Prevalence, Attitudes, and Factors Motivating Conscientious Objection toward Reproductive Health among Medical Students

Abstract

Objective We have evaluated the prevalence of and the motivating factors behind the refusal to provide reproductive health services and the ethical knowledge of the subject among medical students from the Escola Bahiana de Medicina e Saúde Pública, in the state of Bahia, Brazil. Methods The present cross-sectional study involved 120 medical students. A questionnaire was utilized. The dependent variables were students' objections (or not) regarding three clinical reproductive health cases: abortion provided by law, contraceptive guidance to an adolescent without parental consent, and prescription of emergency contraception. The independent variables were age, gender, religion, ethical value, degree of religiosity, and attendance at worship services. Ethical knowledge comprised an obligation to state the reasons for the objection, report possible alternatives, and referral to another professional. Data were analyzed with χ2 tests and t-tests with a significance level of 5%. Results Abortion, contraception to adolescents, and emergency contraception were refused by 35.8%, 17.5%, and 5.8% of the students, respectively. High religiosity (p < 0.001) and higher attendance at worship services (p = 0.034) were predictors of refusing abortion. Refusal to provide contraception to adolescents was significantly higher among women than men (p = 0.037). Furthermore, 25% would not explain the reason for the refusal, 15% would not describe all the procedures used, and 25% would not refer the patient to another professional. Conclusion Abortion provided by law was the most objectionable situation. The motivating factors for this refusal were high commitment and religiosity. A reasonable portion of the students did not demonstrate ethical knowledge about the subject.

Aborto legal no Brasil: revisão sistemática da produção científica, 2008-2018

“…Faúndes et al 27 explored opinions regarding the criminalization of abortion and found low approval (9.9%) for imprisoning women who have had abortions, especially among older, non-religious students. Being religious was the factor most closely associated with restrictive positions 27,29,31 .…”

“…A single article described the results of a census of legal abortion services in the country, analyzing their structure and operations, the characteristics of the women who received care at these services and the perspective of their professionals 14 ; another five studies, of local scope, described the characteristics of women admitted to hospitals for abortion following a rape, the reasons for the decision to have an abortion and repercussions for personal and day-to-day relationships 17,18,19,20,21 . Most studies investigated the behavior, knowledge and opinion of agents involved in providing legal abortion care, whether they were health professionals 16,22,23,24 or medical students 25,26,27,28,29,30,31 . Three studies addressed the theme of malformations and court authorizations for abortion 15,32,33 (Table 2).…”

“…Approval of current rules regarding legal abortion varied between 48% and 90% 27,30 . Objection of conscience was frequently invoked, varying between 4.1% and 71.4%, depending on reason for the abortion and religiousness 29,31 . It was higher for cases of rape (50.8%) 29 and among the more religious (71.4%) 31 .…”

“…Objection of conscience was frequently invoked, varying between 4.1% and 71.4%, depending on reason for the abortion and religiousness 29,31 . It was higher for cases of rape (50.8%) 29 and among the more religious (71.4%) 31 . Aspects of ethical responsibilization connected to objection, such as providing guidance and referring the woman to another professional, were unknown to around 25% of students 31 , or would be denied, depending on the reason for the abortion 29 .…”

“…Aspects of ethical responsibilization connected to objection, such as providing guidance and referring the woman to another professional, were unknown to around 25% of students 31 , or would be denied, depending on the reason for the abortion 29 . The refusal to provide guidance was more common for cases of rape (72.5%) than for those in which the pregnant women's life was at risk (17.3%) 29 , and more common among religious students (40.7%) 31 .…”