Values clarification workshops to improve abortion knowledge, attitudes and intentions: a pre-post assessment in 12 countries

Turner, Katherine; Pearson, Erin; George, Allison; Andersen, Kathryn

doi:10.1186/s12978-018-0480-0

Cited by 68 publications

(49 citation statements)

References 22 publications

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“…Mother church positions on abortion are normally that of pro-life hence less or no involvement of their staffs in post-abortion and comprehensive abortion care-related pieces of training. Post-abortion care training exposes healthcare providers to value clari cation and attitude transformation (VCAT), a very important tool in clarifying about abortion service provision in some circumstances (17). Exposure and training may also explain a positive association about providers who are 40 years and older and an employed in Non-for-pro t NGO health facilities in general support for abortion provision, coe cients 0.85 and 0.67 respectively.…”

Section: Discussionmentioning

confidence: 99%

Healthcare providers’ practice and attitude towards abortion service provision in Gulu city, Northern Uganda

Pebalo¹,

Grace²,

Obol³

2020

Preprint

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Background: Unsafe abortion is a growing public health problem concern globally despite being preventable. The World Health Organization estimates that about 20 million pregnancies results into unsafe abortion globally. The proportion of unsafe abortion has been increasing with developing countries contributing about 97% of unsafe abortions cases including Uganda. Unsafe abortion is among the four leading causes of pregnancy related mortality, injuries, and disability globally. The restrictive abortion laws and religious situation make abortion a highly controversial social issue in Uganda leading to high stigma in the society, and a majority of the healthcare providers are reluctant to perform an abortion even if indicated for fear of possible legal consequences.Methods: We conducted survey among health worker about knowledge of complications, practice, and attitudes of induced abortion between September and November 2019 among 252 healthcare providers in Gulu Municipality, Northern Uganda. Multivariate analysis showed associations between healthcare providers' characteristics and adequate knowledge about abortion complications. Ordinary least square regression analysis found associations between providers' characteristics and their intention for general support, generally not in support, conditional support for abortion provision, as well as their personal attitudes and beliefs against or towards abortion provision.Results: The mean attitudinal score for generally in support, generally not in support, conditional in support, personal attitude, and beliefs against and toward abortion provision were 2.80, 2.71, 2.86, 3.239, and 3.35 respectively. Participants who were married and practice Anglican religion were more likely to have good knowledge of abortion complications, p-values 0.035, and 0.042 respectively, meanwhile participants who were employed in faith-based facilities were more likely to have poor knowledge of abortion complications p-value 0.002.Conclusion: Ministry of Health and stakeholders need to provide training of health workers to improve quality of abortion services. Medical training institutions should ensure that students understand the laws and responsibilities that govern their professional actions with respect to abortion care regardless of their personal views, beliefs, and attitudes.

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Section: Discussionmentioning

confidence: 99%

Healthcare providers’ practice and attitude towards abortion service provision in Gulu city, Northern Uganda

Pebalo¹,

Grace²,

Obol³

2020

Preprint

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“…These findings provide guidance for effective interventions. Given the benefits seen from values clarification exercises, and a Providers Share workshop, 24,25 Catholic physicians will likely benefit from similar workshops tailored to the inherent conflicts and the sensitive nature of this intersection of medicine and religion. Understanding the dilemmas faced by Catholic obstetrician-gynecologists and their moral and ethical decision-making can improve discourse on this topic and help destigmatize the varying choices Catholic patients and health professionals make.…”

Section: Discussionmentioning

confidence: 99%

Integration of Catholic Values and Professional Obligations in the Provision of Family Planning Services

et al. 2020

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IMPORTANCE Religious leaders of the Catholic church created guidelines for practicing medicine, that involve reproductive care restrictions that may conflict with professional obligations. OBJECTIVE To explore how Catholic obstetrician-gynecologists integrate their religious values and professional obligations related to family planning services. DESIGN, SETTING, AND PARTICIPANTS In this qualitative investigation, in 2018, US-based obstetrician-gynecologists were recruited through an online survey and were invited to participate in audio-recorded telephone interviews using a semistructured interview guide. Participants were obstetrician-gynecologists who self-identified as Catholic and reported providing reproductive health care as follows: (1) provide natural family planning only (low practitioners), (2) provide additional contraceptive methods (moderate practitioners), and (3) provide family planning services including abortion (high practitioners). The study purposively sampled those with higher selfreported religiosity. Data were analyzed from November 2018 to February 2019. MAIN OUTCOMES AND MEASURES The primary outcome was understanding how participants describe integration of Catholic values with family planning service provision. The telephone interviews explored their integration of Catholic values and professional obligations, and 3 coders analyzed the responses using grounded theory. RESULTS Among the 34 Catholic obstetrician-gynecologists interviewed (27 women [79.4%]), there were 10 low, 15 moderate, and 9 high practitioners from 19 states. Participants' description of morality was consistent with Albert Bandura's Social-Cognitive Theory of Moral Thought and Action. The findings were used to create a modified framework. Within each group of physicians, 3 themes demonstrating their reconciliations between Catholic values and professional obligations emerged; each of these themes reflected one of the medical ethical principles of autonomy, beneficence, nonmaleficence, or justice. All 10 low practitioners primarily promoted natural family planning approaches to avoid iatrogenic risks and none provided abortion, reflecting nonmaleficence. Alternatively, moderate practitioners focused on nonmaleficence by offering contraception to prevent abortions. High practitioners primarily promoted patient autonomy by separating religious doctrine from medical practice. All had concerns for beneficence. In each group, 1 of the 4 medical ethical principles was underrepresented. CONCLUSIONS AND RELEVANCE In this qualitative analysis, Catholic obstetrician-gynecologists establish their family planning care provision practices by emphasizing certain moral and/or ethical principles over others. These findings highlight how physician morality in the realm of family planning service provision often involves certain religious and/or professional reconciliations. Understanding (continued) Key Points Question How do Catholic obstetriciangynecologists integrate their religious beliefs with family planning services? Findings In ...

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“…All selected the combined training. A values clari cation and attitude transformation (VCAT) session is strongly recommended in advance of the uterine evacuation with medications and MVA trainings [30]. As such, a one-day VCAT workshop preceded the clinical training in Nigeria.…”

Section: Interventionmentioning

confidence: 99%

Strengthening healthcare providers’ capacity for safe abortion and post-abortion care services in humanitarian settings: lessons learned from the clinical outreach refresher training model (S-CORT) in Uganda, Nigeria, and the Democratic Republic of Congo

Tran

Greer

Dah³

et al. 2020

Preprint

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BackgroundFragile and crisis-affected countries account for most maternal deaths worldwide, with unsafe abortion being one of its leading causes. This paper aims to describe the Clinical Outreach Refresher Training strategy for sexual and reproductive health (S-CORT) designed to update health providers’ competencies on uterine evacuation using both medications and manual vacuum aspiration. The paper also explores stakeholders’ experiences and recommendations for improvement.MethodsUsing mixed methods, we evaluated three training workshops that piloted the uterine evacuation module in 2019 in humanitarian contexts of Uganda, Nigeria, and the Democratic Republic of Congo.ResultsResults from the workshops converged to suggest that the module contributed to increasing participants’ theoretical knowledge, technical and counseling skills, confidence, and positive attitudinal changes that promote a rights-based, fearless, non-judgmental, and non-discriminatory approach toward clients. Participants valued the hands-on, humanistic, and competency-based training methodology, although most regretted the short training duration. Recommendations to improve the capacity development continuum of uterine evacuation included recruiting the appropriate health cadres for the training; sharing printed pre-reading materials to all participants; sustaining the availability of medication and supplies to offer services to clients after the training; and helping staff through supportive supervision visits to accelerate skills transfer from training to clinic settings.ConclusionsWhen the lack of skilled human resources is a barrier to lifesaving uterine evacuation services in humanitarian settings, the S-CORT strategy could offer a rapid hands-on refresher training opportunity for service providers needing an update in knowledge and skills. Such a capacity-building approach could be useful in humanitarian and fragile settings as well as in development settings with limited resources as part of an overall effort to strengthen other building blocks of the health system.

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Values clarification workshops to improve abortion knowledge, attitudes and intentions: a pre-post assessment in 12 countries

Cited by 68 publications

References 22 publications

Healthcare providers’ practice and attitude towards abortion service provision in Gulu city, Northern Uganda

Healthcare providers’ practice and attitude towards abortion service provision in Gulu city, Northern Uganda

Integration of Catholic Values and Professional Obligations in the Provision of Family Planning Services

Strengthening healthcare providers’ capacity for safe abortion and post-abortion care services in humanitarian settings: lessons learned from the clinical outreach refresher training model (S-CORT) in Uganda, Nigeria, and the Democratic Republic of Congo

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