"Like a mother-daughter relationship": Community health intermediaries' knowledge of and attitudes to abortion in Karnataka, India
"Like a mother-daughter relationship": Community health intermediaries' knowledge of and attitudes to abortion in Karnataka, India
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DOI：
10.1016/j.socscimed.2019.112525
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发表时间：
2019-10-01
影响因子：
5.4
通讯作者：
Nandagiri, Rishita
中科院分区：
文献类型：
--
作者：
Nandagiri, Rishita
社区卫生中间人(CHI)--ANMS、ASHA和药剂师--是实现任务分担努力的关键，以增加LMIC的堕胎机会，但他们对堕胎的知识和态度仍未得到充分探索。关于堕胎任务分担的证据主要集中在CHIS的技术和临床能力上，而忽略了影响态度和行为的社会背景和规范。这项混合方法研究描述了印度卡纳塔克邦农村地区三名CHI干部的堕胎知识、态度和角色。使用污名化态度、行为和行动量表(SABAS)收集了有关CHIS堕胎态度的定量数据(n=118)，随后在2017年对部分人群进行了深入访谈(n=21)。调查结果显示，CHIS在妇女堕胎轨迹的多个点上存在，充当获得堕胎护理的障碍或促进获得堕胎护理。他们的堕胎态度反映了社会背景和环境，借鉴了围绕生育率、妇女和母亲身份的社会规范。他们表现出对堕胎法知之甚少，将其与性别选择法混为一谈。CHIS还反映出对堕胎方法的了解不足。他们报告很少或根本没有接受过堕胎方面的培训。CHIS在执行任务时面临根深蒂固的社会和结构性不平等，影响了他们能够提供的护理的种类和质量。了解CHIS的经验、知识和态度可以促进堕胎护理的提供，支持任务分担努力，并有可能提高妇女寻求堕胎体验的质量。
Community Health Intermediaries (CHIs)- ANMs, ASHAs, and pharmacists- are key to realising task-sharing efforts to increase abortion access in LMICs, but their knowledge of and attitudes to abortion remains underexplored. Evidence on abortion task-sharing has focused primarily on CHIs' technical and clinical abilities, overlooking social contexts and norms that influence attitudes and behaviours.This mixed-methods study describes the abortion knowledge, attitudes, and roles of three cadres of CHIs in rural districts of Karnataka, India. Quantitative data on CHIs' abortion attitudes (n = 118) were collected using the Stigmatising Attitudes, Behaviours, and Actions Scale (SABAS), followed by in-depth interviews (n = 21) with a subset of the population over eight months in 2017.Findings show that CHIs, present at multiple points in women's abortion trajectories, serve as barriers or facilitate access to abortion care. Their abortion attitudes reflect social contexts and environments, drawing on social norms surrounding fertility, woman- and mother-hood. They demonstrate poor knowledge of abortion laws, conflating them with sex-selection laws. CHIs also reflect poor knowledge of abortion methods. They report little to no training on abortion. CHIs contend with entrenched social and structural inequalities in carrying out their tasks, affecting the kind and quality of care they are able to provide. Understanding CHIs' experiences, knowledge and attitudes can advance abortion care-provision, support task-sharing efforts, and potentially improve the quality of women's abortion-seeking experiences.