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Kimport K, Littlejohn KE. What are We Forgetting? Sexuality, Sex, and Embodiment in Abortion Research. JOURNAL OF SEX RESEARCH 2021; 58:863-873. [PMID: 34080946 DOI: 10.1080/00224499.2021.1925620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Abortion has been alternately legalized and criminalized, tacitly approved of, and stigmatized, in various settings over time. The contours of its treatment are dependent on social and political contexts, including concern over women's sexuality, but it is not clear that existing conceptual frameworks enable expansive examination of the relationship between abortion and sexuality. We conduct a critical interpretive synthesis review of the literature that jointly engages with sexuality and abortion, focusing on the U.S., to highlight the frameworks that authors use to understand the relationship between the two. We find two conceptual frameworks of abortion and sexuality in operation: one that treats the two as discrete, causal variables that operate at the individual level; and another that focuses on how beliefs about what constitutes (in)appropriate sexuality explain ideological positions on abortion. We identify limitations of both frameworks and propose a new conceptual framework - one that highlights sexual embodiment - to inspire future research in this area and generate opportunities for knowledge extension. Such an approach, we contend, can elucidate broader social forces that shape both abortion and sexuality and bring research on abortion into conversation with recent scholarship on the important role of sexuality in other sexual and reproductive domains.
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Affiliation(s)
- Katrina Kimport
- Advancing New Standards in Reproductive Health, University of California
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Ejder Apay S, Gürol A, Gür EY, Church S. Midwifery students' reactions to ethical dilemmas encountered in outpatient clinics. Nurs Ethics 2020; 27:1542-1555. [PMID: 32436429 DOI: 10.1177/0969733020922875] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Midwives are required to make ethical decisions with the support of respective codes of professional ethics which provide a framework for decision making in clinical practice. While each midwife should be ethically aware and sensitive to the ever-changing issues within reproduction, few empirical studies have examined the views of student midwives in relation to reproductive ethical dilemmas. OBJECTIVE The aim of this study was to explore midwifery students' reactions to a number of ethical dilemmas relating to women's experiences of reproductive decision making. DESIGN A series of focus groups were conducted with midwifery students who were asked to discuss five culturally significant scenarios including issues of knowledge acquisition regarding methods of family planning, removal or insertion of an intrauterine device, and abortion. SETTING A University in Turkey was the setting for this study. PARTICIPANTS Purposeful sampling was adopted which resulted in five focus groups with a total of 57 midwifery students. ETHICAL CONSIDERATIONS The study was reviewed and granted formal ethical approval by an ethical committee at the Faculty of Health Science in Atatürk University. The head of the Faculty of Health Science approved the investigation. The participants received both oral and written information about the study and they gave their consent. RESULTS Five themes were identified from the analysis of the focus group data related to all five scenarios. These themes were 'the right to information', 'choice and protection', 'parental rights and welfare of the women', 'make a decision' and 'women rights and sexual abuse'. CONCLUSION This study has shown that while students respected women's choice, they also expressed great ambivalence in some situations when personal values conflict with dominant societal beliefs and professional ethics. A focus on ethics education to include human rights is suggested as a means to enable students to explore their own social-value judgements, and as a means to limit the possible development of ethical confusion and moral distress.
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Affiliation(s)
| | | | | | - Sarah Church
- 4914London South Bank University, UK; Barts Health, UK
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Michalik A, Zdun-Ryżewska A, Pięta B, Basiński K, Kiełbasińska J, Mazurkiewicz B, Olszewska J, Łukaszuk K. Multicenter study on midwifery students' attitudes towards abortion and it's place in their future practice - Comparison of respondents at early and late stages of the university education. Nurse Educ Pract 2019; 35:42-47. [PMID: 30665059 DOI: 10.1016/j.nepr.2019.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 12/20/2018] [Accepted: 01/09/2019] [Indexed: 11/27/2022]
Abstract
Evidence based midwifery education and practice are fundamental to assure high quality care of childbearing women, also with complications. In Poland, midwifery education includes aspects of participation in the abortion. A cross-sectional study was designed to describe the attitudes towards abortion at the beginning and at the end of students' university education. The study was aimed to verify change of attitudes throughout the course of the university education. Most of the students approved abortion if the pregnancy constitutes a threat to woman's health or life, results from a rape, or whenever the fetus presents with a lethal defect. More than a half did not approve participation in the abortion if the fetus presents with a non-lethal defect. Generally, the acceptance rates were significantly higher among the final year students, but more than a half of them stated, that the abortion-related topics were inadequately addressed in their study curriculum. That bring to the conclusion that higher rates of abortion acceptance among the final year students, were not necessarily a manifestation of informed approval for this procedure, but rather a form of a "systemic" adjustment. Midwifery program need to be revised to support students in developing informed and evidence-based attitudes toward abortion.
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Affiliation(s)
- Anna Michalik
- Department of Obstetrical and Gynecological Nursing, Medical University of Gdansk, 80-211, Gdansk, Debinki 7, Poland.
| | - Agata Zdun-Ryżewska
- Department of Quality of Life Research, Medical University of Gdansk, 80-210, Gdansk, Tuwima 15, Poland.
| | - Beata Pięta
- Department of Mother's and Child's Health, University of Medical Sciences, 60-512, Poznan, Jackowskiego 42, Poland.
| | - Krzysztof Basiński
- Department of Quality of Life Research, Medical University of Gdansk, 80-210, Gdansk, Tuwima 15, Poland.
| | - Joanna Kiełbasińska
- Department of Gynecologic and Obstetrical Didactics, Warsaw Medical University, 00-424, Warsaw, Żwirki I Wigury 81, Poland.
| | - Barbara Mazurkiewicz
- Department of Gynecologic and Obstetrical Didactics, Warsaw Medical University, 00-424, Warsaw, Żwirki I Wigury 81, Poland.
| | - Jolanta Olszewska
- Department of Obstetrical and Gynecological Nursing, Medical University of Gdansk, 80-211, Gdansk, Debinki 7, Poland.
| | - Krzysztof Łukaszuk
- Department of Obstetrical and Gynecological Nursing, Medical University of Gdansk, 80-211, Gdansk, Debinki 7, Poland.
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Afhami N, Nekuei N, Bahadoran P, Taleghani-Esfahani H. Evaluation of Ethical Attitude Approaches in Midwives and their Relationship with their Demographic Features. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2018; 23:193-197. [PMID: 29861757 PMCID: PMC5954640 DOI: 10.4103/ijnmr.ijnmr_237_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background: Ethical approach is one of the paramount aspects of life. The position of this approach in medical occupations has always been noticed. This study was carried out to analyze the types of ethical approaches in midwives and their relationship with their demographic features. Materials and Methods: The current descriptive-correlation and cross-sectional study was conducted from October to December 2014 using quota random sampling technique. The participants consisted of 189 midwives employed in Isfahan, Iran. The data collection tool was a researcher-made questionnaire. The midwives' attitudes were examined in the four fields of virtue ethics, deontologism, utilitarianism, and religious ethics. Data were analyzed using descriptive and inferential statistics in SPSS software (p < 0.050). Results: The highest score belonged to religious ethics with the mean value of 64.36 out of 100. A positive significant relationship was found between deontologism and education level (F = 8.74; p = 0.004), and total ethical approach and workplace (F = 2.60; p = 0.053). There was a reverse significant relationship between age and work experience and virtue ethics (r = −0.15; p = 0.035 and r = −0.20; p = 0.005, respectively). Conclusions: The existing high percentage of religious ethics shows the religious tendency of the participants. The determination of ethical approach among midwives as one of the important medical groups and creation and improvement of the most appropriate attitude among them based on the present regulations and requirements in society are principles that we should attempt to achieve.
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Affiliation(s)
- Narges Afhami
- Ayatollah Alimoradian Hospital, Hamedan University of Medical Sciences, Nahavand, Hamedan, Iran
| | - Nafisehsadat Nekuei
- Nursing and Midwifery Care Research Center, Department of Midwifery and Reproductive Health, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parvin Bahadoran
- Nursing and Midwifery Care Research Center, Department of Midwifery and Reproductive Health, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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Håkansson M, Oguttu M, Gemzell-Danielsson K, Makenzius M. Human rights versus societal norms: a mixed methods study among healthcare providers on social stigma related to adolescent abortion and contraceptive use in Kisumu, Kenya. BMJ Glob Health 2018. [PMID: 29527357 PMCID: PMC5841529 DOI: 10.1136/bmjgh-2017-000608] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Adolescent pregnancy represents a serious public health issue in sub-Saharan Africa, and stigmatising attitudes are contributing factors. This study investigates stigmatising attitudes related to adolescent pregnancy, abortion and contraceptive use among healthcare providers working with postabortion care (PAC) in a low-resource setting in Kenya. Methods A mixed methods approach in a convergent design was utilised to capture attitudes related to abortion and contraceptive use among 86 (f=62; m=19) PAC providers in Kisumu, Kenya. Two Likert-scale questionnaires were used: the 18-item Stigmatising Attitudes, Beliefs and Actions Scale (SABAS) and the 7-item Contraceptive Use Stigma Scale (CUSS). 74 PAC providers responded to the SABAS, 44 to the CUSS and 12 participated in two focus group discussions. Descriptive statistics, psychometric tests of instruments and qualitative content analysis were conducted and reported in accordance with Consolidated Criteria for Reporting Qualitative Research. Results Cronbach's α coefficients for the total instrument was 0.88 (SABAS) and 0.84 (CUSS). The majority, 92% (68/74) agreed that a woman who has had an abortion should be treated equally to everyone else, 27% (20/74) considered abortion a sin and 30% (22/74) believed she will make abortion a habit. Contraceptive use among adolescent women was associated with promiscuity (39%; 17/44), hence contraceptives should only be available to married women (36%; 16/44), and 20% (9/44) believed that contraceptive use causes infertility. The providers encouraged women's autonomy and their rights to sexual and reproductive health; however, unclear regulations reinforce religious and cultural beliefs, which hampers implementation of evidence-based contraceptive counselling. Conclusion Stigmatising attitudes towards young women in need of abortion and contraception is common among PAC providers. Their work is characterised by a conflict between human rights and societal norms, thus highlighting the need for interventions targeting PAC providers to reduce stigma and misconceptions related to abortion and contraception among adolescent women.
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Affiliation(s)
- Miranda Håkansson
- Department of Public Health Sciences/Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
| | - Monica Oguttu
- Kisumu Medical and Education Trust (KMET), Kisumu, Kenya
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Division of Obstetrics and Gynaecology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Marlene Makenzius
- Department of Public Health Sciences/Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
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Opportunities, challenges and systems requirements for developing post-abortion family planning services: Perceptions of service stakeholders in China. PLoS One 2017; 12:e0186555. [PMID: 29045434 PMCID: PMC5646849 DOI: 10.1371/journal.pone.0186555] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 09/15/2017] [Indexed: 11/19/2022] Open
Abstract
Post-abortion family planning (PAFP) has been proposed as a key strategy to decrease unintended pregnancy and repeat induced abortions. However, the accessibility and quality of PAFP services remain a challenge in many countries including China where more than 10 million unintended pregnancies occur each year. Most of these unwanted pregnancies end in repeated induced abortions. This paper aims to explore service providers' perceptions of the current situation regarding family planning and abortion service needs, provision, utilization, and the feasibility and acceptability of high quality PAFP in the future. Qualitative methods, including in-depth interviews and focus group discussions, were used with family planning policy makers, health managers, and service providers. Three provinces-Zhejiang, Hubei and Yunnan-were purposively selected, representing high, medium and relatively undeveloped areas of China. A total of fifty-three in-depth interviews and ten focus-group discussions were conducted and analysed thematically. Increased numbers of abortions among young, unmarried women were perceived as a major reason for high numbers of abortions. Participants attributed this to increasing socio-cultural acceptability of premarital sex, and simultaneously, lack of understanding or awareness of contraception among young people. The majority of service stakeholders acknowledged that free family planning services were neither targeted at, nor accessible to unmarried people. The extent of PAFP provision is variable and limited. However, service providers expressed willingness and enthusiasm towards providing PAFP services in the future. Three main considerations were expressed regarding the feasibility of developing and implementing PAFP services: policy support, human resources, and financial resources. The study indicated that key service stakeholders show demand for and perceive considerable opportunities to develop PAFP in China. However, changes are needed to enable the systematic development of high quality PAFP, including actively targeting young and unmarried people in service provision, obtaining policy support and increasing the investment of human and financial resources.
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Park Y, Yeun EJ, Hwang YY. Subjectivity About Sexual Ethics Among Korean Undergraduate Students Using Q Methodology. Asian Nurs Res (Korean Soc Nurs Sci) 2016; 10:143-9. [PMID: 27349672 DOI: 10.1016/j.anr.2016.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 01/21/2016] [Accepted: 03/14/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Most undergraduate students are in the phase of gaining mental and physical autonomy from their parents as they expand their worlds. The ways that sexual ethics are established during this time may have an important influence on healthy lifestyles and the maintenance of social order. This study aims to determine a typology of undergraduate students' sexual ethics and the characteristics that compose the types. METHODS Q methodology, which analyzes the subjectivity of each type of attitude, was used. The 44 selected Q statements from 43 participants were classified into the shape of a normal distribution using a 9-point scale. The collected data were analyzed using the PC-QUANL program. RESULTS The results revealed three discrete groups of students with respect to sexual ethics: traditional absolute purity type, open-minded compromise type, and rational responsibility type. CONCLUSIONS The results of this study indicate that different approaches to educational programs on sexual ethics are recommended for undergraduate students based on the three types studied.
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Affiliation(s)
- Youngrye Park
- Department of Nursing, Kunsan National University, Gunsan, South Korea
| | - Eun Ja Yeun
- Department of Nursing, Konkuk University, Chungju, South Korea
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Rominski SD, Lori J, Nakua E, Dzomeku V, Moyer CA. What makes a likely abortion provider? Evidence from a nationwide survey of final-year students at Ghana's public midwifery training colleges. Contraception 2015; 93:226-32. [PMID: 26569448 DOI: 10.1016/j.contraception.2015.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 11/08/2015] [Accepted: 11/09/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Even in countries where the abortion law is technically liberal, the full application of the law has been delayed due to resistance on the part of providers to offer services. Ghana has a liberal law, allowing abortions for a wide range of indications. The current study sought to investigate factors associated with midwifery students' reported likelihood to provide abortion services. METHODS Final-year students at 15 public midwifery training colleges participated in a computer-based survey. Demographic and attitudinal variables were tested against the outcome variable, likely to provide comprehensive abortion care (CAC) services, and those variables found to have a significant association in bivariate analysis were entered into a multivariate model. Marginal effects were assessed after the final logistic regression was conducted. RESULTS A total of 853 out of 929 eligible students enrolled in the 15 public midwifery schools took the survey, for a response rate of 91.8%. In multivariate regression analysis, the factors significantly associated with reported likeliness to provide CAC services were having had an unplanned pregnancy, currently using contraception, feeling adequately prepared, agreeing it is a good thing women can get a legal abortion and having been exposed to multiple forms of education around surgical abortion. DISCUSSION Midwifery students at Ghana's public midwifery training colleges report that they are likely to provide CAC. Ensuring that midwives-in-training are well trained in abortion services, as well as encouraging empathy in these students, may increase the number of providers of safe abortion care in Ghana.
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Affiliation(s)
| | - Jody Lori
- School of Nursing, University of Michigan
| | - Emmanuel Nakua
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Veronica Dzomeku
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Cheryl A Moyer
- Department of Learning Health Sciences, University of Michigan Medical School
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Andersen KL, Khanal RC, Teixeira A, Neupane S, Sharma S, Acre VN, Gallo MF. Marital status and abortion among young women in Rupandehi, Nepal. BMC WOMENS HEALTH 2015; 15:17. [PMID: 25783648 PMCID: PMC4350858 DOI: 10.1186/s12905-015-0175-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 01/30/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Despite liberalization of the Nepal abortion law, young women continue to experience barriers to safe abortion services. We hypothesize that marital status may differentially impact such barriers, given the societal context of Nepal. METHODS We evaluated differences in reproductive knowledge and attitudes by marital status with a probability-based, cross-sectional survey of young women in Rupandehi district, Nepal. Participants (N = 600) were surveyed in 2012 on demographics, romantic experiences, media habits, reproductive information, and abortion knowledge and attitudes. We used logistic regression to assess differences by marital status, controlling for age. RESULTS Participants, who comprised never-married (54%) and ever-married women (45%), reported good access to basic reproductive health and abortion information. Social desirability bias might have prevented reporting of premarital romantic and sexual activity given that participants reported more premarital activities for their friends than for themselves. Only 45% knew that abortion was legal, and fewer ever-married women were aware of abortion legality. Never-married women expected more negative responses from having an abortion than ever-married women. CONCLUSIONS Findings highlight the need for providing sexual and reproductive health care information and services to young women regardless of marital status.
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Rehnström Loi U, Gemzell-Danielsson K, Faxelid E, Klingberg-Allvin M. Health care providers' perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia: a systematic literature review of qualitative and quantitative data. BMC Public Health 2015; 15:139. [PMID: 25886459 PMCID: PMC4335425 DOI: 10.1186/s12889-015-1502-2] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 02/03/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unsafe abortions are a serious public health problem and a major human rights issue. In low-income countries, where restrictive abortion laws are common, safe abortion care is not always available to women in need. Health care providers have an important role in the provision of abortion services. However, the shortage of health care providers in low-income countries is critical and exacerbated by the unwillingness of some health care providers to provide abortion services. The aim of this study was to identify, summarise and synthesise available research addressing health care providers' perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia. METHODS A systematic literature search of three databases was conducted in November 2014, as well as a manual search of reference lists. The selection criteria included quantitative and qualitative research studies written in English, regardless of the year of publication, exploring health care providers' perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia. The quality of all articles that met the inclusion criteria was assessed. The studies were critically appraised, and thematic analysis was used to synthesise the data. RESULTS Thirty-six studies, published during 1977 and 2014, including data from 15 different countries, met the inclusion criteria. Nine key themes were identified as influencing the health care providers' attitudes towards induced abortions: 1) human rights, 2) gender, 3) religion, 4) access, 5) unpreparedness, 6) quality of life, 7) ambivalence 8) quality of care and 9) stigma and victimisation. CONCLUSIONS Health care providers in sub-Saharan Africa and Southeast Asia have moral-, social- and gender-based reservations about induced abortion. These reservations influence attitudes towards induced abortions and subsequently affect the relationship between the health care provider and the pregnant woman who wishes to have an abortion. A values clarification exercise among abortion care providers is needed.
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Affiliation(s)
- Ulrika Rehnström Loi
- Department of Public Health Sciences/IHCAR, Karolinska Institutet, Stockholm, Sweden.
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institutet/Karolinska University Hospital Stockholm, Stockholm, Sweden.
| | - Elisabeth Faxelid
- Department of Public Health Sciences/IHCAR, Karolinska Institutet, Stockholm, Sweden.
| | - Marie Klingberg-Allvin
- Department of Women's and Children's Health, Karolinska Institutet/Karolinska University Hospital Stockholm, Stockholm, Sweden.
- School of Education, Health and Social studies, Dalarna University, Falun, Sweden.
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Sjöström S, Essén B, Sydén F, Gemzell-Danielsson K, Klingberg-Allvin M. Medical students' attitudes and perceptions on abortion: a cross-sectional survey among medical interns in Maharastra, India. Contraception 2014; 90:42-6. [PMID: 24679479 DOI: 10.1016/j.contraception.2014.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 01/24/2014] [Accepted: 02/07/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Although abortion care has been an established routine since decades in India, 8% of maternal mortality is attributed to unsafe abortion. Increased knowledge and improved attitudes among health care providers have a potential to reduce barriers to safe abortion care by reducing stigma and reluctance to provide abortion. Previous research has shown that medical students' attitudes can predict whether they will perform abortions. The objective of our study was to explore attitudes toward abortion among medical interns in Maharastra, India. STUDY DESIGN A cross-sectional survey was carried out among 1996 medical interns in Maharastra, India. Descriptive and analytical statistics were used to interpret the study instrument. RESULTS Almost one quarter of the respondents considered abortion to be morally wrong, one fifth did not find abortions for unmarried women acceptable and one quarter falsely believed that a woman needs her partner or spouse's approval to have an abortion. Most participants agreed that unsafe abortion is a serious health problem in India. A majority of the respondents rated their knowledge of sexual and reproductive health as good, but only 13% had any clinical practice in abortion care services. CONCLUSION Disallowing attitudes toward abortion and misconceptions about the legal regulations were common among the surveyed medical students. Knowledge and attitudes toward abortion among future physicians could be improved by amendments to the medical education, potentially increasing the number of future providers delivering safe and legal abortion services. IMPLICATION PARAGRAPH Abortion is legal in India since decades, but maternal mortality due to unsafe abortions remains high. This survey of attitudes toward abortion among medical interns in Maharastra indicates that disallowing views prevail. Improved knowledge and clinical training can increase numbers of potential abortion providers, thus limit unsafe abortion.
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Affiliation(s)
- Susanne Sjöström
- Department of Women's and Children's Health, IMCH, Uppsala University, SE-751 85 Uppsala, Sweden; Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.
| | - Birgitta Essén
- Department of Women's and Children's Health, IMCH, Uppsala University, SE-751 85 Uppsala, Sweden
| | - Filip Sydén
- Department of Women's and Children's Health, IMCH, Uppsala University, SE-751 85 Uppsala, Sweden
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Marie Klingberg-Allvin
- Department of Women's and Children's Health, IMCH, Uppsala University, SE-751 85 Uppsala, Sweden; Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, Karolinska University Hospital, SE-171 76 Stockholm, Sweden; School of Health and Social Sciences, Dalarna University, SE-791 88 Falun, Sweden
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Paul M, Gemzell-Danielsson K, Kiggundu C, Namugenyi R, Klingberg-Allvin M. Barriers and facilitators in the provision of post-abortion care at district level in central Uganda - a qualitative study focusing on task sharing between physicians and midwives. BMC Health Serv Res 2014; 14:28. [PMID: 24447321 PMCID: PMC3903434 DOI: 10.1186/1472-6963-14-28] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 01/17/2014] [Indexed: 11/30/2022] Open
Abstract
Background Abortion is restricted in Uganda, and poor access to contraceptive methods result in unwanted pregnancies. This leaves women no other choice than unsafe abortion, thus placing a great burden on the Ugandan health system and making unsafe abortion one of the major contributors to maternal mortality and morbidity in Uganda. The existing sexual and reproductive health policy in Uganda supports the sharing of tasks in post-abortion care. This task sharing is taking place as a pragmatic response to the increased workload. This study aims to explore physicians’ and midwives’ perception of post-abortion care with regard to professional competences, methods, contraceptive counselling and task shifting/sharing in post-abortion care. Methods In-depth interviews (n = 27) with health care providers of post-abortion care were conducted in seven health facilities in the Central Region of Uganda. The data were organized using thematic analysis with an inductive approach. Results Post-abortion care was perceived as necessary, albeit controversial and sometimes difficult to provide. Together with poor conditions post-abortion care provoked frustration especially among midwives. Task sharing was generally taking place and midwives were identified as the main providers, although they would rarely have the proper training in post-abortion care. Additionally, midwives were sometimes forced to provide services outside their defined task area, due to the absence of doctors. Different uterine evacuation skills were recognized although few providers knew of misoprostol as a method for post-abortion care. An overall need for further training in post-abortion care was identified. Conclusions Task sharing is taking place, but providers lack the relevant skills for the provision of quality care. For post-abortion care to improve, task sharing needs to be scaled up and in-service training for both doctors and midwives needs to be provided. Post-abortion care should further be included in the educational curricula of nurses and midwives. Scaled-up task sharing in post-abortion care, along with misoprostol use for uterine evacuation would provide a systematic approach to improving the quality of care and accessibility of services, with the aim of reducing abortion-related mortality and morbidity in Uganda.
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Affiliation(s)
- Mandira Paul
- Department of Women's and Children's Health, Karolinska Institutet, University Hospital, Stockholm, Sweden.
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Hogmark S, Klingberg-Allvin M, Gemzell-Danielsson K, Ohlsson H, Essén B. Medical students' knowledge, attitudes and perceptions towards contraceptive use and counselling: a cross-sectional survey in Maharashtra, India. BMJ Open 2013; 3:e003739. [PMID: 24334156 PMCID: PMC3863118 DOI: 10.1136/bmjopen-2013-003739] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the knowledge, attitudes and perceptions towards contraceptive use and counselling among medical students in Maharashtra, India. SETTING Considerable global maternal mortality and morbidity could be avoided through the use of effective contraception. In India, contraception services are frequently unavailable or there are obstacles to obtaining modern, reversible contraceptives. PARTICIPANTS A cross-sectional descriptive study using a self-administered questionnaire was conducted among 1996 medical students in their fifth year of study at 27 medical colleges in the state of Maharashtra, India. Descriptive and analytical statistics interpreted the survey instrument and significant results were presented with 95% CI. RESULTS Respondents expressed a desire to provide contraceptive services. A few students had experienced training in abortion care. There were misconceptions about modern contraceptive methods and the impact of sex education. Attitudes towards contraception were mainly positive, premarital counselling was supported and the influence of traditional values and negative provider attitudes on services was recognised. Gender, area of upbringing and type of medical college did not change the results. CONCLUSIONS Despite mostly positive attitudes towards modern contraceptives, sex education and family planning counselling, medical students in Maharashtra have misconceptions about modern methods of contraception. Preservice and in-service training in contraceptive counselling should be implemented in order to increase women's access to evidence-based maternal healthcare services.
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Affiliation(s)
- Sara Hogmark
- Department of Obstetrics and Gynaecology, Falu County Hospital, Falun, Sweden
- Department of Women's and Children's Health (IMCH), Uppsala University, Uppsala, Sweden
| | - Marie Klingberg-Allvin
- Department of Women's and Children's Health (IMCH), Uppsala University, Uppsala, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, School of Social and Health Science, Dalarna University, Falun, Sweden
| | | | - Hannes Ohlsson
- Department of Women's and Children's Health (IMCH), Uppsala University, Uppsala, Sweden
| | - Birgitta Essén
- Department of Women's and Children's Health (IMCH), Uppsala University, Uppsala, Sweden
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Student midwives' responses to reproductive ethics: a qualitative focus group approach using case scenarios. Midwifery 2013; 29:895-901. [PMID: 23399320 DOI: 10.1016/j.midw.2012.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 10/05/2012] [Accepted: 10/12/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE the aim of this study was to gain an understanding of how midwifery students respond to a range of ethical dilemmas which they may encounter in clinical practice in relation to the use of reproductive technologies. DESIGN during a series of focus groups, student midwives were asked to consider four novel scenarios, which highlighted some of the most controversial issues in contemporary reproductive ethics. These included assisted reproduction for older women, surrogacy and mental health, sex selection and reproductive cloning. SETTING a University in the East Midlands, England. PARTICIPANTS purposeful sampling was adopted which resulted in four focus groups with a total of 16 student midwives. FINDINGS a process of thematic analysis generated four key themes: choice and expectation, consumer society; distributive justice; parental rights and welfare of the child. CONCLUSIONS our results suggest that student midwives are sensitive to the range of ethical dilemmas associated with the increased use of technology in human reproduction, and construct distinct boundaries in relation to what is considered of benefit or good to the mother, parents, the child and to society and what is considered harmful to the individual, the child and society. They also expressed their opposition to the excessive use of technological intervention, preferring instead to maintain a more naturalistic approach to reproduction. This is especially significant where concerns about the welfare of the child are articulated.
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Zeyneloğlu S, Kısa S, Yılmaz D. Turkish nursing students' knowledge and perceptions regarding virginity. NURSE EDUCATION TODAY 2013; 33:110-115. [PMID: 22405344 DOI: 10.1016/j.nedt.2012.01.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 01/01/2012] [Accepted: 01/16/2012] [Indexed: 05/31/2023]
Abstract
The aim of this study was to describe the level of knowledge and perceptions of the Turkish nursing students regarding virginity, the virginity examination and the hymen repair. A convenience sample was used for the study purpose. An investigator designed questionnaire was administered to a total sample of 781 undergraduate nursing students originating from two universities in Mersin and Gaziantep, Turkey, respectively. The results showed that the participating nursing students agreed that a man must marry a virgin woman and the students' opinions had been affected by the social pressures and the social values regarding virginity. In additon, it was found that the repair of the hymen was acceptable by the participating students. The findings of this study addressed and highlighted the gap in the knowledge on virginity related violence so as to improve the educational programmes and clinical practice within the context of preparing nurses for an extended role in violence against women.
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Affiliation(s)
- Simge Zeyneloğlu
- Gaziantep University, Faculty of Health Sciences, Department of Nursing, Gaziantep, Turkey.
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16
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University students' attitudes towards Voluntary Interruption of Pregnancy. Leg Med (Tokyo) 2012; 14:209-13. [PMID: 22498236 DOI: 10.1016/j.legalmed.2012.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 02/02/2012] [Accepted: 02/02/2012] [Indexed: 11/20/2022]
Abstract
An evaluation of the future professional trends was performed by analyzing the attitudes of university students to the Voluntary Interruption of Pregnancy (VIP). An anonymous questionnaire was distributed to 300 students (Medicine, Nursing and Law) of the University of Santiago de Compostela, with questions on their personal beliefs, opinion on the law and intention to participate in VIP. Of the 245 respondents (response rate 82%), 66.5% were pro-abortion and their attitudes towards VIP were consistent with their opinion on the beginning of life and with the ethical arguments related to the fetus and the mother. No differences were found with age, sex or degree. The students showed to be well informed on the VIP law, and the majority of them considered unsuitable termination of pregnancy in minors without parental consent. Students' intentions to take part in abortion provision were influenced by their views on abortion, level of participation and circumstances of pregnancy. Although the majority of participants would be willing to perform VIP in situations that affect fetus and mother's life or health (87-66%), their intentions clearly diminished in other situations, such as abortion on demand (17%). These data suggest that conscientious objection of health professionals can even increase with the new policy, a fact that might affect VIP availability. It is important to stress the need of ethical training to help in the solution of conflicts between patient and health professional values.
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Mizuno M. Confusion and ethical issues surrounding the role of Japanese midwives in childbirth and abortion: a qualitative study. Nurs Health Sci 2011; 13:502-6. [PMID: 22093688 DOI: 10.1111/j.1442-2018.2011.00647.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This qualitative study describes midwives' experiences in providing care in both pregnancy termination and childbirth in Japan. Midwives working in the general hospital maternity unit assist in both, which is an ethical issue warranting further exploration. Eleven midwives working in a general hospital were interviewed using a semistructured interview, and responses were coded using thematic analysis. Two major themes emerged: the experience of midwives involved in childbirth and pregnancy termination (three subthemes: confusion about care of the baby and aborted fetus, inability to cater to different mothers' needs, and establishing emotional control) and professional awareness and attitude as a midwife (three subthemes: consistency with professional principles, suppression of feelings in relation to aborted fetus, and previous and current professional identities). We found that midwives are isolated in this important social moral issue and its accompanying professional confusion. Suppressing their feelings remains the most common way of dealing with the ambivalence of the roles they fulfill. Improved working conditions and enhanced training on aspects of professional ethics would assist in reducing professional confusion.
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Affiliation(s)
- Maki Mizuno
- Division of Health Science, Kanazawa University, 5-11-80 Kodatuno, Kanazawa city, Ishikawa, Japan.
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Ege E, Akin B, Kültür Can R, Ariöz A. Knowledge and Practices About Sexual and Reproductive Health in University Students. SEXUALITY AND DISABILITY 2011. [DOI: 10.1007/s11195-011-9205-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Klingberg-Allvin M, Binh N, Johansson A, Berggren V. One foot wet and one foot dry: transition into motherhood among married adolescent women in rural Vietnam. J Transcult Nurs 2008; 19:338-46. [PMID: 18669900 DOI: 10.1177/1043659608322419] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study explores married Vietnamese adolescents' perceptions and experiences related to transition into motherhood and their encounter with health care service. In-depth interviews were conducted with 22 women younger than 20 who were either pregnant or had newly delivered. It emerged from the narratives that young women experienced ambivalence in the transition to motherhood in that they felt too young but also happy to be able to please their husband and the extended family. Patterns were shown indicating that the participants experienced lacking power with regard to decisions in relation to pregnancy, delivery, and contraceptive usage. Feelings of being patronized and ignored in the encounter with health care providers were seen in the narratives. Findings might be used for reproductive health care providers, social workers, and educators in their contact with young mothers to empower them to make their own decisions with regard to marriage, childbearing, and contraception.
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Mngadi PT, Faxelid E, Zwane IT, Höjer B, Ransjo-Arvidson AB. Health providers' perceptions of adolescent sexual and reproductive health care in Swaziland. Int Nurs Rev 2008; 55:148-55. [PMID: 18477098 DOI: 10.1111/j.1466-7657.2007.00625.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To explore health providers' perceptions of adolescent sexual and reproductive healthcare services in Swaziland. METHODS Fifty-six healthcare providers, working in 11 health clinics in Swaziland in 2005, were surveyed using a semi-structured questionnaire. The data were analysed by descriptive statistics and content analysis to identify key themes. FINDINGS Most participants were women with a mean age of 36 years and a mean number of 6 years in the profession. Services provided included STIs/HIV/AIDS advice, pre- and post-test counselling and testing on HIV, contraceptives and condom use. Half of the nurses/midwives had no continued education and lacked supervision on adolescent sexual and reproductive health care. The majority had unresolved moral doubts, negative attitudes, values and ethical dilemmas towards abortion care between the law, which is against abortion, and the reality of the adolescents' situation. Forty-four wanted to be trained on post-abortion care while eight on how to perform abortions. Twenty-six wanted the government to support adolescent-friendly services and to train heathcare providers in adolescent sexual and reproductive health services. CONCLUSION The curricula within nursing and midwifery preservice education need to be reviewed to incorporate comprehensive services for adolescents. There is need for provision of comprehensive services for adolescents in Swaziland and appropriate youth-friendly services at all levels. There is need for nurse/midwifery participation, advocacy and leadership in policy development.
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Affiliation(s)
- P T Mngadi
- Division of International Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.
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Ege E, Akin B, Altuntuğ K. OPINIONS OF MIDWIFERY STUDENTS ON ADOLESCENT SEXUALITY AND REPRODUCTIVE HEALTH IN TURKEY. SOCIAL BEHAVIOR AND PERSONALITY 2008. [DOI: 10.2224/sbp.2008.36.7.965] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The purpose of this study was to evaluate how midwifery students feel about adolescent sexuality, the use of contraceptive methods, and abortion. A total of 55 students in the second year of a midwifery course were included in the sampling. Data were evaluated by percentage distribution
and McNamara's Test. An evaluation of the students' thoughts on sexuality showed that 87.3% believed a girl should be a virgin when she married, that 50.9% believed abortion was morally wrong and that 23.6% believed only married couples should be informed of
contraceptive methods. The study showed that students were influenced in their attitudes by social-value judgments about adolescent sexual and reproductive health.
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Norman I, Griffiths P. ‘… And midwifery’: Time for a parting of the ways or a closer union with nursing? Int J Nurs Stud 2007; 44:521-2. [PMID: 17445530 DOI: 10.1016/j.ijnurstu.2007.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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