Ethiopian Midwives Association, Equatorial Guinea Road, Behind Elsa Kolo, Addis Ababa, Ethiopia.
UNFPA, Old ECA Building, 5th Floor, Menelik Avenue, Addis Ababa, Ethiopia.
Reprod Health. 2022 Jun 13;19(Suppl 1):197. doi: 10.1186/s12978-021-01238-0.
Midwives are a large proportion of Ethiopia's health care workforce, and their attitudes and practices shape the quality of reproductive health care, including safe abortion care (SAC) services. This study examines how midwives' conceptions of their professional roles and views on women who have abortions relate to their willingness to provide respectful SAC.
This study uses a cross-sectional, mixed methods design to conduct a regionally representative survey of midwives in Ethiopia's five largest regions (Oromia; Amhara; Southern Nations, Nationalities, and Peoples [SNNP]; Tigray; and Addis Ababa) with a multistage, cluster sampling design (n = 944). The study reports survey-weighted population estimates and the results of multivariate logistic regression analyzing factors associated with midwives' willingness to provide SAC. Survey data were triangulated with results from seven focus group discussions (FGDs) held with midwives in the five study regions. Deductive and inductive codes were used to thematically analyze these data.
The study surveyed 960 respondents. An estimated half of midwives believed that providing SAC was a professional duty. Slightly more than half were willing to provide SAC. A belief in right of refusal was common: two-thirds of respondents said that midwives should be able to refuse SAC provision on moral or religious grounds. Modifiable factors positively associated with willingness to provide SAC were SAC training (AOR 4.02; 95% CI 2.60, 6.20), agreeing that SAC refusal risked women's lives (AOR 1.69; 95% CI 1.20, 2.37), and viewing SAC provision as a professional duty (AOR 1.72; 95% CI 1.23, 2.39). In line with survey findings, a substantial number of FGD participants stated they had the right to refuse SAC. Responses to client scenarios revealed "directive counseling" to be common: many midwives indicated that they would actively attempt to persuade clients to act as they (the midwives) thought was best, rather than support clients in making their own decisions.
Findings suggest a need for new guidelines to clarify procedures surrounding conscientious objection and refusal to provide SAC, as well as initiatives to equip midwives to provide rights-based, patient-centered counseling and avoid directive counseling.
在埃塞俄比亚的医疗保健工作者中，助产士占很大比例，他们的态度和做法影响着生殖健康护理的质量，包括安全堕胎护理（SAC）服务。本研究考察了助产士对其专业角色的看法以及对堕胎妇女的看法如何影响他们提供尊重的 SAC 的意愿。
本研究采用横断面混合方法设计，对埃塞俄比亚五个最大地区（奥罗米亚、阿姆哈拉、南方各族人民国家、提格雷和亚的斯亚贝巴）的助产士进行了具有代表性的区域调查，采用多阶段、聚类抽样设计（n=944）。该研究报告了调查加权的人口估计数和多变量逻辑回归分析与助产士提供 SAC 的意愿相关因素的结果。调查数据与五个研究地区的 7 次助产士焦点小组讨论（FGD）的结果进行了三角分析。采用演绎和归纳代码对这些数据进行了主题分析。
该研究调查了 960 名受访者。估计有一半的助产士认为提供 SAC 是一种职业责任。略多于一半的人愿意提供 SAC。对拒绝权的信念很普遍：三分之二的受访者表示，助产士应该能够以道德或宗教为由拒绝提供 SAC。与提供 SAC 的意愿呈正相关的可改变因素包括 SAC 培训（AOR 4.02；95%CI 2.60，6.20）、同意拒绝 SAC 会危及妇女生命（AOR 1.69；95%CI 1.20，2.37）以及将 SAC 提供视为职业责任（AOR 1.72；95%CI 1.23，2.39）。与调查结果一致，大量 FGD 参与者表示他们有权拒绝 SAC。对客户情景的回应表明，直接咨询很常见：许多助产士表示，他们将积极尝试说服客户按照他们（助产士）认为最好的方式行事，而不是支持客户做出自己的决定。
研究结果表明，需要制定新的准则来澄清围绕谨慎反对和拒绝提供 SAC 的程序，并采取措施使助产士能够提供基于权利和以患者为中心的咨询，并避免直接咨询。
