Postdoctoral Fellow, Centre for Human Rights, University of Pretoria, Pretoria, South Africa.
Professor of Health and International Development, London School of Economics, London, UK. Correspondence :
Sex Reprod Health Matters. 2020 Dec;28(2):1832291. doi: 10.1080/26410397.2020.1832291.
Universal Health Coverage (UHC) forces governments to consider not only how services will be provided - but which services - and to whom, when, where, how and at what cost. This paper considers the implications for achieving UHC through the lens of abortion-related care for adolescents. Our comparative study design includes three countries purposively selected to represent varying levels of restriction on access to abortion: Ethiopia (abortion is legal and services implemented); Zambia (legal, complex services with numerous barriers to implementations and provision of information); Malawi (legally highly restricted). Our policy and legal analyses are supplemented by comparative vignettes based on interviews (= 330) in 2018/2019 with adolescents aged 10-19 who have sought abortion-related care in each country. We focus on an under-considered but critical legal framing for adolescents - the age of consent. We compare legal and political commitments to advancing adolescent sexual and reproductive health and rights, including abortion-related care. Ethiopia appears to approach UHC for safe abortion care, and the legal provision for under 18-year-olds appears to be critical. In Malawi, the most restrictive legal environment for abortion, little progress appears to have been made towards UHC for adolescents. In Zambia, despite longstanding legal provision for safe abortion on a wide range of grounds, the limited services combined with low levels of knowledge of the law mean that the combined rights and technical agendas of UHC have not yet been realised. Our comparative analyses showing how policies and laws are framed have critical implications for equity and justice.
全民健康覆盖（UHC）迫使政府不仅要考虑服务将如何提供——还要考虑提供哪些服务——以及向谁、何时、何地、如何以及以何种成本提供服务。本文从与青少年堕胎相关的护理的角度来考虑实现全民健康覆盖的影响。我们的比较研究设计包括三个国家，这些国家是有目的地选择的，代表了对堕胎准入的不同限制程度：埃塞俄比亚（堕胎合法，服务实施）；赞比亚（合法的，服务复杂，实施和提供信息存在众多障碍）；马拉维（法律上高度限制）。我们的政策和法律分析辅以比较情况介绍，这些情况介绍是基于 2018/2019 年在这三个国家对寻求堕胎相关护理的 10-19 岁青少年进行的 330 次访谈。我们重点关注一个被认为是未成年人的同意年龄，这个年龄在法律上对青少年堕胎护理的考虑不足，但却至关重要。我们比较了各国在促进青少年性健康和生殖健康及权利方面的法律和政治承诺，包括堕胎相关护理。埃塞俄比亚似乎在朝着为安全堕胎护理提供全民健康覆盖的方向前进，而对 18 岁以下未成年人的法律规定似乎是关键。在最严格的堕胎法律环境的马拉维，似乎在为青少年提供全民健康覆盖方面没有取得什么进展。在赞比亚，尽管在广泛的理由上早就有安全堕胎的法律规定，但有限的服务加上对法律的了解程度低，意味着全民健康覆盖的综合权利和技术议程尚未实现。我们的比较分析表明，政策和法律是如何制定的，这对公平和正义具有关键影响。
