Monday, March 8, 2010

Recent Scholarship on International Issues in Abortion and Other Reproductive Health Services

Suzanne Belton, et al.. have posted Attitudes Towards the Legal Context of Unsafe Abortion in Timor-Leste on SSRN.  Here is the abstract:

The new Penal Code in 2009 was an opportunity for Timor-Leste to allow some legal grounds for abortion, which was highly restricted under Indonesian rule. Public debate was contentious before ratification of the new code, which allowed abortion to save a woman’s life and health. A month later, 13 amendments to the code were passed, highly restricting abortion again. This paper describes the socio-legal context of unsafe abortion in Timor-Leste, based on research in 2006–08 on national laws and policies and interviews with legal professionals, police, doctors and midwives, and community-based focus group discussions. Data on unsafe abortions in Timor-Leste are rarely recorded. A small number of cases of abortion and infanticide are reported but are rarely prosecuted, due to deficiencies in evidence and procedure. While there are voices supporting law reform, the Roman Catholic church heavily influences public policy and opinion. Professional views on when abortion should be legal varied, but in the community people believed that saving women’s lives was paramount and came before the law. The revised Penal Code is insufficient to reduce unsafe abortion and maternal mortality. Change will be slow, but access to safe abortion and modern contraception are crucial to women’s ability to participate fully as citizens in Timor-Leste.

Joyce Kinaro, et al., have posted Unsafe Abortion and Abortion Care in Khartoum, Sudan on SSRN.  Here is the abstract:

Globe Unsafe abortion in Sudan results in significant morbidity and mortality. This study of treatment for complications of unsafe abortion in five hospitals in Khartoum, Sudan, included a review of hospital records and a survey of 726 patients seeking abortion-related care from 27 October 2007 to 31 January 2008, an interview of a provider of post-abortion care and focus group discussions with community leaders. Findings demonstrate enormous unmet need for safe abortion services. Abortion is legally restricted in Sudan to circumstances where the woman's life is at risk or in cases of rape. Post-abortion care is not easily accessible. In a country struggling with poverty, internal displacement, rural dwelling, and a dearth of trained doctors, mid-level providers are not allowed to provide post-abortion care or prescribe contraception. The vast majority of the 726 abortion patients in the five hospitals were treated with dilatation and curettage (D&C), and only 12.3% were discharged with a contraceptive method. Some women waited long hours before treatment was provided; 14.5% of them had to wait for 5-8 hours and 7.3% for 9-12 hours. Mid-level providers should be trained in safe abortion care and post-abortion care to make these services accessible to a wider community in Sudan. Guidelines should be developed on quality of care and should mandate the use of manual vacuum aspiration or misoprostol for medical abortion instead of D&C.

Lidia C. Casas, et al., have posted Invoking Conscientious Objection in Reproductive Health Care: Evolving Issues in Peru, Mexico and Chile on SSRN.  Here is the abstract:

As Latin American countries seek to guarantee sexual and reproductive health and rights, opponents of women's rights and reproductive choice have become more strident in their opposition, and are increasingly claiming conscientious objection to providing these services. Conscientious objection must be seen in the context of the rights and interests at stake, including women's health needs and right to self-determination. An analysis of law and policy on conscientious objection in Peru, Mexico and Chile shows that it is being used to erode women's rights, especially where it is construed to have no limits, as in Peru. Conscientious objection must be distinguished from politically-motivated attempts to undermine the law; otherwise, the still fragile re-democratisation processes underway in Latin America may be placed at risk. True conscientious objection requires that a balance be struck between the rights of the objector and the health rights of patients, in this case women. Health care providers are entitled to their beliefs and to have those beliefs accommodated, but it is neither viable nor ethically acceptable for conscientious objectors to exercise this right without regard for the right to health care of others, or for policy and services to be rendered ineffectual because of individual objectors.

Romeo B. Lee, et al., have posted The Influence of Local Policy on Contraceptive Provision and Use in Three Locales in the Philippines on SSRN.  Here is the abstract:

The Philippines has a family planning programme, but modern contraceptive prevalence has been moderate. Among low-income women, fewer are using modern methods, resulting in a fertility rate among them of 5.9. This limited use is due to lack of consistent national and local government support for modern methods because of religious opposition. Following devolution of responsibility for health services to local government in 1991, three local leaders – in Laguna Province and the cities of Manila and Puerto Princesa – passed anti-modern contraceptive policies. This paper analyses the status and impact of these policies, using information from interviews with local government officials and family planning officers, published data and studies, and accounts in national newspapers. In Laguna Province and Puerto Princesa, the policies were ineffectually implemented or short-lived. The strictly-enforced Manila law, however, has severely disrupted the city's provision of free contraception to and method use by low-income women. The great majority of Filipinos (89%) approve of modern contraceptives. There is an urgent need to improve low-income women's access to modern contraceptives through itinerant and community-based distribution, especially in poor neighbourhoods in Manila, but also throughout the country. Strategies for increasing local government support for and provision of modern methods are also needed.

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