Accommodating conscientious objection in the midwifery workforce: a ratio-data analysis of midwives, birth and late abortions in 18 European countries in 2016.

BACKGROUND: In recent years, the role of a midwife has expanded to include the provision of abortion-related care. The laws on abortion in many European countries allow for those who hold a conscientious objection to participating to refrain from such participation. However, some writers have expressed concerns that this may have a detrimental effect on the workforce and limit women's access to the service. METHOD: The aim of this study was to provide a picture of the potential exposure midwives in Europe have to late abortions, an important factor in the integration of accommodation of conscientious objection to abortion by midwives into workload planning. We collected data from Ministries of Health or government statistical departments in 32 European countries on numbers of births, abortions, late abortions and midwives in 2016. We conducted a ratio-data analysis in those countries that met the inclusion criteria. RESULTS: Eighteen of the 32 countries provided full data; thus, our calculations are based on a total of 4 036 633 live births, 49 834 late abortions and a total of 132 071 midwives. The calculated ratios of live births to midwife, abortions to midwife and late abortions to midwife illustrate the wide variations between countries in relation to ratios of midwives to live births (15.22-53.99) and late abortions (0.17-1.47) CONCLUSIONS: This study provides the first comprehensive insight to ratios relating to birth and abortion, especially late abortion services, with regard to the midwifery workforce. It is essential to improve the reporting of abortion data and access to it within Europe to support evidence-informed decisions on optimising the contribution of the midwifery workforce especially within highly contentious fields such as abortion services. The study's findings suggest that there should be neither be any difficulty for those who are responsible for workload allocation nor compromises to a women's right to abortion services.

Percepción del alumnado de medicina sobre la objeción de conciencia a la interrupción voluntaria del embarazo en Galicia / Perception of medical students in Galicia (Spain) regarding conscientious objection to the voluntary termination of pregnancy

OBJETIVO: Conocer si los futuros médicos y médicas de Galicia ejercerían la objeción de conciencia en la práctica de la interrupción voluntaria del embarazo (IVE), así como indagar sobre el conocimiento de que dispone actualmente el alumnado de medicina sobre la objeción de conciencia sanitaria y cuáles creen que son los costes que han de soportar las pacientes al no poder ejercer su derecho a la IVE dentro del servicio sanitario público. MÉTODO: Estudio transversal mediante una encuesta a 350 estudiantes de segundo y quinto curso del Grado de Medicina de la Universidad de Santiago de Compostela, en el curso académico 2017-2018. RESULTADOS: El 70,8% de las personas encuestadas no se declararía objetor/a de conciencia a la IVE. Además, el 70% estima que la objeción de conciencia a la IVE puede provocar consecuencias negativas para las gestantes cuando son derivadas desde la sanidad pública a la sanidad privada. No obstante, el 72,9% está a favor de que los médicos y las médicas tengan derecho a declararse objetores/as de conciencia a la práctica sanitaria de la IVE. CONCLUSIONES: La derivación de gestantes como consecuencia de la objeción de conciencia a la IVE es un importante problema en España en general y en Galicia en particular, frente al cual se observa que el futuro personal médico muestra una elevada predisposición a no objetar esta práctica sanitaria, lo que facilitaría su solución en un futuro próximo

OBJECTIVE: To discover whether future doctors in Galicia (Spain) are willing to express conscientious objection to voluntary termination of pregnancy (VTP). The medical students' level of knowledge regarding conscientious objection in health care was also examined, and their knowledge regarding the costs patients would incur if unable to exercise their right to VTP. METHOD: Cross-sectional study by conducting a survey of 350 medical students in the 2nd and the 5th years of the Degree in Medicine at the University of Santiago de Compostela, in the academic year 2017-2018. RESULTS: 70.8% of those surveyed would not declare conscientious objection to VTP. In addition, 70% believe that conscientious objection to VTP can have negative consequences for pregnant women if they are referred from public to private healthcare. However, 72.9% support physicians having the right to declare their conscientious objection to VTP. CONCLUSIONS: The problem of referring pregnant women to private healthcare, as a consequence of conscientious objection to VTP, is presented as critical in Spain, and in Galicia in particular. The future physicians showed that they strongly favoured not objecting to this healthcare practice, which will enable the problem to be resolved in the near future

Situación de la circuncisión por motivos religiosos en España / Situation of religious circumcision in Spain

Introducción: la realización de la circuncisión por motivos culturales o religiosos es una práctica cuya indicación no está bien definida dentro de nuestra práctica médica. El objetivo de nuestro trabajo es mostrar la diversidad de su práctica en España a fin de establecer un protocolo de actuación general con respecto a este tema. Material y métodos: se ha realizado una encuesta nacional en 49 centros públicos con disponibilidad de servicio de cirugía pediátrica, en la que se recogen datos epidemiológicos, descriptivos y de opinión tanto colectiva como del personal médico sobre las derivaciones recibidas para hacer circuncisión. Resultados: se enviaron 200 encuestas, de las que se obtuvieron un total de 142 respuestas, el 76,6% de los facultativos no realizan circuncisiones por motivo religioso en el ámbito público. El 89% de los pacientes vistos en consulta son derivados por su pediatra. Hasta el 65% de los médicos afirman que han tenido algún conflicto con la familia del paciente cuando rechazan la indicación de la circuncisión por esta razón. De los profesionales que aceptan la intervención, el 39% lo hace para evitar la cirugía en peores condiciones fuera del hospital. El 57% de los cirujanos desconoce si esta indicación está incluida en la cartera de servicios del Sistema Nacional de Salud. Conclusiones: en base a nuestra encuesta, la mayoría de los profesionales desconoce si esta indicación está dentro de la cartera de servicios y coinciden en la necesidad de tener un consenso de actuación. Es importante tener una actitud conjunta, conocer todas las opiniones, y crear un protocolo de manejo de esta situación

Introduction: the performance circumcision for cultural or religious reasons is a practice whose indication is not well defined within the scope of medical practice in Spain. The objective of this study was to illustrate the variability in its practice in Spain with the purpose of eventually establishing a general protocol on the subject. Material and methods: we conducted a nationwide survey of public hospitals with a paediatric surgery department to collect epidemiological and descriptive data and opinions, both general and from individual medical providers, on the referrals received for performance of circumcision. Results: we submitted 200 questionnaires and received 142 responses, and 76.6% of the responding physicians reported not performing circumcisions for religious reasons in their practice in the public health system. Of all patients seen for a consultation, 89% had been referred by their paediatricians. Up to 65% of doctors reported having conflict with families when they refused to perform circumcision for this indication. Of the professionals who agreed on religious reasons as an indication, 39% performed the surgery to prevent its being performed under poorer conditions outside a hospital. Of all paediatric surgeons, 57% did not know whether this indication is included among the services covered by the National Health System. Conclusions: based on our survey, most professionals do not know whether this indication is included in the services covered by the public health system and agree on the need of establishing a consensus guideline. We believe that it is important to have a homogeneous approach, to explore the opinions of the professional collective as a whole and to develop a general protocol for approaching this situation