Physicians, abortion provision and the legitimacy paradox

Harris, Lisa H.; Martin, Lisa; Debbink, Michelle; Hassinger, J.

doi:10.1016/j.contraception.2012.08.031

Cited by 72 publications

(53 citation statements)

References 7 publications

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“…In the USA, Harris et al advanced the concept of courtesy stigma by describing both the negative stereotypes of abortion providers and the multiple levels at which providers experience stigma, as well as developing tools to measure abortion stigma [43]. Importantly, abortion provider stigmatisation has implications for the psychosocial well-being of TOP providers, availability of scarce human resources, patient safety and health policy [21]. …”

Section: Discussionmentioning

confidence: 99%

‘I am all alone’: factors influencing the provision of termination of pregnancy services in two South African provinces

Teffo

Rispel

2017

Global Health Action

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Background: Globally, universal access to sexual and reproductive health care services has been re-emphasised. One-third of maternal deaths could be averted by improving access to safe abortion services. Anecdotal evidence suggests that the implementation of the Choice of Termination of Pregnancy Act has been suboptimal in South Africa. Objectives: In two South African provinces, determine: the proportion of designated termination of pregnancy (TOP) facilities that provide these services; explore the factors that influence the provision of TOP services; and explore the work experiences of health care providers at designated TOP facilities. Methods: During 2014 and 2015, we conducted a cross-sectional study at designated TOP facilities in Gauteng and North West provinces. A combination of methods was used, consisting of: site visits to, and observation of, each of the designated facilities using a checklist, and in-depth interviews with a sub-set of 30 TOP service providers, using a semi-structured interview schedule. The interview questions focused on the factors influencing TOP service provision, and the work experiences of TOP service providers. We used interpretative phenomenological analysis to analyse the data from the interviews. Results: Overall, 77% (47/61) of designated facilities were providing TOP services, with 87.5% (28/32) in Gauteng Province, compared with 65.5% (19/29) in North West Province. Service provision was influenced by health system deficiencies, human resource challenges, lack of prioritisation and lack of management support. Study participants reported a heavy burden of care provision and expressed an overwhelming feeling of loneliness, courtesy stigma and lack of support from other nurses and doctors, which further influence TOP service provision. Conclusions: South Africa has an enabling legal environment for the provision of TOP services. Supportive management, prioritisation of TOP services and employee wellness programmes to address the psychosocial issues experienced by providers are critical elements of an enabling health policy environment.

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Section: Discussionmentioning

confidence: 99%

‘I am all alone’: factors influencing the provision of termination of pregnancy services in two South African provinces

Teffo

Rispel

2017

Global Health Action

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“…The medical record also contributes to what abortion scholars have termed ‘the legitimacy paradox’ of abortion stigma for health care providers (Harris et al, 2012). The lack of disclosure about treating abortion complications among providers reproduces the notion that work involving induced abortion constitutes illegitimate medical practice.…”

Section: Discussionmentioning

confidence: 99%

“…In the United States, abortion may be perceived as morally corrupt, ‘dirty work’ when equated to murder (O’Donnell, Weitz, & Freedman, 2011). Abortion practice may also mark such physicians as technically inferior to physicians in other areas of medicine (Harris, Debbink, Martin, & Hassinger, 2011; Harris, Martin, Debbink, & Hassinger, 2012). In the United States and Mexico, individuals who practice abortion may experience harassment and violence both inside and outside the work place (Harris et al, 2011; Mollmann, 2006).…”

Section: Introductionmentioning

confidence: 99%

Rewriting abortion: Deploying medical records in jurisdictional negotiation over a forbidden practice in Senegal

Suh

2014

Social Science & Medicine

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Boundary work refers to the strategies deployed by professionals in the arenas of the public, the law and the workplace to define and defend jurisdictional authority. Little attention has been directed to the role of documents in negotiating professional claims. While boundary work over induced abortion has been extensively documented, few studies have examined jurisdictional disputes over the treatment of abortion complications, or post-abortion care (PAC). This study explores how medical providers deploy medical records in boundary work over the treatment of complications of spontaneous and induced abortion in Senegal, where induced abortion is prohibited under any circumstance. Findings are based on an institutional ethnography of Senegal’s national PAC program over a period of 13 months between 2010 and 2011. Data collection methods included in-depth interviews with 36 health care professionals, observation of PAC services at three hospitals, a review of abortion records at each hospital, and a case review of illegal abortions prosecuted by the state. Findings show that health providers produce a particular account of the type of abortion treated through a series of practices such as the patient interview and the clinical exam. Providers obscure induced abortion in medical documents in three ways: the use of terminology that does not differentiate between induced and spontaneous abortion in PAC registers, the omission of data on the type of abortion altogether in PAC registers, and reporting the total number but not the type of abortions treated in hospital data transmitted to state health authorities. The obscuration of suspected induced abortion in the record permits providers to circumvent police inquiry at the hospital. PAC has been implemented in nearly 50 countries worldwide. This study demonstrates the need for additional research on how medical professionals negotiate conflicting medical and legal obligations in the daily practice of treating abortion complications.

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“…Stigma surrounding abortion provision has been described as the "legitimacy paradox" wherein physicians doing abortions are depicted as illegitimate or deviant doctors. They become less likely to disclose their abortion work, which acts to further the social stereotype and alienate providers [23,24]. As a result, some providers may limit their practice to "non-elective" procedures in an attempt to achieve legitimacy.…”

Section: Discussionmentioning

confidence: 99%

Barriers to dilation & evacuation practice among Maternal-Fetal Medicine subspecialists: quantitative and qualitative results from a national survey

Kerns¹,

Lederle²,

Rosenstein³

et al. 2016

Clin Obstet Gynecol Reprod Med

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Objective: To quantitatively and qualitatively describe specific barriers encountered by Maternal-Fetal Medicine (MFM) subspecialists to providing second-trimester termination by dilation and evacuation (D&E) using a mixed methods approach. Methods:We surveyed all members of the Society for Maternal-Fetal Medicine, and all faculty and fellows associated with MFM fellowships regarding practice characteristics and barriers to second-trimester termination. We categorized barrier responses into five categories: lack of training, logistical issues, negative culture, personal issues and no barriers. We compared respondent characteristics across barrier categories. We qualitatively analyzed barrier-related themes from respondents' comments using a grounded theory approach. Results:Of the 689 (32%) physicians who completed the survey, 591 (86%) reported at least one barrier to D&E provision. Main barriers among D&E providers (n=216) and D&E non-providers (N=473) differed, with providers reporting negative culture (37%) and logistical issues (33%) and non-providers reporting personal issues (36%) and lack of training (28%). Qualitative themes related to practice barriers paralleled the above categories. Conclusion:Addressing logistical barriers faced by D&E providers may streamline D&E services. Establishing routine D&E training in MFM fellowships is critical for supporting MFMs who wish to provide D&E. Collaborative partnerships with family planning subspecialists may facilitate this process.

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Physicians, abortion provision and the legitimacy paradox

Cited by 72 publications

References 7 publications

‘I am all alone’: factors influencing the provision of termination of pregnancy services in two South African provinces

‘I am all alone’: factors influencing the provision of termination of pregnancy services in two South African provinces

Rewriting abortion: Deploying medical records in jurisdictional negotiation over a forbidden practice in Senegal

Barriers to dilation & evacuation practice among Maternal-Fetal Medicine subspecialists: quantitative and qualitative results from a national survey

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