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Implementing the liberalized abortion law in Kigali, Rwanda: Ambiguities of rights and responsibilities among health care providers
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
Univ Rwanda, Sch Med & Pharm, Dept Obstet & Gynecol, Coll Med & Hlth Sci, POB 3286, Kigali, Rwanda; Univ Teaching Hosp Kigali, Dept Clin Res, BP 655, Kigali, Rwanda.
Dalarna Univ, Sch Educ Hlth & Social Studies, SE-79188 Falun, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
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2020 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 80, article id 102568Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Rwanda amended its abortions law in 2012 to allow for induced abortion under certain circumstances. We explore how Rwandan health care providers (HCP) understand the law and implement it in their clinical practice.

DESIGN: Fifty-two HCPs involved in post-abortion care in Kigali were interviewed by qualitative individual in-depth interviews (n =32) and in focus group discussions (n =5) in year 2013, 2014, and 2016. All data were analyzed using thematic analysis.

FINDINGS: HCPs express ambiguities on their rights and responsibilities when providing abortion care. A prominent finding was the uncertainties about the legal status of abortion, indicating that HCPs may rely on outdated regulations. A reluctance to be identified as an abortion provider was noticeable due to fear of occupational stigma. The dilemma of liability and litigation was present, and particularly care providers' legal responsibility on whether to report a woman who discloses an illegal abortion.

CONCLUSION: The lack of professional consensus is creating barriers to the realization of safe abortion care within the legal framework, and challenge patients right for confidentiality. This bring consequences on girl's and women's reproductive health in the setting.

IMPLICATIONS FOR PRACTICE: To implement the amended abortion law and to provide equitable maternal care, the clinical and ethical guidelines for HCPs need to be revisited.

Place, publisher, year, edition, pages
2020. Vol. 80, article id 102568
Keywords [en]
Maternal morbidity, Maternal near miss, Post-abortion care, Stigma
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-397483DOI: 10.1016/j.midw.2019.102568ISI: 000500915600005PubMedID: 31698295OAI: oai:DiVA.org:uu-397483DiVA, id: diva2:1371739
Funder
Sida - Swedish International Development Cooperation Agency, SWE 2010-060Available from: 2019-11-20 Created: 2019-11-20 Last updated: 2020-01-20Bibliographically approved

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Påfs, JessicaKlingberg Allvin, MarieBinder, PaulineMusafili, AimableEssén, Birgitta

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