Physician Opinions Toward Legal Abortion in Bogotá, Colombia: Barriers and Facilitators, 2014 Public

Abstract

Background: Since the Colombian Constitutional Court decriminalized abortion in selected situations in 2006, the number of illegal, clandestine abortions has remained, endangering women's health and contributing to maternal mortality and morbidity.

Goal: The goal of this project is to understand the factors influencing physician´s option on abortion provision in different clinical cases in Bogotá, Colombia.

Methodology: The research team conducted twelve qualitative key informant interviews with advocates, doctors and program directors in Bogotá, Colombia. Researchers then conducted quantitative surveys with a cluster probability sample of doctors working in public hospitals in Bogotá. Researchers then conducted a thematic analysis of the key informant interviews and descriptive analysis using SAS.

Results: Key informants described ignorance of the law, lack of abortion inclusion in medical school curriculum, and cultural barriers as key physician-side barriers to legal abortion. In the survey, 34% of respondents had performed an abortion and 51% had referred for an abortion (n=49). In a predictive model for belief toward legal abortion, male sex (OR: 0.04, 95% CI: 0.01, 0.20) and self-reported religiosity (OR: 0.36 95% CI: 0.18, 0.698) were inversely associated with believing abortion should always be legal. Having seen an abortion complication was not predictive of believing abortion should always be legal (OR: 2.09 95% CI: 0.56, 7.84).

Discussion: Though respondents reported a variety of options and knowledge regarding abortion techniques and the legal framework for abortion, many physician side barriers to accessing legal abortion remain.

Table of Contents

Introduction. 1

Problem Statement. 1

Purpose Statement. 3

Significance. 3

Literature Review. 4

Abortion Legalization and Public Health. 4

Abortion and Human Rights. 6

Abortion in Latin America. 7

Decriminalization of Abortion in Colombia. 8

Estimates of Abortion Incidence in Colombia. 9

Barriers to Legal Abortion in Colombia. 14

Physician Attitudes towards Abortion. 15

Conscientious Objection to Abortion.18

Delays in Accessing Abortion Care. 19

Characteristics of Colombian Women Who Seek Abortions. 19

Methods of Abortion. 20

Methods. 22

Population. 22

Qualitative Data. 23

Procedures and Sampling. 23

Qualitative Data Analysis. 24

Quantitative Data. 25

Procedures and Sampling. 25

Quantitative Data Analysis. 26

Ethical Approval. 27

Results. 28

Qualitative Results. 28

Ignorance of the Law. 28

Legal Barriers. 30

Gestational Age. 31

Medical Education. 32

Cultural Barriers. 33

Survey Results. 34

Strengths and Limitations. 42

Discussion. 44

Resource List. 49

Appendix. 53

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Obstetrics and Gynecology Health Sciences, Public Health
Mot-clé	Legal abortion Reproductive health Colombia
Committee Chair / Thesis Advisor	Rochat, Roger, Emory University
Committee Members	Comeau, Dawn L, Emory University

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