Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
Melbourne Medical School, The University of Melbourne, Melbourne, Australia.
Glob Public Health. 2022 Aug-Sep;17(9):2190-2205. doi: 10.1080/17441692.2021.2020318. Epub 2022 Feb 7.
Conscientious objection to provide abortion has been enshrined in laws and policies globally. Insufficient attention has been paid to the direct and indirect ways in which conscientious objection compromises women's access to a lawful abortion. Using a systematic search strategy, this narrative literature review synthesises the literature exploring conscientious objection's impact on women's access to abortion in a range of countries. This narrative literature review builds on an extensive literature review published by Chavkin et al. (2013. Conscientious objection and refusal to provide reproductive healthcare: A white paper examining prevalence, health consequences, and policy responses. , , S41-S56. https://doi.org/10.1016/S0020-7292(13)60002-8). Searches were undertaken on the Medline (Ovid), Global Health, CINAHL, Scopus and Science Direct databases. Thirty six papers were included for thematic analysis. Conscientious objection to abortion was found to impact women's access to abortion at three main levels: the practitioner level, the healthcare system level and the sociocultural environment level. Conscientious objection was found to impact access directly through attempts by health professionals to restrict access, and indirectly by exacerbating pre-existing barriers to access. Further research is required to better quantify the extent to which this impacts women and whether interventions are effective in reducing the barriers that conscientious objection creates and exacerbates.
全球范围内的法律和政策都规定了出于良心拒绝对堕胎提供服务。然而，人们对出于良心拒绝对堕胎提供服务会以直接和间接的方式影响妇女获得合法堕胎的机会这一点，关注不足。本叙事文献综述使用系统搜索策略，综合了在多个国家探索出于良心拒绝对堕胎提供服务对妇女获得堕胎机会的影响的文献。本叙事文献综述是基于 Chavkin 等人（2013 年）发表的一篇广泛文献综述的基础上进一步扩展的，该综述探讨了出于良心拒绝对生殖保健提供服务的现象：审查其流行程度、对健康的影响以及政策应对措施（,, S41-S56. https://doi.org/10.1016/S0020-7292(13)60002-8）。在 Medline（Ovid）、全球健康、CINAHL、Scopus 和 Science Direct 数据库中进行了检索。有 36 篇论文被纳入主题分析。研究发现，出于对堕胎的良心反对，会在三个主要层面上影响妇女获得堕胎的机会：从业者层面、医疗保健系统层面和社会文化环境层面。出于对堕胎的良心反对，被发现通过卫生专业人员限制获取途径的尝试，直接影响了获取途径，也通过加剧现有的获取障碍，间接地影响了获取途径。需要进一步研究，以更好地量化这种影响对妇女的程度，以及干预措施是否有效，能否减少出于良心拒绝对堕胎提供服务所产生和加剧的障碍。
