Medical society engagement in contentious policy reform: the Ethiopian Society for Obstetricians and Gynecologists (ESOG) and Ethiopia’s 2005 reform of its Penal Code on abortion

Abstract

Unsafe abortion is one of the three leading causes of maternal mortality in low-income countries; however, few countries have reformed their laws to permit safer, legal abortion, and professional medical associations have not tended to spearhead this type of reform. Support from a professional association typically carries more weight than does that from an individual medical professional. However, theory predicts and the empirical record largely reveals that medical associations shy from engagement in conflictual policymaking such as on abortion, except when professional autonomy or income is at stake. Using interviews with 10 obstetrician–gynaecologists and 44 other leaders familiar with Ethiopia’s reproductive health policy context, as well as other primary and secondary sources, this research examines why, counter to theoretical expectations from the sociology of medical professions literature and experience elsewhere, the Ethiopian Society of Obstetricians & Gynecologists (ESOG) actively supported reform of national law on abortion. ESOG leadership participation was motivated by both individual and ESOG’s organizational commitments to reducing maternal mortality and also by professional training and work experience. Further, typical constraints on medical society involvement in policymaking were relaxed or removed, including those related to ESOG’s organizational structure and history, and to political environment. Findings do not contradict theory positing medical society avoidance of socially conflictual health policymaking, but rather identify how the expected restrictions were less present in Ethiopia, facilitating medical society participation. Results can inform efforts to encourage medical society participation in policy reform to improve women’s health elsewhere in sub-Saharan Africa.

Advocating safe abortion: outcomes of a multi‐country needs assessment on the potential role of national societies of obstetrics and gynecology

“…24 30,31 Factors that facilitated reform in these countries were organizational commitments to reduce maternal mortality and a vocal public health sector, in addition to an active civil society movement, favorable public opinion, and the right political momentum. abortion.…”

“…This phenomenon is not new, given the historical experience and empirical evidence as described by Holcombe. 24 It is rare for medical societies, by nature collectives of autonomous professionals, to be at the forefront of policy reform to politically sensitive issues, unless professional autonomy or income is at stake. While the right to autonomous decisions such as conscientious objection should be secondary to the provider's duty to treat and prevent harm, in practice professional autonomy has often overruled scientific evidence and (inter)national ethical statements on abortion and women's rights.…”

“…While the right to autonomous decisions such as conscientious objection should be secondary to the provider's duty to treat and prevent harm, in practice professional autonomy has often overruled scientific evidence and (inter)national ethical statements on abortion and women's rights. [24][25][26][27] However, several ObGyn societies in other countries have successfully deployed their role as advocates to publicly support abortion reform. In Ethiopia the ObGyn society actively supported the 2005 liberalization of abortion 24 and more recently this happened in Uruguay 28 and Ireland.…”

“…[24][25][26][27] However, several ObGyn societies in other countries have successfully deployed their role as advocates to publicly support abortion reform. In Ethiopia the ObGyn society actively supported the 2005 liberalization of abortion 24 and more recently this happened in Uruguay 28 and Ireland. 29 In the United Kingdom, the Royal College of Obstetricians and Gynaecologists (RCOG) has recently established an abortion task force, advocating the decriminalization of abortion and bringing abortion services back into the public health sector.…”

“…30,31 Factors that facilitated reform in these countries were organizational commitments to reduce maternal mortality and a vocal public health sector, in addition to an active civil society movement, favorable public opinion, and the right political momentum. 18,24,28,32 This implies that, to become stronger advocates for safe abortion, ObGyn societies will have to deepen their internal reflections and discussions, as well as strengthen their interplay with civil society, other medical bodies, and the political environment. Only when ObGyn societies are clear on their own position in relation to safe abortion and its contribution to maternal health, can they facilitate this interplay with partners to improve safe abortion advocacy.…”