Bixby Center for Population, Health and Sustainability, University of California, 17 University Hall, Berkeley, CA 94720-7360 USA.
Health Policy Plan. 2018 May 1;33(4):583-591. doi: 10.1093/heapol/czy019.
Unsafe abortion is one of the three leading causes of maternal mortality in low-income countries; however, few countries have reformed their laws to permit safer, legal abortion, and professional medical associations have not tended to spearhead this type of reform. Support from a professional association typically carries more weight than does that from an individual medical professional. However, theory predicts and the empirical record largely reveals that medical associations shy from engagement in conflictual policymaking such as on abortion, except when professional autonomy or income is at stake. Using interviews with 10 obstetrician-gynaecologists and 44 other leaders familiar with Ethiopia's reproductive health policy context, as well as other primary and secondary sources, this research examines why, counter to theoretical expectations from the sociology of medical professions literature and experience elsewhere, the Ethiopian Society of Obstetricians & Gynecologists (ESOG) actively supported reform of national law on abortion. ESOG leadership participation was motivated by both individual and ESOG's organizational commitments to reducing maternal mortality and also by professional training and work experience. Further, typical constraints on medical society involvement in policymaking were relaxed or removed, including those related to ESOG's organizational structure and history, and to political environment. Findings do not contradict theory positing medical society avoidance of socially conflictual health policymaking, but rather identify how the expected restrictions were less present in Ethiopia, facilitating medical society participation. Results can inform efforts to encourage medical society participation in policy reform to improve women's health elsewhere in sub-Saharan Africa.
不安全的堕胎是低收入国家孕产妇死亡的三个主要原因之一；然而，很少有国家改革其法律以允许更安全、合法的堕胎，而且专业医疗协会也没有倾向于带头进行这种改革。专业协会的支持通常比单个医疗专业人员的支持更有分量。然而，理论预测和经验记录在很大程度上表明，医疗协会回避参与有争议的决策制定，例如堕胎问题，除非涉及到专业自主权或收入。本研究通过对 10 名妇产科医生和 44 名熟悉埃塞俄比亚生殖健康政策背景的其他领导人进行访谈，并结合其他主要和次要资料，探讨了为什么与医学职业社会学文献中的理论预期以及其他地方的经验相反，埃塞俄比亚妇产科医师协会（ESOG）积极支持改革国家堕胎法。ESOG 领导层的参与既是出于个人和 ESOG 组织的承诺，即减少孕产妇死亡率，也是出于专业培训和工作经验。此外，放松或消除了通常限制医疗协会参与决策制定的因素，包括与 ESOG 的组织结构和历史以及政治环境有关的因素。研究结果并没有反驳医学协会回避社会冲突性卫生决策制定的理论，但确实指出了在埃塞俄比亚，预期的限制因素较少，这使得医疗协会更容易参与。研究结果可以为鼓励医疗协会参与政策改革以改善撒哈拉以南非洲其他地区妇女健康的努力提供信息。
