Kagaha Alexander, Manderson Lenore
School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Institute at Brown for Environment and Society, Brown University, Providence, RI, USA; School of Social Sciences, Monash University, Melbourne, Australia.
Soc Sci Med. 2020 Feb;247:112813. doi: 10.1016/j.socscimed.2020.112813. Epub 2020 Jan 21.
Manual Vacuum Aspirators (MVA), Dilation and Curettage (D&C), and medical abortifacients (Misoprostol, Mifepristone and Divabo) are available in clinical settings that offer abortion and post-abortion care in Uganda. While these technologies imply appropriate and safe abortion care, legal and policy ambiguities impact health outcomes. In this article, we draw on an ethnography of abortion care delivery practice conducted in one district in Eastern Uganda between August 2018 and March 2019, with data from interviews and observations, both of interactions and during quality of care improvement and training meetings. We illuminate how, in the context of a financialized healthcare system and legal restrictions, the meanings and use of medical technologies and abortion care vary across different health facility types. In public health facilities, health workers become state agents in the control of women's bodies. In private health facilities, they become transgressors, who use medical technologies to help women attain termination surreptitiously. Health workers offset risks associated with any involvement in termination, such that pecuniary interests dominate their motivation. Normalized and disciplinary power enact and reproduce unsafe and risky conditions, leading to poor abortion care outcomes. We illustrate the mechanisms of domination and tactics of resistance in abortion care, and expose conditions upon which unsafe and risky outcomes are contingent.
在乌干达提供堕胎及堕胎后护理的临床环境中，可获得手动真空吸引器（MVA）、刮宫术（D&C）以及药物堕胎药（米索前列醇、米非司酮和迪瓦博）。虽然这些技术意味着适当且安全的堕胎护理，但法律和政策上的模糊性会影响健康结果。在本文中，我们借鉴了2018年8月至2019年3月在乌干达东部一个地区进行的堕胎护理实践民族志研究，数据来自访谈以及对互动情况、护理质量改进会议和培训会议的观察。我们阐明了在金融化的医疗体系和法律限制背景下，医疗技术和堕胎护理的意义及使用在不同类型的医疗机构中是如何变化的。在公共卫生设施中，医护人员成为控制女性身体的国家代理人。在私立卫生设施中，他们成为违规者，利用医疗技术帮助女性秘密终止妊娠。医护人员抵消了与参与终止妊娠相关的风险，以至于金钱利益主导了他们的动机。规范化和纪律性权力制定并重现不安全和有风险状况，导致堕胎护理效果不佳。我们阐述了堕胎护理中的支配机制和抵抗策略，并揭示了不安全和有风险结果所依赖的条件。
