Ipas, Chapel Hill, NC, USA.
Ipas Central America and Mexico, Mexico City, Mexico.
Reprod Health. 2021 Feb 17;18(1):44. doi: 10.1186/s12978-021-01101-2.
The misuse of conscientious objection (CO) is a significant barrier to legal abortion access in many countries, especially in Latin America. We examine the reasons for denial of legal abortion services in Mexico and Bolivia and identify ways to mitigate the misuse of CO.
We conducted 34 in-depth interviews and 12 focus group discussions in two states in Mexico and four departments in Bolivia. Results were coded and categorized using a thematic analysis approach.
Denial of abortion services based on CO is widespread in health facilities in Mexico and Bolivia and is primarily employed for reasons other than moral, religious, or ethical considerations. The main reasons for denial of services based on CO is lack of knowledge about abortion-related laws and fear of legal problems in abortion service provision. Conversely, the main reason to provide services is to comply with relevant laws. Denying services under the guise of CO negatively impacts pregnant people and health care teams, including fewer safe abortion options and increased workload and stigma, respectively. Most respondents cited training and education on abortion law as the foremost way to mitigate the negative impacts of the misuse of CO.
For many health personnel, knowing, understanding, and following the law is reason enough to provide abortion services. Individuals who object due to lack of knowledge about laws and fear of legal problems represent a key population that can be sensitized and equipped with the necessary information and resources to provide legal abortion services.
在许多国家，尤其是在拉丁美洲，出于良心拒绝对合法堕胎服务的滥用是合法堕胎服务获取的一个重大障碍。我们检查了在墨西哥和玻利维亚拒绝合法堕胎服务的原因，并确定了减轻出于良心拒绝对合法堕胎服务滥用的方法。
我们在墨西哥的两个州和玻利维亚的四个省进行了 34 次深入访谈和 12 次焦点小组讨论。结果使用主题分析方法进行编码和分类。
在墨西哥和玻利维亚的卫生机构中，基于出于良心拒绝对堕胎服务的拒绝是普遍存在的，并且主要是出于与道德、宗教或伦理考虑无关的原因。拒绝基于出于良心拒绝对堕胎服务的主要原因是缺乏有关堕胎相关法律的知识以及担心在提供堕胎服务方面出现法律问题。相反，提供服务的主要原因是遵守相关法律。以出于良心拒绝对堕胎服务为幌子拒绝服务会对孕妇和医疗保健团队产生负面影响，分别表现为减少安全堕胎的选择以及增加工作量和耻辱感。大多数受访者表示，对堕胎法的培训和教育是减轻出于良心拒绝对合法堕胎服务滥用的负面影响的首要方法。
对许多卫生人员来说，了解、理解和遵守法律足以提供堕胎服务。由于缺乏对法律的了解和对法律问题的恐惧而出于良心拒绝对堕胎服务的个人代表了一个可以进行宣传并提供必要信息和资源以提供合法堕胎服务的关键人群。
