Suh Siri
Department of Sociology, Brandeis University, Mailstop 071, 415 South Street, Waltham, MA, 02453, USA.
Soc Sci Med. 2020 Jun;254:112248. doi: 10.1016/j.socscimed.2019.03.044. Epub 2019 Apr 3.
Since the early 1990s, post-abortion care (PAC) has been advocated as a harm reduction approach to maternal mortality and morbidity in countries with restrictive abortion laws. PAC indicators demonstrate that the intervention integrates safer uterine aspiration technology such as the Manual Vacuum Aspiration (MVA) syringe into obstetric practice and facilitates task-shifting from physicians to midwives. In other words, PAC not only saves women's lives, but more generally enhances the organization, quality, and cost-effectiveness of obstetric care. This article draws on my ethnography of Senegal's PAC program, conducted between 2010 and 2011, to illustrate how PAC indicators obscure the professional and technological complexities of treating abortion complications in contexts where abortion is illegal. Data collection methods include observation of PAC services and records at three hospitals; 66 in-depth interviews with health workers, government health officials, and NGO personnel; and a review of national and global PAC data. I show how anxieties about the capacity of the MVA syringe to induce abortion have engendered practices and policies that compromise the quality and availability of care throughout the health system. I explore the multivalent power of MVA statistics in strategically conveying commitments to national and global maternal mortality reduction agendas while eliding profound gaps in access to and quality of care for low-income and rural women. I argue that PAC strategies, technologies, and indicators must be situated within a global framework of reproductive governance, in which safe abortion has been omitted from maternal and reproductive health care associated with reproductive rights. Ethnographic attention to daily obstetric practices challenges globally circulating narratives about PAC as an apolitical intervention, revealing not only how anxieties about abortion ironically suppress the very rates of MVA utilization that purportedly convey PAC quality, but also how they simultaneously give rise to and obscure obstetric violence against women.
自20世纪90年代初以来，在堕胎法律严格的国家，堕胎后护理（PAC）作为一种降低孕产妇死亡率和发病率的减少伤害方法得到了倡导。PAC指标表明，该干预措施将更安全的子宫抽吸技术，如手动真空抽吸（MVA）注射器，纳入产科实践，并促进了从医生到助产士的任务转移。换句话说，PAC不仅挽救了妇女的生命，更普遍地提高了产科护理的组织、质量和成本效益。本文借鉴了我在2010年至2011年期间对塞内加尔PAC项目的人种志研究，以说明在堕胎非法的情况下，PAC指标如何掩盖了治疗堕胎并发症的专业和技术复杂性。数据收集方法包括观察三家医院的PAC服务和记录；对卫生工作者、政府卫生官员和非政府组织人员进行66次深入访谈；以及对国家和全球PAC数据的审查。我展示了对MVA注射器导致堕胎能力的担忧如何引发了一些做法和政策，这些做法和政策损害了整个卫生系统护理的质量和可及性。我探讨了MVA统计数据在战略上表达对国家和全球降低孕产妇死亡率议程的承诺的多方面力量，同时忽略了低收入和农村妇女在获得护理和护理质量方面的巨大差距。我认为，PAC战略、技术和指标必须置于生殖治理的全球框架内，在这个框架中，安全堕胎已被排除在与生殖权利相关的孕产妇和生殖保健之外。对日常产科实践的人种志关注挑战了全球流传的关于PAC是一种无政治倾向干预的说法，不仅揭示了对堕胎的担忧如何具有讽刺意味地抑制了据称传达PAC质量的MVA使用率，还揭示了它们如何同时引发并掩盖了针对妇女的产科暴力。
