Using the Social Ecological Model to Analyze Population Access to Abortion Care in Costa Rica: A Qualitative Study Restricted; Files Only
Halper, Emma (Spring 2023)
Published
Abstract
Background: In Costa Rica, abortion is criminalized in all instances except “when the life of the woman is at risk”. Despite restrictions, individuals living in Costa Rica still seek abortion services outside of the public healthcare system. There is very little published literature that explores abortion access in Costa Rica or on the attitudes and opinions of the medical community and key policy makers, both of whom are involved in both shaping and implementing abortion policy in Costa Rica. No published research is available regarding the vulnerable populations’ unique barriers to accessing safe abortion services in Costa Rica.
Methods: We conducted 22 in depth-interviews (IDIs) with OB/GYN clinicians (n=10) OB/GYN medical residents (n=3) and key policy stakeholders (n=8). We coded IDIs and analyzed them for themes using MAXQDA. The lead author completed additional analysis using the Social Ecological Model (SEM) to analyze determinants of abortion access for the general population and for vulnerable populations.
Results: A range of factors across the SEM were identified as impacting abortion access in Costa Rica. Both clinicians and stakeholders described barriers and facilitators to accessing abortion services and unique considerations for vulnerable populations. Themes at each level of SEM included access to comprehensive sexual health education (individual), interpersonal networks and familial support (interpersonal), gender biases and abortion stigma (community), provider abortion training, policy knowledge, stigma, beliefs and fear, and differences between public and private facilities (institutional/health system), migratory status, financial status, and the impact of religion on abortion policy (structural).
Conclusions: This is a unique study that contributes to a gap in published research around social determinants of abortion in Costa Rica, as well as around attitudes and opinions of the medical and stakeholder communities about abortion access and perceived barriers and facilitators to care. The study findings highlight an opportunity for expanded access to comprehensive sexual health education, abortion training for healthcare providers, and increased programming and advocacy efforts for safe abortion care and reproductive healthcare services, more broadly, for populations living in situations of vulnerability in Costa Rica.
Table of Contents
CHAPTER 1: INTRODUCTION............... 1
Background............ 1
Objectives and Significance...........1
A Note About Language.......... 2
CHAPTER 2: LITERATURE REVIEW........ 3
Unintended Pregnancy............ 3
SRH & Abortion Policy Landscape in Latin America.......... 16
Costa Rican Context......... 24
Gaps in the Literature......... 40
CHAPTER 3: MANUSCRIPT......... 43
Abstract......... 43
Introduction.......... 43
Methods........ 45
Results....... 47
Discussion.......... 60
CHAPTER 4: PUBLIC HEALTH IMPLICATIONS......... 64
REFERENCES........ 71
APPENDIXES.......... 85
Appendix A. English In-Depth Interview Guide: Clinicians and Medical Residents.......... 85
Appendix B. Spanish In-Depth Interview Guide: Clinicians and Medical Residents........... 88
Appendix C: English In-Depth Interview Guide: Stakeholders......... 91
Appendix D. Spanish In-Depth Interview Guide: Stakeholders............ 94
About this Master's Thesis
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File download under embargo until 18 May 2025 | 2023-04-14 18:49:03 -0400 | File download under embargo until 18 May 2025 |
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