Attitudes and intentions of future health care providers toward abortion provision

CONTEXT: Induced abortion is one of the most common procedures performed among women in the United States. However, 87% of all counties had no abortion provider in 2000, and little is known about the attitudes and intentions of future health care providers, including advanced clinical practitioners, regarding abortion provision. METHODS: During March 2002, first- and second-year students in health sciences programs (i.e., medicine, physician assistant and nursing) at the University of Washington were anonymously surveyed. Univariate, bivariate and multivariate analyses were used to determine students' attitudes and intentions regarding provision of abortion services. RESULTS: Of the 312 students who completed the survey, 70% supported the availability of legal abortion under any circumstances. Thirty-one percent intended to provide medical abortion in their practice, and 18% planned to offer surgical abortion. Fifty-two percent of all respondents agreed that advanced clinical practitioners should be able to provide medical abortion, and 37% agreed that they should be able to provide surgical abortion services; however, greater proportions of advanced clinical practitioners (45-83%) than of medical students (21-43%) expressed such support. Sixty-four percent of all respondents were willing to attend a program whose curriculum requires abortion training. CONCLUSIONS: Although it may not be possible to require abortion training for every future health care provider, making abortion a standard part of clinical training would provide opportunities for future physicians and advanced clinical practitioners, and would likely ameliorate the abortion provider shortage.     

'It hurts, but I don't have a choice, I'm not working and I'm sick': decisions and experiences regarding abortion of women living with HIV in Cape Town, South Africa

Research was conducted with 36 women living with HIV in Cape Town, South Africa, regarding their decision-making about, and experiences with, abortion of unwanted pregnancies in the public health sector. Abortion intentions and decisions were explored by investigating influencing factors; knowledge of abortion policy and public health sector services; and abortion perceptions and experiences. Findings reveal that many women face censure both for becoming pregnant and terminating a pregnancy, including by family, partners, community members and healthcare providers. Data suggest that abortion may be more stigmatised than HIV despite South Africa's liberal abortion law. Generally, however, study participants were satisfied with the abortion care received. Most would advise women living with HIV to think carefully about abortion, but to make a decision in their own best interests, including only seeking care early in pregnancy from an accredited clinic. Study implications include a need to integrate information and counselling on safe legal abortion within sexual and reproductive health services, especially in efforts to integrate sexual and reproductive health into HIV care, and to forge greater linkages between HIV and abortion services more generally to ensure continuity in follow-up of care for women.     

‘It hurts,but I don't have a choice,I'm not working and I'm sick’: decisions and experiences regarding abortion of women living with HIV in Cape Town,South Africa

Research was conducted with 36 women living with HIV in Cape Town, South Africa, regarding their decision-making about, and experiences with, abortion of unwanted pregnancies in the public health sector. Abortion intentions and decisions were explored by investigating influencing factors; knowledge of abortion policy and public health sector services; and abortion perceptions and experiences. Findings reveal that many women face censure both for becoming pregnant and terminating a pregnancy, including by family, partners, community members and healthcare providers. Data suggest that abortion may be more stigmatised than HIV despite South Africa's liberal abortion law. Generally, however, study participants were satisfied with the abortion care received. Most would advise women living with HIV to think carefully about abortion, but to make a decision in their own best interests, including only seeking care early in pregnancy from an accredited clinic. Study implications include a need to integrate information and counselling on safe legal abortion within sexual and reproductive health services, especially in efforts to integrate sexual and reproductive health into HIV care, and to forge greater linkages between HIV and abortion services more generally to ensure continuity in follow-up of care for women.     

Safe illegal abortion would make an important contribution to decreasing maternal mortality and female suffering

Unsafe abortion is a major public health concern in many developing countries, contributing to a substantial proportion of maternal deaths. Increased legal access to abortion services is associated with improvement in mortality and morbidity. Safe illegal abortion by means of drugs is another possible way to prevent this unnecessary harm to women. The Dutch government, however, is now proposing legal changes that will diminish the access to medical abortion by general practitioners.     

Hangers,Potions, and Pills: Abortion Procedures on American Television, 2008 to 2018

BackgroundTelevision portrayals of medical procedures may contribute to patient anxieties and cultural myths. We explored how television depicts abortion procedures, focusing on what these portrayals communicate about abortion access and safety.MethodsResearchers identified all abortion procedure plotlines on American television from 2008 to 2018 through Internet searches. We viewed plotlines and coded for type of abortion, health outcome, and whether the abortion occurred on or off screen. We used inductive content analysis to identify themes.FindingsWe identified 96 television plotlines between 2008 and 2018 in which a character obtains or discloses an abortion. Of these, 39 plotlines (40%) depict some aspect of the abortion procedure. Twenty-three of the 39 abortion portrayals (59%) depict a surgical abortion procedure, of which about one-half were legal abortions and one-half were illegal. Only 7 of the 39 procedure plotlines (18%) portray medication abortions. Five of these plotlines depict illegal abortions; only two depict legal abortions. Four plotlines depict attempted abortions by supernatural means or ingestion of a toxic liquid.ConclusionThe majority of abortions on television are surgical, contrasting with the reality of abortion practice in which one-third of U.S. abortions are by medication. Portrayals of surgical abortion often reinforce the misperception that abortion is a surgical intervention requiring hospitalization. The few portrayals of medication abortion also perpetuate inaccuracies, including that it is easily accessible, uncommon, and dangerous. Portrayals of illegal abortions are overrepresented. This misinformation may seed unnecessary fear for patients before an abortion, and may create confusion among the public about abortion access and safety.     

United States government policy on abortion.

Federal government policy in the United States lacks uniformity, as is indicated by the fact that the Dept. of Defense permits the performance of abortion for medical and mental health reasons, the Office of Economic Opportunity states that no project funds may be used for any surgical procedure intended to result in abortion, and the Dept. of Health, Education and Welfare has no policy concerning abortion in its programs but that abortion is a reimbursable expense under Title XIX Medicaid payments in enrolled states. This ambiguity of the federal government is considered a reflection of the complexity of the issue and the lack of clear consensus concerning abortion among the American public. Factors that federal family planning officials must consider are: 1) the ethical and moral considerations that confront the individual citizen making a private decusion about abortion; 2) legal and constitutional issues, such as that of discrimination in the availability of abortion services on economic grounds; and 3) the relationship of abortion to public service needs and public health considerations, given that 1/4-1/5 of pregnancies in the United States end in legal or illegal abortion. Clandestine abortion constitutes a significant health problem, accounting for a significant proportion of maternal mortality, especially among the poor (the 1967 rate of reported mortality due to abortion with sepsis being 7 times greater for nonwhites than whites). The Office of Economic Opportunity in reassessing its current policy needs to ascertain the standards of medical care, cost projections, and logistics of providing abortion services. It is recommended that abortion services be combined with serious efforts to provide effective subsequent contraception, as abortion as an exclusive method of birth control would cost up to $2000 per year while the provision of high quality family planning services is $60-$80 per woman per year.     

Epidemiology of legal abortion in Italy

The paper reports on the trends of induced abortion in Italy since its legalization in 1978. Data collected through the national surveillance system show that the abortion rates and ratios in Italy, after an initial increase, have been stable in the last four years, and are comparable to those of other European countries. Italian women seeking abortion, however, are generally older and more frequently married and parous than in most other western countries. The data on abortion services and procedures show a slow improvement with increasing use of local rather than general anaesthesia, suction rather than surgical curettage, and outpatient rather than inpatient admissions. Post-abortion complications are infrequent and there have been no cases of death from legal abortion. The paper attempts to analyse the effect of legal abortion on fertility and on other maternal and child health indices, reaching tentative conclusions on the contribution of the legalization of abortion to the improvement of reproductive health. Uneven availability of abortion services, however, is currently a major problem; in many of the less developed areas of the country, it is estimated that as many as 50% of abortions are still performed outside the legal abortion service network.     

Consent for Adolescent Vaccination: Issues and Current Practices

ABSTRACT: To identify and describe implementation of state-level informed consent requirements for adolescent immunizations, current state regulations on informed consent and immunization services for children and adolescents were identified through the LEXIS-NEXIS® legal data base. Regulations were coded for informed consent characteristics, consent exemptions, and current immunization requirements. State immunization program directors, project managers, and state hepatitis coordinators were surveyed to catalogue how regulations were implemented and document new policies or regulations under consideration.
Parental consent for immunizations is standard practice in 43 states. Most states (n=34) require separate consent for each injection when more than one injection is required to complete a vaccination, but only for a limited number of medical procedures. Nine states allow adolescents to self-consent for hepatitis B vaccination in sexually transmitted disease clinics and family planning clinics as part of the exemption for minors' receipt of sexual health services.
Most states require consent for vaccination services provided to adolescents. Parental consent requirements are a potential barrier to vaccinating adolescents in some settings.     

Regulating Conscientious Objection to Legal Abortion in Argentina: Taking into Consideration Its Uses and Consequences

Claims of conscientious objection (CO) have expanded in the health care field, particularly in relation to abortion services. In practice, CO is being used in ways beyond those originally imagined by liberalism, creating a number of barriers to abortion access. In Argentina, current CO regulation is lacking and insufficient. This issue was especially evident in the country’s 2018 legislative debate on abortion law reform, during which CO took center stage. This paper presents a mixed-method study conducted in Argentina on the uses of CO in health facilities providing legal abortion services, with the goal of proposing specific regulatory language to address CO based not only on legal standards but also on empirical findings regarding CO in everyday reproductive health services. The research includes a review of literature and comparative law, a survey answered by 269 health professionals, and 11 in-depth interviews with stakeholders. The results from our survey and interviews indicate that Argentine health professionals who use CO to deny abortion are motivated by a combination of political, social, and personal factors, including a fear of stigmatization and potential legal issues. Furthermore, we find that the preeminent consequences of CO are delays in abortion services and conflicts within the health care team. The findings of this research allowed us to propose specific regulatory recommendations on CO, including limits and obligations, and suggestions for government and health system leaders.     

International developments in abortion laws: 1977-88

International developments in abortion laws have been diverse, but the general thrust of legislation and court decisions has been towards decriminalization and liberalization of laws and the reduction of legal barriers to access to therapuetic abortion services presented by spousal and parental authorization requirements. Most legislation has extended abortion eligibility through traditional indications such as danger to maternal health or fetal handicap, but other indications have also been created, such as adolescence, advanced maternal age, family circumstances and Acquired Immunodeficiency Syndrome or Human Immunodeficiency Virus infection. Several jurisdictions established stages of early gestation within which abortion could be undertaken with minimal legal scrutiny. In Canada, the entire prohibition of abortion was held unconstitutional for violating women's integrity and security. Under medical and public health guidance, several countries have amended their constitutions to recognize and protect human life from contraception. Cyprus, Italy, and Taiwan have created an indication for abortion of welfare of the women's family, while France and the Netherlands recognize the women's distress and Hungary cites cases where the women is single or separated for 6 months, where appropriate housing is lacking or where she is 35 years or older and has had 3 deliveries. National health services and insurance schemes vary in their coverage of abortion costs, but generally tend to fund the major park of lawful services. In Britain, France, Israel, the US and Yugoslavia husband's claims to veto abortions have been rejected. Courts have also established that mature adolescents, although legally minors, may give autonomous consent to abortion and are entitled to confidentiality. Few countries' laws define when criminal abortion liability commences or when conception occurs, but the law has moved to restrict abortion in Israel, Honduras, Romania and Finland.     

Effect of nurses' attitudes on hospital-based abortion procedures in Massachusetts

Our study explored a largely unacknowledged obstacle to abortion access in Massachusetts: the unwillingness of nurses to staff abortion procedures. Evidence suggests that nurses tend to be more likely to oppose abortion than other medical professionals. However, the attitudes and practices of hospital-based nurses regarding abortion have not been thoroughly investigated. We collected qualitative information from physicians and nurse managers to understand how nurses' attitudes affect hospital-based abortion services in Massachusetts. We surveyed key respondents at all hospitals in Massachusetts where abortion services are available to any woman who requests them. Of the 20 individuals who responded (87%), 17 were physicians and 3 were nurse managers. We found that over half of physician respondents believed that the unavailability or unwillingness of nurses to staff abortions is a slight or moderate problem, and nearly a quarter of physician respondents characterized it as a large or very large problem. Thus, nurses' attitudes towards abortion and their unwillingness to assist with procedures may hinder patient access to abortion services.     

Making abortions safe: a matter of good public health policy and practice

Globally, abortion mortality accounts for at least 13% of all maternal mortality. Unsafe abortion procedures, untrained abortion providers, restrictive abortion laws and high mortality and morbidity from abortion tend to occur together. Preventing mortality and morbidity from abortion in countries where these remain high is a matter of good public health policy and medical practice, and constitutes an important part of safe motherhood initiatives. This article examines the changes in policy and health service provision required to make abortions safe. It is based on a wide-ranging review of published and unpublished sources. In order to be effective, public health measures must take into account the reasons why women have abortions, the kind of abortion services required and at what stages of pregnancy, the types of abortion service providers needed, and training, cost and counselling issues. The transition from unsafe to safe abortions demands the following: changes at national policy level; abortion training for service providers and the provision of services at the appropriate primary level health service delivery points; and ensuring that women access these services instead of those of untrained providers. Public awareness that abortion services are available is a crucial element of this transition, particularly among adolescent and single women, who tend to have less access to reproductive health services generally.     

Medical students' attitudes toward abortion and other reproductive health services

This paper investigated the attitude toward abortion and other reproductive health services of first- and second-year medical students at the Seattle campus of the University of Washington, a large regional primary care-oriented medical school, in 1996-97. A total of 219 (76.6%) students responded. The majority of the students support the availability of a broad range of reproductive health services including abortion; 58.1% felt that first-trimester abortions should be available to patients under most circumstances. Of the 43.4% of students who anticipated a career in family practice, most expected to provide abortions in their future practices. Moreover, older students and women were more likely to support the provision of abortion services. This study concludes that despite the continuing pressure on abortion providers, most first- and second-year medical students at a fairly state-supported medical school intend to incorporate this procedure into their future practices.     

Abortion attitudes and practices of family and general practice physicians.

BACKGROUND. Approximately 1.5 million abortions are performed each year in the United States. Little information has been published on the abortion attitudes and practices of family physicians. The object of this investigation was to assess the abortion attitudes and practices of family and general practice physicians in Kansas. METHODS. A 19-item self-administered survey questionnaire was designed and mailed to 856 family and general practice physicians in Kansas. RESULTS. A 63% survey response rate was obtained. Seventy-eight percent of the physicians reported that abortion should be legal, but only 56% of the respondents classified themselves as pro-choice. Conversely, only 8% reported that legal abortion should not be available, even though 33% classified themselves as pro-life. The majority of physicians reported that abortion is an appropriate option to save the life of the mother, in cases of rape or incest, and when a fetal anomaly is diagnosed. Only three respondents (0.5%) had performed abortions during the previous year. In general, female physicians and physicians over the age of 40 years (regardless of sex) were more likely to be pro-choice and to view a woman's personal decision as a circumstance in which abortion may be appropriate. CONCLUSIONS. Physician's views about abortion and their practice patterns are important components of health care for thousands of women each day.     

加强社会办医管理的思考与对策

通过对无锡市社会办医现状的分析,提出了加强社会办医管理的思考和对策。指出必须深入学习《医疗机构管理条例》及其《实施细则》,提高认识;合理规划,严格按照区域卫生规划设点布局,规范行医;加强监督,强化管理;健全法规,依法行政,以病人为中心,为社会提供良好的医疗服务。     

医疗事故争议处理中的疑点及难点

《医疗事故处理条例》的实施为医疗机构防范和处理医疗纠纷提供了新的框架，较之《医疗事故处理办法》，有许多可圈可点之处。但作为一部新出台的法规，无疑需在运行中接受来自多方面的考验和挑战。作者试从以下几个角度表明观点：①医疗事故定性与医疗过失参与度挂钩，轻微责任不宜戴上“医疗事故”的帽子。②协商解决中认定事故等级的规定欠合理，操作性差，且增加了协商解决的难度。③不是医疗事故不赔偿的规定是否合情、合理、合法?是否有利于医疗纠纷的协商解决?④《医疗事故处理条例》缺乏对“以医疗事故为由，长期滞留医院”这一问题的关注。作者提出了卫生行政法规应“对通过司法解决此类案件提供必要的卫生法规支持”的建议。     

Frequently asked questions about medical abortion

The development of methods of inducing abortion medically (nonsurgically) has created alternative options to make abortion available to women in a variety of health-care settings. Medical abortion is induced with a regimen of mifepristone followed by a prostaglandin analogue. Since its first introduction in the late 1980s, the regimen has undergone some modifications based on research evidence, and, in many countries, clinicians are using regimens that may differ from the one that has been licensed. This causes confusion among providers, also because only a few countries have developed national guidelines for the provision of medical abortion. We approached health care personnel providing abortion services in various countries and asked them to send us questions that they, or their colleagues, might have concerning the clinical practice of medical abortion in the early first trimester (up to 63 days since the first day of the last menstrual period). These questions were sent to experts representing the fields of biomedical and clinical research, clinical practice and family planning, who conducted literature reviews so that, whenever possible, the answers could be based on existing evidence. A consensus meeting was held in Bellagio, Italy, between November 1 and 5, 2004, to review the questions and to discuss the answers. The aim of this article is to provide a brief overview of some of the questions asked and the answers discussed.     

Women's reproductive health needs in Russia: what can we learn from an intervention to improve post-abortion care?

It has been well documented that abortion is a common means of controlling fertility in Russia. Women undergo repeat abortions throughout their reproductive lives, but recent studies of abortion trends in the Russian Federation suggest that abortion rates are on the decline, use of modern contraceptives is increasing, and women dislike abortion as a method of fertility control. Using data collected during 1999-2003 in women's health facilities in three Russian cities, this paper reports the results of an evaluation of interventions to improve post-abortion care, which show an impressive increase in post-abortion contraceptive counselling but no reduction in the rate at which women present at clinics for repeat abortions. The findings indicate a discrepancy between women's stated preferences for modern medical contraceptive methods and their abortion-seeking behaviour. Further exploration of these data suggests that certain women resort to abortion with greater frequency than others, and points to the need for a more focused investigation of these women. These results indicate the complexities associated with changing what has been a relatively common and long-standing practice, and have implications for improving reproductive health services. Meeting the reproductive health needs of Russian women requires not only improved provider and client knowledge but may also demand a more focused delivery of client-centred care than may be the case in other settings.     

The role of interpersonal communication in preventing unsafe abortion in communities: the dialogues for life project in Nepal

Legal, procedural, and institutional restrictions on safe abortion services-such as laws forbidding the practice or policies preventing donors from supporting groups who provide legal services-remain a major access barrier for women worldwide. However, even when abortion services are legal, women face social and cultural barriers to accessing safe abortion services and preventing unwanted pregnancy. Interpersonal communication interventions play an important role in overcoming these obstacles, including as part of broad educational- and behavioral-change efforts. This article presents results from an interpersonal communication behavior change pilot intervention, Dialogues for Life, undertaken in Nepal from 2004 to 2006, after abortion was legalized in 2002. The project aimed to encourage and enable women to prevent unplanned pregnancies and unsafe abortions and was driven by dialogue groups and select community events. The authors' results confirm that a dialogue-based interpersonal communication intervention can help change behavior and that this method is feasible in a low-resource, low-literacy setting. Dialogue groups play a key role in addressing sensitive and stigmatizing health issues such as unsafe abortion and in empowering women to negotiate for the social support they need when making decisions about their health.