“一个不安的妥协”：在埃塞俄比亚实现宽松堕胎法的策略和困境。
'An uneasy compromise': strategies and dilemmas in realizing a permissive abortion law in Ethiopia.
机构信息
Department of Sociology, Addis Ababa University, Addis Ababa, Ethiopia.
Department of Health Promotion and Development, University of Bergen, Bergen, Norway.
出版信息
Int J Equity Health. 2019 Sep 27;18(1):138. doi: 10.1186/s12939-019-1017-z.
INTRODUCTION
At the turn of the century, when the Millennium Development Goals placed maternal mortality reduction high on the global agenda, Ethiopia relaxed its restrictive abortion law to expand grounds on which a woman could legally obtain an abortion. This radical policy shift took place within a context of predominant anti-abortion public opinion shaped by strong religious convictions. Drawing upon Walt and Gilson's policy analysis framework, this paper explores the tension between public policy and religious dogma for the strategies chosen by the Ethiopian Ministry of Health and its partners implementing the new policy, and for access to safe abortion services.
METHODS
The study employed a qualitative research methodology. It targeted organizations that are key stakeholders in the field of reproductive health. These included policy makers and policy implementers like ministries, UN agencies and international and national NGOs as well as religious organizations as key opinion leaders. The data collection took place in Addis Ababa between 2016 and 2018. A total of 26 interviews were conducted, transcribed, and analyzed using the principles of qualitative content analysis.
RESULTS
Our analysis showed that the implementing organizations adopted a strategy of silence not to provoke anti-abortion sentiments and politicization of the abortion issue which was seen as a threat to the revised law and policy. This strategy has facilitated a rollout of services and has improved access to safe abortion care. Nevertheless informants were concerned that the silence strategy has prevented dissemination of knowledge about the revised law to the general public, to health workers and to the police. In turn this has caused confusion about eligibility to legal and safe abortion procedures.
CONCLUSIONS
While silence as a strategy works to protect the law enhancing the health and survival of young women, it may at the same time prevent the law from being fully effective. As a long term strategy, silence fails to expand awareness and access to safe abortion services, and may not sufficiently serve to fulfill the potential of the law to prevent abortion related maternal deaths.
简介
在世纪之交，千年发展目标将降低孕产妇死亡率置于全球议程的重要位置时，埃塞俄比亚放宽了其限制堕胎的法律，扩大了妇女合法堕胎的理由。这一激进的政策转变发生在强烈的宗教信仰塑造的主要反堕胎公众舆论的背景下。本文借鉴 Walt 和 Gilson 的政策分析框架，探讨了公共政策与宗教教义之间的紧张关系，这种紧张关系体现在埃塞俄比亚卫生部及其合作伙伴为实施新政策而选择的策略，以及获得安全堕胎服务的机会方面。
方法
本研究采用定性研究方法。它以生殖健康领域的主要利益攸关方为目标。这些组织包括政策制定者和执行者，如部委、联合国机构以及国际和国家非政府组织，以及宗教组织，作为主要意见领袖。数据收集于 2016 年至 2018 年在亚的斯亚贝巴进行。共进行了 26 次访谈，访谈内容被转录，并根据定性内容分析的原则进行了分析。
结果
我们的分析表明，执行组织采取了沉默策略，以免激起反堕胎情绪和将堕胎问题政治化，因为这被视为对修订后的法律和政策的威胁。这一策略促进了服务的推出，并改善了安全堕胎护理的获取。然而，知情者担心，沉默策略阻止了向公众、卫生工作者和警察传播关于修订后法律的知识。反过来，这导致了对合法和安全堕胎程序的资格的混淆。
结论
虽然沉默作为一种策略有助于保护法律，提高年轻女性的健康和生存，但它也可能使法律无法充分发挥作用。作为一种长期策略，沉默未能扩大对安全堕胎服务的认识和获取，也可能不足以充分发挥法律防止与堕胎相关的孕产妇死亡的潜力。
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