Conscientious objection and its impact on abortion service provision in South Africa: a qualitative study.
Conscientious objection and its impact on abortion service provision in South Africa: a qualitative study.
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DOI：
10.1186/1742-4755-11-16
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发表时间：
2014-02-26
影响因子：
3.4
通讯作者：
Colvin CJ
中科院分区：
文献类型：
--
作者：
Harries J;Cooper D;Strebel A;Colvin CJ
尽管在1996年修改立法后，堕胎在南非是合法的，但获得安全堕胎服务的障碍仍然存在。这些障碍包括提供者往往以宗教或道德信仰为由反对堕胎，包括无管制的依良心拒服兵役的做法。很少有研究探讨南非的服务提供者如何理解拒不提供堕胎护理服务的良心拒服兵役及其对堕胎机会的影响。采用了定性的方法，其中包括对南非西开普省有目的地选择的与堕胎有关的保健服务提供者、管理人员和政策影响者进行了48次深入访谈。采用专题分析方法对数据进行分析。探讨了依良心拒服兵役的解释和实施方式及其对堕胎服务提供的影响。在大多数公共部门设施中，普遍缺乏对保健提供者在何种情况下有权援引其拒绝提供或协助堕胎服务的权利的了解。服务提供者似乎对如何执行依良心拒服兵役理解不足，但也受到限制，因为在这一过程中几乎没有指导他们的准则或制度。探讨不同级别的保健工作者如何解释和适用良心上的反对与堕胎规定有关的问题，提出了多个相互矛盾的问题。从提供者的陈述中，往往很难区分在如何根据《终止妊娠选择法》执行依良心拒服兵役的具体情况方面，什么构成混淆，什么是基于普遍反对堕胎而拒绝堕胎护理。为了理清什么是普遍抵制堕胎条款，什么是基于宗教或道德理由的良心反对，需要提供明确的指导方针，包括需要采取哪些措施才能提出良心拒服兵役的权利。这将有助于制定长期应急计划，全面提供堕胎服务。
Despite abortion being legally available in South Africa after a change in legislation in 1996, barriers to accessing safe abortion services continue to exist. These barriers include provider opposition to abortion often on the grounds of religious or moral beliefs including the unregulated practice of conscientious objection. Few studies have explored how providers in South Africa make sense of, or understand, conscientious objection in terms of refusing to provide abortion care services and the consequent impact on abortion access. A qualitative approach was used which included 48 in-depth interviews with a purposively selected population of abortion related health service providers, managers and policy influentials in the Western Cape Province, South Africa. Data were analyzed using a thematic analysis approach. The ways in which conscientious objection was interpreted and practiced, and its impact on abortion service provision was explored. In most public sector facilities there was a general lack of understanding concerning the circumstances in which health care providers were entitled to invoke their right to refuse to provide, or assist in abortion services. Providers seemed to have poor understandings of how conscientious objection was to be implemented, but were also constrained in that there were few guidelines or systems in place to guide them in the process. Exploring the ways in which conscientious objection was interpreted and applied by differing levels of health care workers in relation to abortion provision raised multiple and contradictory issues. From providers’ accounts it was often difficult to distinguish what constituted confusion with regards to the specifics of how conscientious objection was to be implemented in terms of the Choice on Termination of Pregnancy Act, and what was refusal of abortion care based on opposition to abortion in general. In order to disentangle what is resistance to abortion provision in general, and what is conscientious objection on religious or moral grounds, clear guidelines need to be provided including what measures need to be undertaken in order to lodge one’s right to conscientious objection. This would facilitate long term contingency plans for overall abortion service provision.
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