Stigmatized by association: challenges for abortion service providers in Ghana
Stigmatized by association: challenges for abortion service providers in Ghana
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DOI：
10.1186/s12913-016-1733-7
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发表时间：
2016-09-10
影响因子：
2.8
通讯作者：
Mayhew, Susannah H.
中科院分区：
文献类型：
--
作者：
Aniteye, Patience;O'Brien, Beverley;Mayhew, Susannah H.
背景：不安全堕胎是一个公共卫生问题，在全球范围内对孕产妇发病率和死亡率有很大影响。堕胎引起了宗教、道德、伦理、社会文化和医学方面的担忧，这意味着它被高度污名化，这对提供者和研究人员都构成了威胁。本研究试图从加纳卫生服务提供者的角度探讨提供安全堕胎服务面临的挑战。方法：采用深入访谈的描述性定性研究。这项研究在加纳首都的三(3)家医院和五(5)家健康中心进行。参与者(n=36)由产科医生/妇科医生、护士助产士和药剂师组成。结果：耻辱以多种方式影响加纳安全堕胎服务的提供。加纳堕胎法的模棱两可，以及对从业人员缺乏公开的机构支持，增加了不愿公开提供堕胎服务的意愿，因为他们担心受到污名和法律威胁。使寻求堕胎护理的妇女蒙受耻辱的提供者的消极态度往往是由高度污蔑堕胎做法的社会文化和宗教规范推动的。接受更高水平的教育，包括在海外接受培训，似乎会使人们对安全堕胎服务的必要性产生更积极、更少羞辱的观点。尽管如此，对堕胎持开放态度的医生仍然非常关注协会的污名。结论：污名是提供堕胎服务的主要障碍。它影响到提供这种服务的卫生服务提供者，甚至影响到研究这一主题的研究人员。接触更广泛的辩论和教育似乎会影响态度和价值观澄清，培训可能会被证明是有用的。还需要适当传播提供安全服务的现有准则和公开的机构支持。
Background: Unsafe abortion is an issue of public health concern and contributes significantly to maternal morbidity and mortality globally. Abortion evokes religious, moral, ethical, socio-cultural and medical concerns which mean it is highly stigmatized and this poses a threat to both providers and researchers. This study sought to explore challenges to providing safe abortion services from the perspective of health providers in Ghana.Methods: A descriptive qualitative study using in-depth interviews was conducted. The study was conducted in three (3) hospitals and five (5) health centres in the capital city in Ghana. Participants (n = 36) consisted of obstetrician/gynaecologists, nurse-midwives and pharmacists.Results: Stigma affects provision of safe-abortion services in Ghana in a number of ways. The ambiguities in Ghanaian abortion law and lack of overt institutional support for practitioners increased reluctance to openly provide for fear of stigmatisation and legal threat. Negative provider attitudes that stigmatised women seeking abortion care were frequently driven by socio-cultural and religious norms that highly stigmatise abortion practice. Exposure to higher levels of education, including training overseas, seemed to result in more positive, less stigmatising views towards the need for safe abortion services. Nevertheless, physicians open to practicing abortion were still very concerned about stigma by association.Conclusions: Stigma constitutes an overarching impediment for abortion service provision. It affects health providers providing such services and even researchers who study the subject. Exposure to wider debate and education seem to influence attitudes and values clarification training may prove useful. Proper dissemination of existing guidelines and overt institutional support for provision of safe services also needs to be rolled out.