Rahman Atiya, Strong Joe, Mondal Pragna Paramita, Maynard Audrey, Haque Tasnima, Moore Ann M, Afsana Kaosar
BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
London School of Economics and Political Science, London, UK.
Confl Health. 2024 Mar 4;18(1):19. doi: 10.1186/s13031-024-00574-9.
Rohingya women suffer from inaccessibility to sexual and reproductive health services in Myanmar. After the forcible displacement of the Rohingya from Myanmar to Bangladesh in 2017, pregnancy termination services have been increasingly important and desired, while knowledge gaps and obstacles to access services still exist. The role of community stakeholders is critical as gatekeepers and decision-makers to improve and strengthen pregnancy termination services for women in camps. However, there is paucity of evidence on their perspectives about pregnancy termination. This qualitative study aims to understand the perception and attitudes of Rohingya community stakeholders to pregnancy termination in the camps of Cox's Bazar.
We used purposive sampling to select 48 participants from the community stakeholders, 12 from each group: majhis (Rohingya leaders), imams (religious leaders), school teachers, and married men. We conducted in-depth interviews of all the participants between May-June 2022 and October-November 2022. Data were coded on Atlas.ti and analysed using a thematic content analysis approach.
Multiple socio-cultural and religious factors, gendered norms and stigma associated with pregnancy termination acted as barriers to women seeking services for it. From a religious stance, there was greater acceptance of pregnancy termination in the earlier period than in the later period of pregnancy. We observed that pregnancy termination among community stakeholders in earlier stages of pregnancy than later. However, circumstances, such as a woman's marital status, whether she sought her husband's permission or her ability of childcare capacity, were often framed by community stakeholders as 'acceptable' for pregnancy termination. Health concerns and social and contextual factors can influence community stakeholders supporting pregnancy termination.
The community stakeholders perspectives on barriers and enablers of pregnancy termination were variable with the context. These perspectives may support or impede women's ability to choice to seek pregnancy termination services. To improve women's choice to pregnancy termination, it is critical to consider roles of community stakeholders in creating their supporting attitudes to women's choice and access, and to designing targeted culturally appropriate interventions with communities support and engagement.
在缅甸，若开邦妇女难以获得性健康和生殖健康服务。2017年若开邦人从缅甸被强制流离至孟加拉国后，终止妊娠服务变得愈发重要且备受需求，然而，在获取服务方面仍存在知识差距和障碍。社区利益相关者作为守门人和决策者，对于改善和加强难民营中妇女的终止妊娠服务至关重要。然而，关于他们对终止妊娠的看法，证据却很少。这项定性研究旨在了解若开邦社区利益相关者对科克斯巴扎尔难民营中终止妊娠的认知和态度。
我们采用目的抽样法从社区利益相关者中选取了48名参与者，每组12名：马吉斯（若开邦领袖）、伊玛目（宗教领袖）、学校教师和已婚男性。我们在2022年5月至6月以及2022年10月至11月期间对所有参与者进行了深入访谈。数据在阿特拉斯.ti软件上进行编码，并采用主题内容分析法进行分析。
多种社会文化和宗教因素、与终止妊娠相关的性别规范和耻辱感成为妇女寻求终止妊娠服务的障碍。从宗教立场来看，妊娠早期比晚期对终止妊娠的接受度更高。我们观察到，社区利益相关者对妊娠早期而非晚期终止妊娠的接受度更高。然而，诸如妇女的婚姻状况、她是否寻求丈夫的许可或她的育儿能力等情况，社区利益相关者通常认为是终止妊娠的“可接受”因素。健康问题以及社会和背景因素会影响社区利益相关者对终止妊娠的支持。
社区利益相关者对终止妊娠的障碍和促成因素的看法因具体情况而异。这些看法可能支持或阻碍妇女选择寻求终止妊娠服务的能力。为了改善妇女对终止妊娠的选择，至关重要的是要考虑社区利益相关者在营造对妇女选择和获取的支持态度方面所起的作用，并在社区支持和参与下设计有针对性的、符合文化背景的干预措施。
