes were identified: 'Being committed to quality care: taking a holistic approach', 'Surmounting challenges: being an abortion provider is difficult', and 'Meeting external roadblocks: deficiencies in the wider healthcare system'. Participants felt well-supported by their team to provide person-centred and holistic care, while facing the emotional and ethical challenges of their role. The limited abortion workforce capacity in the wider healthcare system was perceived to compromise equitable access to care. CONCLUSIONS: Providers of abortion at 20 weeks and over for non-medicalised indications encounter systemic enablers and barriers to delivering care at personal, service delivery and healthcare levels. There is an urgent need for supportive policies and frameworks to strengthen and support the abortion provider workforce and expand provision of affordable, acceptable and accessible abortions at 20 weeks and over in Victoria and in Australia more broadly.


Assuntos
Aborto Induzido , Atitude do Pessoal de Saúde , Gravidez , Feminino , Humanos , Vitória , Aborto Induzido/psicologia , Anticoncepção , Pessoal de Saúde/psicologia , Pesquisa Qualitativa , Acesso aos Serviços de Saúde
3.
Contraception ; 120: 109956, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36634729

RESUMO

OBJECTIVES: Pregnant people have traveled across state and national borders for the purpose of abortion since at least the 1960s. Scholarship has robustly documented the financial and logistical costs associated with travel, but less work has examined the emotional costs of abortion travel. We investigate whether abortion travel has emotional costs and, if so, how they come about. STUDY DESIGN: We conducted in-depth interviews with 30 women who had to travel across state borders in the United States for abortion care because of their gestation. We analyzed findings thematically. RESULTS: Interviewees described having to travel to obtain abortion care as emotionally burdensome, causing distress, stress, anxiety, and shame. Because they had to travel, they were compelled to disclose their abortion to others and obtain care in an unfamiliar place and away from usual networks of support, which engendered emotional costs. Additionally, travel induced feelings of shame and exclusion because it stemmed from a law-based denial of in-state abortion care, which some experienced as marking them as deviant or abnormal. CONCLUSIONS: People who have to travel for abortion care experience emotional costs alongside financial and logistical costs. The circumstances of that travel-specifically, being forced to travel because of legal restriction and service unavailability-are foundational to the ensuing emotional burdens. Findings add to the emerging literature on how laws and other structures produce the stigmatization of abortion at interpersonal and individual levels. IMPLICATIONS: With abortion bans following the overturning of the right to abortion and existing gestational limits in the US, more people will have to travel for abortion care. Attention to the emotional costs of abortion travel can help providers understand what their patients may be experiencing when they present for care.


Assuntos
Aborto Induzido , Acesso aos Serviços de Saúde , Gravidez , Estados Unidos , Feminino , Humanos , Aborto Induzido/psicologia , Ansiedade , Viagem/psicologia , Aborto Legal
4.
Contraception ; 117: 45-49, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36087646

RESUMO

OBJECTIVES: Existing research has not thoroughly characterized the psychosocial costs associated with seeking abortion care in restrictive states. Our study seeks to fill this gap by analyzing the accounts of Ohio abortion patients from 2018 to 2019. STUDY DESIGN: Using inductive and deductive approaches, we analyzed semi-structured in-depth qualitative interviews with 41 Ohio residents who obtained abortion care from one of three clinics in Ohio or Pennsylvania. RESULTS: Ohioans seeking abortion care often experienced fear of judgment, interpersonal strain, and stress as a result of efforts to overcome pre-Dobbs financial, geographic, and timing challenges. Those who needed financial assistance or traveled more than an hour generally reported greater exposure to psychosocial costs. CONCLUSIONS: Participants in this study incurred a complex set of psychosocial costs. Psychosocial costs often resulted from, or were exacerbated by, the financial, geographic, and time-sensitive burdens that patients experienced seeking care. IMPLICATIONS: The psychosocial costs incurred by patients seeking abortion care may be exacerbated in restrictive contexts, especially those who do not have access to insurance coverage for care. Psychosocial costs associated with care seeking are likely to increase as states implement more severe restrictions post-Dobbs. To fully understand abortion costs, researchers must examine costs comprehensively, including both financial and psychosocial costs.


Assuntos
Aborto Induzido , Acesso aos Serviços de Saúde , Gravidez , Feminino , Humanos , Ohio , Aborto Induzido/psicologia , Cobertura do Seguro , Viagem
6.
Soc Sci Med ; 293: 114667, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34954671

RESUMO

In the United States, travel is a fact of the abortion care provision landscape. This is largely due to the uneven geographical distribution of providers and state-level gestational duration bans that constrain what abortion care is available locally. When abortion travel is compelled by legal restriction, it is forced travel. Research has comprehensively documented that forced abortion travel is burdensome; people who must travel for abortion experience financial, logistical, and emotional burdens. Generally overlooked, however, is variation in the experience of travel-related burdens and whether and how such burdens can be reduced. Given current political hostility to abortion, the number of people who must travel and the distances they must travel for abortion are likely to grow, making the question of how travel-related burdens can be reduced in the absence of policy change of increasing relevance. Using thematic analysis of semi-structured interviews with 30 cisgender women in the United States who were forced to travel to obtain third-trimester abortion care, I identify three ways that the burdens of forced abortion travel can be mitigated without policy change: prompt referrals; financial and practical support for travel; and emotional support. In some instances, respondents experienced the received emotional support as so valuable as to offset the other burdens of travel, pointing to the possibility that some people might prefer to travel for abortion care whether or not they are forced to do so. Respondents also reported unexpected positive aspects of traveling, including experiences of kindness and human connection, underscoring that not all aspects of abortion travel are negative. Findings thicken our understanding of forced abortion travel and identify structural and interpersonal practices that can reduce the associated burdens, complementing legal and policy-oriented critiques of legal regulation that makes abortion travel necessary.


Assuntos
Aborto Induzido , Viagem , Aborto Induzido/psicologia , Feminino , Acesso aos Serviços de Saúde , Humanos , Gravidez , Terceiro Trimestre da Gravidez , Encaminhamento e Consulta , Viagem/psicologia , Doença Relacionada a Viagens , Estados Unidos
7.
J Genet Couns ; 31(3): 641-652, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-34755409

RESUMO

Since 2010, Ohio legislators have passed more than 15 legislative changes related to abortion and abortion providers, and nine procedural abortion clinics have closed. We investigated reproductive genetic counselors' perceptions, attitudes and self-reported practices regarding Ohio's current and proposed abortion regulations. We conducted five focus groups and two telephone interviews in 2019-2020, with a total of 19 reproductive genetic counselors. Participants discussed difficulties keeping current on abortion legislation and clinics' and hospitals' policies, resulting in anticipatory anxiety and leading to additional work to discuss the laws with patients. Participants articulated that practices of reproductive genetic counseling-and patient advocacy-are impeded by the legislation. Genetic counselors perceive negative impacts on patients' autonomy, particularly reflective of healthcare disparities of marginalized groups, which may contribute to frustration and anger. Ultimately, the mental and emotional burden on genetic counselors created by abortion legislation contributes to compassion fatigue and burnout. Our findings show that Ohio's abortion regulations negatively impact reproductive genetic counselors and their relationships with their patients. Repealing existing abortion regulations and preventing future restrictive legislation may ameliorate the negative effects of regulations on reproductive genetic counselors and their patients. In the event that these laws remain, innovative communication tools and proactive professional society advocacy are potential means to mitigate the negative impact on reproductive genetic counselors.


Assuntos
Aborto Induzido , Conselheiros , Aborto Induzido/psicologia , Conselheiros/psicologia , Feminino , Aconselhamento Genético/psicologia , Humanos , Ohio , Gravidez , Reprodução
8.
Contraception ; 107: 48-51, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34748751

RESUMO

OBJECTIVE: To describe changes in contraceptive method plans pre-appointment, after counseling, and post-procedure in patients having an abortion. STUDY DESIGN: We reviewed electronic medical records of University of California, Davis Health patients who had an operating room abortion from January 2015 to December 2016. We excluded persons with procedures for fetal anomaly or demise. We extracted patient demographics and contraceptive plans reported at each encounter (telephone intake, pre-operative appointment, and day of abortion). We evaluated individual contraceptive plans across the encounters, identified patient characteristics that contributed to plan change, and created a multivariable logistic regression model for predictors of contraception method plan change from telephone intake to post-procedure. RESULTS: The 747 patients had a mean gestational age of 16 4/7 ± 5 0/7 weeks with 244 (32.7%) <15 weeks and 235 (31.5%) ≥20 weeks. At telephone intake, 273 (36.4%) wanted a long-acting method (139 [50.9%] intrauterine device [IUD]; 99 [36.3%] implant; 35 [12.3%] unspecified), 11 (3.9%) permanent contraception, and 248 (33.2%) a less effective or no method; 215 (28.8%) stated they were undecided. Most (357/433 [82.4%]) patients who planned a reversible method based on the telephone intake obtained that or a similar method. Of the 273 patients planning a long-acting method, 258 (94.5%) received an IUD (158 [40.9%]) or implant (100 [36.6%]). Of the 215 undecided patients, 88 (40.9%) received an IUD and 55 (25.6%) an implant. No demographic factors predicted a change in method plan. CONCLUSIONS: Most patients will receive the method they initially identified at the telephone intake after an abortion, especially those planning an IUD or implant. Undecided patients are commonly open to discussing options.


Assuntos
Aborto Induzido , Dispositivos Intrauterinos , Aborto Induzido/psicologia , Anticoncepção/métodos , Anticoncepcionais , Aconselhamento , Feminino , Humanos , Gravidez
9.
PLoS One ; 16(12): e0261005, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34932576

RESUMO

This study seeks to identify the socio-demographic, reproductive, partner-related, and facility-level characteristics associated with women's immediate and subsequent use of post-abortion contraception in Ghana. Secondary data from the 2017 Ghana Maternal Health Survey were utilized in this study. The weighted data comprised 1,880 women who had ever had an abortion within the five years preceding the survey. Binary logistic regression analyses were performed to examine the associations between the predictor and outcome variables. Health provider and women's socio-demographic characteristics were significantly associated with women's use of post-abortion contraception. Health provider's counselling on family planning prior to or after abortion and place of residence were associated with both immediate and subsequent post-abortion uptake of contraception. Among subsequent post-abortion contraceptive users, older women (35-49), women in a union, and women who had used contraception prior to becoming pregnant were strong predictors. Partner-related and reproductive variables did not predict immediate and subsequent use of contraception following abortion. Individual and structural/institutional level characteristics are important in increasing women's acceptance and use of contraception post abortion. Improving and intensifying family planning counselling services at the health facility is critical in increasing contraceptive prevalence among abortion seekers.


Assuntos
Aborto Induzido/psicologia , Aborto Induzido/estatística & dados numéricos , Comportamento Contraceptivo/psicologia , Comportamento Contraceptivo/estatística & dados numéricos , Serviços de Planejamento Familiar/métodos , Adolescente , Adulto , Feminino , Humanos , Saúde Materna , Pessoa de Meia-Idade , Gravidez , Fatores Socioeconômicos , Adulto Jovem
11.
Public Health Res Pract ; 31(3)2021 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-34494073

RESUMO

INTRODUCTION: Nine different sets of laws govern abortion in Australia, and the criteria for an abortion to be considered lawful varies considerably by jurisdiction. We explored how the criminal status of abortion affected patients' experiences in accessing care in a country where abortion services are widely available. METHODS: We conducted qualitative, in-depth interviews with 22 people who had an abortion in Australia since 2009 across a variety of legal contexts. We audio-recorded all interviews and transcribed them in their entirety. We carried out content and thematic analyses of the interviews using deductive and inductive techniques. RESULTS: At the time of their procedures, more than half of our participants (n = 13) obtained their abortion in a state or territory that had criminal sanctions associated with procuring an abortion and required abortion seekers to meet strict legal requirements to access care. In general, participants reported confusion about the legal status of abortion. Participants who had an abortion in criminalised settings described significant negative emotional impacts that were directly linked to the law. They were often required to fit their abortion story into a state-mandated narrative. Further, the criminalisation of abortion meant that some participants felt they could not be honest with clinicians for fear of being denied care. The participants were overwhelmingly in support of decriminalisation of abortion and increased consistency of the legal status of the procedure across Australia. CONCLUSIONS: The criminalisation of abortion in some Australian states negatively impacts patients' emotional wellbeing, undermines the patient-clinician relationship, and perpetuates abortion stigma. In the absence of legislative reform, training for clinicians - including abortion providers and general practitioners - to explain the implications of the legal status to their patients appears warranted. Patient-centred resources, such as a website with state-specific information, could fill an important knowledge gap for the public.


Assuntos
Aborto Induzido/legislação & jurisprudência , Aborto Induzido/psicologia , Adulto , Austrália , Crime , Revelação , Feminino , Acesso aos Serviços de Saúde , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Gravidez , Relações Profissional-Paciente , Saúde Pública , Pesquisa Qualitativa , Adulto Jovem
12.
BJOG ; 128(11): 1752-1761, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34138505

RESUMO

OBJECTIVE: To explore the experiences of women in Scotland who accessed medical abortion at home up to 12 weeks' gestation, delivered via a telemedicine abortion service implemented in response to the coronavirus (COVID-19) pandemic, to identify areas for improvement and inform service provision. DESIGN: Qualitative interview study. SETTING: Abortion service in one National Health Service health board in Scotland. POPULATION OR SAMPLE: Twenty women who accessed telemedicine abortion services and self-administered mifepristone and misoprostol at home up to 12 weeks' gestation. METHODS: Thematic analysis of semi-structured qualitative interviews, informed by the Framework analytic approach. MAIN OUTCOME MEASURES: Women's experiences of accessing telemedicine for medical abortion at home, specifically: acceptability of the telephone consultation and remote support; views on no pre-abortion ultrasound scan; and self-administration of abortion medications at home. RESULTS: Novel study findings were three-fold: (1) participants valued the option of accessing abortion care via telemedicine and emphasised the benefits of providing a choice of telephone and in-person consultation to suit those with different life circumstances; (2) the quality of abortion care was enhanced by the telemedicine service in relation to access, comfort and flexibility, and ongoing telephone support; (3) participants described being comfortable with, and in some cases a preference for, not having an ultrasound scan. CONCLUSIONS: This research demonstrates support for the continuation of telemedicine abortion services beyond the temporary arrangements in place during COVID-19, and lends weight to the argument that offering the option of telemedicine abortion care can enable women to access this essential health service. TWEETABLE ABSTRACT: #Telemedicine provision of medical #abortion at home up to 12 weeks' gestation is acceptable and highly valued by #women #Research #SRHR @nbw80 @doctorjjrw @jeniharden @cameronsharon @mrc_crh @edinuniusher.


Assuntos
Abortivos não Esteroides/administração & dosagem , Aborto Induzido/métodos , Satisfação do Paciente , Autoadministração/psicologia , Telemedicina/métodos , Aborto Induzido/psicologia , Adulto , COVID-19 , Feminino , Acesso aos Serviços de Saúde , Humanos , Mifepristona/administração & dosagem , Misoprostol/administração & dosagem , Gravidez , Pesquisa Qualitativa , SARS-CoV-2 , Escócia , Medicina Estatal
13.
Contraception ; 104(1): 54-60, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33939985

RESUMO

OBJECTIVE: To examine provision of direct-to-patient medication abortion during COVID-19 by United States family physicians through a clinician-supported, asynchronous online service, Aid Access. STUDY DESIGN: We analyzed data from United States residents in New Jersey, New York, and Washington who requested medication abortion from 3 family physicians using the online service from Aid Access between April and November 2020. This study seeks to examine individual characteristics, motivations, and geographic locations of patients receiving abortion care through the Aid Access platform. RESULTS: Over 7 months, three family physicians using the Aid Access platform provided medication abortion care to 534 residents of New Jersey, New York, and Washington. There were no demographic differences between patients seeking care in these states. A high percentage (85%) were less than 7 weeks gestation at the time of their request for care. The reasons patients chose Aid Access for abortion services were similar regardless of state residence. The majority (71%) of Aid Access users lived in urban areas. Each family physician provided care to most counties in their respective states. Among those who received services in the three states, almost one-quarter (24%) lived in high Social Vulnerability Index (SVI) counties, with roughly one-third living in medium-high SVI counties (33%), followed by another quarter (26%) living in medium-low SVI counties. CONCLUSIONS: Family physicians successfully provided medication abortion in three states using asynchronous online consultations and medications mailed directly to patients. IMPLICATIONS: Primary care patients are requesting direct-to-patient first trimester abortion services online. By providing abortion care online, a single provider can serve the entire state, thus greatly increasing geographic access to medication abortion.


Assuntos
Abortivos/uso terapêutico , Aborto Induzido/estatística & dados numéricos , COVID-19 , Atenção à Saúde/métodos , Medicina de Família e Comunidade/métodos , Aborto Induzido/psicologia , Adolescente , Adulto , COVID-19/prevenção & controle , Prescrições de Medicamentos , Feminino , Idade Gestacional , Humanos , Internet , Pessoa de Meia-Idade , Motivação , New Jersey , New York , Gravidez , SARS-CoV-2 , Estigma Social , Fatores Socioeconômicos , Washington , Adulto Jovem
14.
PLoS One ; 16(2): e0246238, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33600471

RESUMO

BACKGROUND: Although abortions are a common aspect of people's reproductive lives, the economic implications of abortion and the stigmas that surround abortion are poorly understood. This article provides an analysis of secondary data from a scoping review on the economic impact of abortion to understand the intersections between stigma and economics outcomes at the microeconomic (i.e., abortion seekers and their households), mesoeconomic (i.e., communities and health systems), and macroeconomic (i.e., societies and nation states) levels. METHODS AND FINDINGS: We conducted a scoping review using the PRISMA extension for Scoping Reviews. Studies reporting on qualitative and/or quantitative data from any world region were considered. For inclusion, studies must have examined one of the following microeconomic, mesoeconomic, or macroeconomic outcomes: costs, benefits, impacts, and/or value of abortion-related care or abortion policies. Our searches yielded 19,653 items, of which 365 items were included in our final inventory. As a secondary outcome, every article in the final inventory was screened for abortion-related stigma, discrimination, and exclusion. One quarter (89/365) of the included studies contained information on stigma, though only 32 studies included stigma findings directly tied to economic outcomes. Studies most frequently reported stigma's links with costs (n = 24), followed by economic impact (n = 11) and economic benefit (n = 1). Abortion stigma can prevent women from obtaining correct information about abortion services and laws, which can lead to unnecessary increases in costs of care and sizeable delays in care. Women who are unable to confide in and rely on their social support network are less likely to have adequate financial resources to access abortion. CONCLUSIONS: Abortion stigma has a clear impact on women seeking abortion or post-abortion care at each level. Programmatic interventions and policies should consider how stigma affects delays to care, access to accurate information, and available social and financial support, all of which have economic and health implications.


Assuntos
Aborto Induzido/economia , Estigma Social , Aborto Induzido/psicologia , Feminino , Política de Saúde , Humanos , Gravidez , Fatores Socioeconômicos
15.
Reprod Health ; 18(1): 28, 2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33541377

RESUMO

BACKGROUND: Women's empowerment is multidimensional. Women's education, employment, income, reproductive healthcare decision making, household level decision making and social status are vital for women's empowerment. Nepal is committed to achieving women empowerment and gender equality, which directly affects the reproductive health issues. This can be achieved by addressing the issues of the poor and marginalized communities. In this context, we aimed to find the association of women's empowerment with abortion and family planning decision making among marginalized women in Nepal. METHODS: A cross sectional study was conducted at selected municipalities of Morang district of Nepal from February 2017 to March 2018. A mixed method approach was used, where 316 married marginalized women of reproductive age (15-49 years) and 15 key informant interviews from representative healthcare providers and local leaders were taken. From key informants, data were analysed using the thematic framework method. Findings obtained from two separate analyses were drawn together and meta inferences were made. RESULTS: Women's empowerment was above average, at 50.6%. Current use of modern contraceptives were more among below average empowerment groups (p 0.041, OR 0.593 C.I. 0.36-0.98). We could not find any statistically significant differences among levels of women's empowerment, including those women with abortion knowledge (p 0.549); family planning knowledge (p 0.495) and women's decision for future use of modern contraceptives (p 0.977). Most key informants reported that unsafe abortion was practiced. CONCLUSIONS: Women's empowerment has no direct role for family planning and abortion decision making at marginalized communities of Morang district of Nepal. However, different governmental and non-governmental organizations influence woman for seeking health care services and family planning in rural community of Nepal irrespective of empowerment status.


Assuntos
Aborto Induzido/psicologia , Tomada de Decisões , Empoderamento , Serviços de Planejamento Familiar , Direitos Sexuais e Reprodutivos , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Nepal , Gravidez , Saúde Reprodutiva , Direitos da Mulher , Adulto Jovem
16.
Sex Reprod Health Matters ; 29(3): 2038359, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-35262471

RESUMO

Access to abortion throughout much of Mexico has been restricted. Fondo Maria is an abortion accompaniment fund that provides informational, logistical, financial, and emotional support to people seeking abortion care in Mexico. This cross-sectional study examines the factors that influenced decision-making and contributed to delays in accessing care and explores experiences with Fondo Maria's support among women living outside Mexico City (CDMX). We describe and compare the experiences of women across the sample (n = 103) who were either supported by Fondo Maria to travel to CDMX to obtain an abortion (n = 60), or self-managed a medical abortion in their home state (n = 43). Data were collected between January 2017 and July 2018. Seventy-seven percent of participants reported that it was difficult to access abortion care in their home state and 34% of participants indicated they were delayed in accessing care, primarily due to a lack of financial support. The majority of participants (58%) who travelled to CDMX for their abortion did so because it seemed safer. The money/cost of the trip was the most commonly cited reason (33%) why participants who self-managed stayed in their home state. Eighty-seven percent of participants said Fondo Maria's services met or exceeded their expectations. Our data suggest that people seeking abortion and living outside CDMX face multiple and overlapping barriers that can delay care-seeking and influence decision-making. Abortion accompaniment networks, such as Fondo Maria, offer a well-received model of support for people seeking abortion in restrictive states across Mexico.


Assuntos
Aborto Induzido , Aborto Espontâneo , Aborto Induzido/psicologia , Estudos Transversais , Feminino , Acesso aos Serviços de Saúde , Humanos , México , Gravidez
17.
HEC Forum ; 33(3): 189-213, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31273516

RESUMO

This paper examines a legal case arising from a workplace grievance that progressed to being heard at the UK's Supreme Court. The case of Doogan and Wood versus Greater Glasgow and Clyde Health Board concerned two senior midwives in Scotland, both practicing Roman Catholics, who exercised their perceived rights in accordance with section 4(1) of the Abortion Act not to participate in the treatment of women undergoing abortions. The key question raised by this case was: "Is Greater Glasgow and Clyde Health Board entitled to require the midwives to delegate, supervise and support staff in the treatment of patients undergoing termination of pregnancy?" The ethical issues concerning conscientious objection to abortion have been much debated although the academic literature is mainly concerned with the position of medical practitioners rather than what the World Health Organization terms "mid-level professionals" such as midwives. This paper examines the arguments put forward by the midwives to justify their refusal to carry out tasks they felt contravened their legal right to make a conscientious objection. We then consider professional codes, UK legislation and church legislation. While the former are given strong weighting the latter was been ignored in this case, although cases in other European countries have been prevented from escalating to such a high level by the intervention of prominent church figures. The paper concludes by stating that the question put to the courts remains as yet unanswered but offers some recommendations for future policy making and research.


Assuntos
Aborto Induzido/legislação & jurisprudência , Ética Médica , Jurisprudência , Enfermeiras Obstétricas/legislação & jurisprudência , Aborto Induzido/ética , Aborto Induzido/psicologia , Atitude do Pessoal de Saúde , Direitos Humanos/legislação & jurisprudência , Humanos , Enfermeiras Obstétricas/ética , Enfermeiras Obstétricas/psicologia , Escócia
18.
Health Care Women Int ; 41(10): 1128-1146, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33156737

RESUMO

There are a growing number of abortion helplines where counselors provide person-centered medication abortion services in legally restrictive settings. Few researchers have explored the perceptions and experiences of the people who obtain support from these helplines. Between April and August 2017, we conducted 30 interviews with women who had a medication abortion with support from helpline counselors in Poland, Brazil, or Nigeria. Before seeking care with the helpline, women often heard negative stories about abortion and faced enacted stigma from the formal healthcare sector, or chose not to seek services from their doctors due to fear of stigmatizing treatment. Conversely, during their care with the helpline counselors, women received clear information in a timely manner, and were treated with kindness, compassion, respect, and without judgment. Many women gained knowledge and understanding of medication abortion, and some gained a sense of community among those who experienced abortion. Helpline models can provide high-quality, person-centered abortion care to people seeking abortions in legally restrictive contexts. Evidence from these service-delivery models could help improve service within the formal healthcare systems and expand access to high-quality, safe abortion by redefining what it means to provide care.


Assuntos
Aborto Induzido/psicologia , Conselheiros , Atenção à Saúde/organização & administração , Acesso aos Serviços de Saúde , Linhas Diretas , Aborto Induzido/legislação & jurisprudência , Aborto Induzido/métodos , Adulto , Brasil , Feminino , Humanos , Nigéria , Assistência Centrada no Paciente , Polônia , Gravidez , Estigma Social , Inquéritos e Questionários , Telemedicina , Adulto Jovem
19.
Eur J Contracept Reprod Health Care ; 25(5): 387-393, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32683990

RESUMO

OBJECTIVE: To study whether the social correlates of subsequent abortions vary depending on the order of the abortion. Methodology: Drawing upon the Flemish abortion centres' anonymized patient records (2010-2019), discrete-time hazard models were used to examine whether individual abortion experiences across women's reproductive life course have different social correlates. RESULTS: Overall, women who were in their twenties, of foreign origin, single, had non-tertiary education, were not in paid employment, had children, did not (consistently and without errors) use contraception and had a previous abortion through medication, had an elevated probability to experience subsequent abortions. While single women and women with a vulnerable socioeconomic status were more likely to have a second or third abortion, this difference is no longer prevalent when considering higher-order abortions. The hazard for higher-order abortions was more pronounced in women with a migration background, regardless of the order considered. Contraceptive use was unrelated to fourth or higher-order abortions. CONCLUSION: Using discrete-time hazard models, we unpack individual abortion experiences across women's reproductive life courses. By studying the transitions into different orders of subsequent abortions separately, we provide a more detailed understanding of risk factors compared to other European studies. The social correlates vary by the order considered: A certain profile emerges for women who have a second or third abortion, but disintegrates when considering higher-order abortions. This knowledge enables clinicians and policymakers to better understand women who experience subsequent abortions and to tailor services best suited to their needs.


Assuntos
Aborto Induzido/estatística & dados numéricos , Aborto Induzido/psicologia , Adolescente , Adulto , Bélgica , Comportamento Contraceptivo/psicologia , Comportamento Contraceptivo/estatística & dados numéricos , Feminino , Humanos , Estado Civil , Paridade , Gravidez , Modelos de Riscos Proporcionais , Fatores Sociais , Adulto Jovem
20.
Pan Afr Med J ; 35: 80, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32537083

RESUMO

Empirical research showcases that pre-abortion counseling scarcely reverses the woman's decision either to terminate a pregnancy or not. Growing evidence regarding the high levels of decisional certainty among women seeking abortions renders a careful rethink of the place of mandatory pre-abortion counseling packages. Mandatory counseling packages, when inscribed in the laws, at times contain false information that can deter women from going in for safe abortions. Mandatory waiting times indirectly label opting for an abortion as not being the right thing to do. In areas where abortion stigma from health care providers and communities remains highly prevalent, women are forced to incur extra expenses by travelling to other countries. I argue that pre-abortion counseling on opting-in grounds is ethically sound (enhances the woman's reproductive autonomy), since most clients in need of abortions are certain on their decisions before the abortion care provider and do not regret these decisions after the process. Regrets are prone to be more prevalent in areas with high unsafe abortion practices, generally due to complications from excessive bleeding, pain, and post abortion infections. Allowing systematic mandatory pre-abortion counseling practice as the rule in a competent adult is unjustified ethically and empirically, is time consuming and presents the legality of abortions in most settings an oxymoron.


Assuntos
Aspirantes a Aborto/legislação & jurisprudência , Aborto Induzido/legislação & jurisprudência , Aborto Legal/legislação & jurisprudência , Aconselhamento/legislação & jurisprudência , Aspirantes a Aborto/psicologia , Aborto Induzido/psicologia , Aborto Legal/psicologia , Serviços de Planejamento Familiar/legislação & jurisprudência , Feminino , Acesso aos Serviços de Saúde , Humanos , Gravidez , Fatores de Tempo
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