Suh Siri
Department of Sociomedical Sciences, Columbia University, 722 West 168th Street, 5th Floor, New York, NY 10032, USA.
Soc Sci Med. 2014 May;108:20-33. doi: 10.1016/j.socscimed.2014.02.030. Epub 2014 Feb 19.
Boundary work refers to the strategies deployed by professionals in the arenas of the public, the law and the workplace to define and defend jurisdictional authority. Little attention has been directed to the role of documents in negotiating professional claims. While boundary work over induced abortion has been extensively documented, few studies have examined jurisdictional disputes over the treatment of abortion complications, or post-abortion care (PAC). This study explores how medical providers deploy medical records in boundary work over the treatment of complications of spontaneous and induced abortion in Senegal, where induced abortion is prohibited under any circumstance. Findings are based on an institutional ethnography of Senegal's national PAC program over a period of 13 months between 2010 and 2011. Data collection methods included in-depth interviews with 36 health care professionals, observation of PAC services at three hospitals, a review of abortion records at each hospital, and a case review of illegal abortions prosecuted by the state. Findings show that health providers produce a particular account of the type of abortion treated through a series of practices such as the patient interview and the clinical exam. Providers obscure induced abortion in medical documents in three ways: the use of terminology that does not differentiate between induced and spontaneous abortion in PAC registers, the omission of data on the type of abortion altogether in PAC registers, and reporting the total number but not the type of abortions treated in hospital data transmitted to state health authorities. The obscuration of suspected induced abortion in the record permits providers to circumvent police inquiry at the hospital. PAC has been implemented in approximately 50 countries worldwide. This study demonstrates the need for additional research on how medical professionals negotiate conflicting medical and legal obligations in the daily practice of treating abortion complications.
边界工作指的是专业人士在公共领域、法律领域和工作场所所采用的策略，用以界定和捍卫管辖权。很少有人关注文件在协商专业主张方面所起的作用。虽然关于人工流产的边界工作已有大量记录，但很少有研究探讨过人工流产并发症治疗或流产后护理（PAC）方面的管辖权争议。本研究探讨了在塞内加尔，医疗服务提供者如何在自然流产和人工流产并发症治疗的边界工作中运用医疗记录，在塞内加尔，任何情况下人工流产都是被禁止的。研究结果基于对2010年至2011年期间塞内加尔国家PAC项目进行的为期13个月的机构人种志研究。数据收集方法包括对36名医疗保健专业人员进行深入访谈、观察三家医院的PAC服务、查阅每家医院的流产记录以及对国家起诉的非法流产案件进行案例审查。研究结果表明，医疗服务提供者通过患者访谈和临床检查等一系列实践，对所治疗的流产类型给出了特定描述。医疗服务提供者在医疗文件中以三种方式掩盖人工流产：在PAC登记册中使用无法区分人工流产和自然流产的术语、在PAC登记册中完全省略流产类型的数据，以及在传输给国家卫生当局的医院数据中报告治疗的流产总数但不报告流产类型。记录中对疑似人工流产的掩盖使医疗服务提供者能够规避医院的警方询问。全球约有50个国家实施了PAC。本研究表明，有必要进一步研究医疗专业人员在治疗流产并发症的日常实践中如何协商相互冲突的医疗和法律义务。
