Stifani Bianca M, Mishtal Joanna, Chavkin Wendy, Reeves Karli, Grimes Lorraine, Chakravarty Dyuti, Duffy Deirdre, Murphy Mark, Horgan Trish, Favier Mary, Lavelanet Antonella
Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, NY, USA.
New York Medical College / Westchester Medical Center, Valhalla, NY, USA.
SSM Qual Res Health. 2022 Dec;2:None. doi: 10.1016/j.ssmqr.2022.100090.
To describe successes and highlight remaining challenges in the establishment of hospital-based abortion services after legal change in the Republic of Ireland.
We conducted a mixed-methods study on the implementation of abortion policy in Ireland. In this manuscript, we present the results from a qualitative analysis of in-depth interviews conducted with hospital-based providers, service users, and key informants. We used Dedoose software to conduct a thematic analysis of the data.
We report findings from interviews with 28 obstetrician gynecologists, midwives, psychiatrists, anesthesiologists, and nurses; a subset of 7 service users who sought care in hospitals; and 27 key informants. In this analysis, we describe how key themes that pertain to information, capacity and power, facilitated and hindered the implementation of hospital-based abortion services. We found that individual champions are key to establishing the service, but their motivation is not always sufficient to integrate abortion into existing clinical services, and conscientious objection is a persistent barrier to expanding abortion services. The main challenges highlighted here are lack of abortion provision at some hospitals and limited access to surgical abortion at most hospitals due to provider-level, logistical, and infrastructure barriers.
This study presents new information on how abortion policy is implemented on the ground in hospital settings. Its findings can inform public health officials and providers in Ireland and other countries wishing to establish abortion services.
描述爱尔兰共和国法律变更后建立医院堕胎服务方面的成功之处，并突出尚存的挑战。
我们对爱尔兰堕胎政策的实施开展了一项混合方法研究。在本论文中，我们呈现了对医院提供者、服务使用者和关键信息提供者进行的深入访谈的定性分析结果。我们使用Dedoose软件对数据进行了主题分析。
我们报告了对28名妇产科医生、助产士、精神科医生、麻醉师和护士、7名在医院寻求护理的服务使用者子集以及27名关键信息提供者的访谈结果。在此分析中，我们描述了与信息、能力和权力相关的关键主题如何促进和阻碍了医院堕胎服务的实施。我们发现个人倡导者对于建立该服务至关重要，但他们的积极性并不总是足以将堕胎纳入现有的临床服务，并且出于良心拒绝对扩大堕胎服务而言是一个持续存在的障碍。这里突出的主要挑战是一些医院缺乏堕胎服务，并且由于提供者层面、后勤和基础设施方面的障碍，大多数医院进行手术堕胎的机会有限。
本研究提供了关于堕胎政策在医院环境中实际如何实施的新信息。其研究结果可为爱尔兰以及其他希望建立堕胎服务的国家的公共卫生官员和提供者提供参考。
