Sahin Hodoglugil Nuriye Nalan, Ngabo Fidele, Ortega Joanna, Nyirazinyoye Laetitia, Ngoga Eugene, Dushimeyezu Evangeline, Kanyamanza Eugene, Prata Ndola
University of California at Berkeley, School of Public Health, Bixby Center for Population, Health and Sustainability, Berkeley, CA, USA.
Rwanda Ministry of Health, Kigali, Rwanda.
Afr J Reprod Health. 2017 Mar;21(1):82-92. doi: 10.29063/ajrh2017/v21i1.7.
Penal code was revised in Rwanda in 2012 allowing legal termination of pregnancy resulting from rape, incest, forced marriage, or on medical grounds. An evaluation was conducted to assess women's access to abortion services as part of an ongoing program to operationalize the new exemptions for legal abortion. Data was collected from eight district hospitals; seven gender-based violence (GBV) centers and six intermediate courts. Three focus group discussions and 22 in-depth interviews were conducted with key informants. At hospitals, of the 2,644 uterine evacuation records (July 2012-June 2014), and 312 monitoring cases (August-December 2014), majority of all uterine evacuations (97% and 85% respectively, for the two periods) were for obstetric conditions, and induced abortion on medical grounds accounted for 2% vs. 15% respectively. Medical abortion was the prominent method of uterine evacuation. At the GBV centers, 3,763 records were identified retrospectively; 273 women were pregnant. Since the legal reform there was only one abortion for a pregnancy resulting from rape. Abortion stigma and court order requirement are major barriers to access services. The operationalization program has made significant contributions to make abortion safer in Rwanda but this evaluation demonstrates that further work is required to reach the goal of providing safe abortion services to all eligible women. Addressing abortion stigma at the community, organizational and structural levels; further strengthening of service provision; and streamlining legal requirements to protect particularly young women from sexual violence and making abortion a realistic option for GBV victims are some of the important next steps.
2012年卢旺达修订了刑法典，允许因强奸、乱伦、强迫婚姻或基于医学理由而合法终止妊娠。作为一项正在实施的使合法堕胎新豁免条款得以落实的计划的一部分，开展了一项评估，以评估妇女获得堕胎服务的情况。数据收集自八家地区医院、七个性别暴力中心和六个中级法院。与关键信息提供者进行了三次焦点小组讨论和22次深入访谈。在医院，在2644份子宫排空记录（2012年7月至2014年6月）和312例监测病例（2014年8月至12月）中，所有子宫排空的大多数（两个时期分别为97%和85%）是出于产科情况，基于医学理由的人工流产分别占2%和15%。药物流产是子宫排空的主要方式。在性别暴力中心，回顾性地识别出3763份记录；273名妇女怀孕。自法律改革以来，因强奸导致的怀孕仅有一例堕胎。堕胎污名和法院命令要求是获得服务的主要障碍。该实施计划为使卢旺达的堕胎更安全做出了重大贡献，但这项评估表明，要实现向所有符合条件的妇女提供安全堕胎服务的目标，还需要进一步努力。在社区、组织和结构层面消除堕胎污名；进一步加强服务提供；简化法律要求以特别保护年轻妇女免受性暴力，并使堕胎成为性别暴力受害者的现实选择，这些都是接下来的一些重要步骤。
