Raifman Sarah, Hajri Selma, Gerdts Caitlin, Foster Diana
a Project Director, Advancing New Standards in Reproductive Health (ANSIRH) , University of California , Oakland , CA , USA.
b Director, Group Tawhida Ben Cheikh , Tunis , Tunisia.
Reprod Health Matters. 2018 Dec;26(52):47-57. doi: 10.1080/09688080.2018.1472486.
Despite Tunisia's historically progressive reproductive health policies, Tunisian women now face significant challenges accessing legal abortion. Through in-depth interviews with providers at six facilities, we explored factors influencing provider attitudes about abortion and provider perspectives about abortion morality, safety, and legality. We found that gatekeepers (counsellors and front office staff) generally believed abortion was immoral, while obstetricians and gynecologists were more likely to support an individual's right to access abortion. However, providers' actions do not necessarily align with their stated beliefs regarding abortion; some providers who said they support abortion access generally held personal beliefs about when and for whom abortion is appropriate which influenced their provision of care. System-level barriers to abortion provision, such as a lack of resources, hinder some providers who may otherwise be willing to provide the service. These system-level barriers may also account for inconsistencies between providers' beliefs and actions related to abortion. Illuminating the complexity in provider beliefs and attitudes about abortion can help us to better understand whether and why abortion care is provided, as well as the factors that ultimately determine whether a woman can obtain an abortion.
尽管突尼斯在历史上有着进步的生殖健康政策，但突尼斯女性如今在获得合法堕胎服务方面面临重大挑战。通过对六个机构的提供者进行深入访谈，我们探讨了影响提供者对堕胎态度的因素，以及他们对堕胎道德、安全性和合法性的看法。我们发现，把关者（咨询师和前台工作人员）普遍认为堕胎不道德，而产科医生和妇科医生更有可能支持个人获得堕胎的权利。然而，提供者的行为不一定与他们对堕胎的既定信念一致；一些表示支持堕胎服务的提供者通常对何时以及为谁堕胎合适持有个人信念，这影响了他们提供护理的方式。提供堕胎服务存在系统层面的障碍，比如资源匮乏，这阻碍了一些原本可能愿意提供该服务的提供者。这些系统层面的障碍也可能解释了提供者在与堕胎相关的信念和行为上的不一致。阐明提供者对堕胎的信念和态度的复杂性，有助于我们更好地理解是否以及为何提供堕胎护理，以及最终决定女性能否获得堕胎服务的因素。
