Perceptions of unwanted pregnancy, emergency contraception and abortion: a qualitative study of healthcare providers and community leaders in the Amazon Region of Colombia Open Access
Rao, Shreya (2011)
Abstract
Background: Colombia's 2006 decision to liberalize its
abortion policy has made it
one of the most progressive policies in the region to reduce the
practice of unsafe
abortion. In the capital city of the Amazon region, a local
physician and founder of La
Fundación Clínica Leticia identified adolescent
pregnancies and unsafe abortions as
a priority health concern in the community. No research has been
done in this
community to examine experiences of unwanted pregnancy and
abortion.
Objective: Investigators sought to elucidate issues
underlying unwanted
pregnancies and propose solutions for Clínica Leticia. During
the summer of 2010,
we examined healthcare provider and community leader perceptions of
unwanted
pregnancies, emergency contraception (EC) and abortions through a
qualitative
research approach.
Methods: In-depth interviews were conducted with 33
healthcare providers and
community leaders. Interviews were conducted in Spanish,
transcribed verbatim
and coded using MAXQDA10 software.
Results: Providers and leaders reported adolescence,
poverty, poor education,
inadequate access to contraception and local culture as
determinants of what they
called 'irresponsible sexual practices' that lead to unwanted
pregnancy and
abortion. Decision-making for managing an unwanted pregnancy was
influenced by
families and partners, financial considerations, young age and
cultural or religious
disapproval of abortion. Respondents commonly opposed abortion and
its
legalization on moral grounds, while they objected to EC based on
fears of
complications from long-term use. Their perceptions of
irresponsible sexual
behaviors led them to oppose EC and abortion.
Discussion: Participants identified adolescents as a
high-risk group for unwanted
pregnancies and unsafe abortions and suggested a need for sex
education targeted
to this group. Many reported that existing efforts lack consistency
and should be
adapted to address challenges adolescents face in accessing
contraception.
Respondents suggested barriers to preventing unwanted pregnancies
might be
reduced by increasing dialogue about sex and contraception and with
efforts to
promote education and employment opportunities for adolescents.
Increasing
awareness of current abortion laws and judicial decisions among
providers and
women may facilitate improved acceptance of legal abortions in the
region while
increased education about the safety and efficacy of EC products
may address local
barriers to the provision of EC.
Table of Contents
Table of Contents
Chapter 1. Introduction 3
Chapter 2. Literature Review 5
2.1 Abortion and Emergency Contraception 5
2.1.1 Abortion in Colombia 7
2.1.2 Emergency Contraception 12
2.1.3 Areas for Future Research 14
2.2 Background on Colombia and Las Amazonas 17
2.2.1 General Demographic Information 17
2.2.2 Politics 19
2.2.3 Religion 20
2.2.4 The Amazon Region 21
Chapter 3. Manuscript 22
3.0 Abstract 24
3.1 Introduction 25
3.2 Methods 26
3.3 Results 34
3.3.1 Table 1. Summary of participant demographic characteristics in the Amazon region of Colombia, 2010 35
3.3.2 Figure 1. Provider and community leader perceptions of the causes, decision-making and acceptability of unwanted pregnancy and abortion among adolescents in the Amazon region of Colombia, 2010 37
3.3.3 Causes and Social Determinants of Unwanted Pregnancy 38
3.3.3.1 Figure 2. Provider and leader perceptions of "irresponsibility" as it applies to sexual behaviors in the Amazon region of Colombia, 2010 39
3.3.4 Decision-making for Women Experiencing an Unwanted Pregnancy 43
3.3.5 Cultural Acceptability of Abortion 52
3.4 Discussion 61
Chapter 4. Conclusions and Policy Recommendations 67
References 70
Appendix A. Informed Consent 73
English 73 Spanish 75
Appendix B. In-Depth Interview Guide 77
English 77
Spanish 82
Appendix C. Participant Line Listing: Demographic Information 88About this Master's Thesis
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