“I’m Not Going to Judge but I’m Not Going to Do it”: The Implications of Physician Inaction on Abortion Care in Costa Rica Restricted; Files Only
Cole, Whitney (Spring 2023)
Abstract
Background
Unsafe abortion accounts for an estimated 10% of maternal mortality in Latin America, though no relevant data are available for Costa Rica. There are much higher rates of unsafe abortion in environments where abortion is restricted. In Costa Rica, induced abortion is only legally permissible to save the life or health of the pregnant individual. Costa Rica's 2019 "Technical Standard" aimed to clarify abortion protocols and gave healthcare professionals the right to opt out of providing abortions for ethical, moral, or religious reasons. Use of conscientious objection creates barriers to legal abortion services and may cause pregnant individuals to procure extra-legal abortions, which are more likely to be unsafe.
Objectives
To understand what influences healthcare practitioners’ perspectives on the ethics of abortion, willingness to provide abortions, and, specifically, the use of conscientious objection in Costa Rica.
Methods
Obstetrician-gynecologists and medical residents practicing at public and private hospitals in San José, Costa Rica were interviewed using semi-structured, in-depth interviews. Interviews were coded in pairs and analyzed using thematic analysis.
Results
Most study participants considered abortion to be ethically justifiable in more circumstances than those permitted by law in Costa Rica. Many believed physicians should be the ones to decide whether an abortion is ethical. Participants discussed a lack of clarity on abortion law, fear of legal repercussions, situational judgment as the main reasons to not provide abortion services.
Conclusion
Physicians may refuse to provide abortions due to fear of legal repercussions even when they believe an abortion to be ethically justified. Initiatives to sensitize and familiarize physicians with current laws could prevent overuse of conscientious objection and may increase participation in the provision of abortion services.
Table of Contents
Table of Contents
Chapter 1. Background ……………………………………………………………..........…………… 1
Terminology ………………………………………………………………………..…................ 1
Abortion Worldwide ……………………………………………………………………............. 1
Abortion in Latin America ……………………………………………………………............. 3
Abortion in Costa Rica ………………………………………………………………............…. 4
Abortion Law in Costa Rica ……………………………………………………………............ 7
Chapter 2. Literature Review ……………………………………………………………............… 10
Conscientious Objection ………………………………………………………..........………. 10
Conscientious Responsibility …………………………………………………………........... 12
Participation of the Medical Community in Abortion Policy …………..………………. 13
Research Gaps ………………………………………………………………….............………..15
Problem Statement …………………………………………………………...........………….. 16
Chapter 3. Methods ………………………………………………………………………….........…. 18
Chapter 4. Manuscript …………………………………………………………………………......... 22
Chapter 5. Public Health Implications ………………………………………………………….... 43
Conclusion ……………………………………………………………………………............... 45
Appendix A. Clinician Interview Guide …………………………………………………….…..... 46
Appendix B. WHO’s Recommended Training Content for Abortion Service Providers ... 49
References …………………………………………………………………………………..........…… 50
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File download under embargo until 18 May 2025 | 2023-04-20 02:30:05 -0400 | File download under embargo until 18 May 2025 |
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