Abstract
Purpose
Health service providers play a crucial role in providing post abortion care in countries where abortion legislation is restrictive and abortion is stigmatised. Research in countries where these factors apply has shown that health service providers can be barriers to women accessing post abortion services. Much of this research draws from attitude theory. In this paper, we utilise positioning theory to show how the ways in which Zimbabwean health service providers’ position women and themselves are rooted in cultural and social power relations. In light of recent efforts by the Zimbabwean Ministry of Health and foreign organisations to improve post abortion care, we explore the implications that these positionings have for post abortion care.
Method
As part of a larger study on abortion decision-making, the data featured in this article were collected using in-depth semi-structured interviews with six health service providers working in different facilities in Harare, Zimbabwe. Discursive and positioning thematic analysis was used to analyse the data.
Results
Our analysis points to women who have abortions being positioned in negative terms, as transgressors of acceptable norms; irresponsible and manipulative; and ignorant. The health service providers drew from cultural, religious, gender and trauma discourses that portray abortion as evil and socially unacceptable. Reflexive positions taken up by the health service providers include positions as being experts, helpers and protectors of culture/religion, sympathisers and professional positions as health care providers.
Conclusion
The continued strengthening of post abortion services should be conducted in conjunction with dialogical interventions that challenge health service providers to reflect on the power relations within which women who terminate pregnancies are located, that contest their negative positionings of these women and that present alternative narratives and subject positionings for both the women who have abortions and the health service providers.
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Harries J, Stinson K, Orner P. Health care providers’ attitudes towards termination of pregnancy: a qualitative study in South Africa. BMC Public Health. 2009;9:296–307.
Vlassoff M, Singh S, Suárez G, Jafarey SN. Post abortion care in Pakistan. 2013. https://www.guttmacher.org/report/postabortion-care-pakistan. Accessed 15 July 2016.
Maternowska MC, Mashu A, Moyo P, Withers M, Chipato T. Perceptions of misoprostol among providers and women seeking post-abortion care in Zimbabwe. Reprod Health Matters. 2015;44:16–25.
Jewkes R, Gumede T, Westaway M, Dickson K, Brown H, Rees H. Why are women still aborting outside designated facilities in metropolitan South Africa? Int J Obstet Gynaecol. 2005;1:36–42.
Gresh A, Maharaj PA. Qualitative assessment of the acceptability and potential demand for medical abortion among university students in Durban, South Africa. Eur J Contracept Reprod Health Care. 2011;16:67–75.
Schwandt HM, Creanga AA, Richard MK, Adanu K, Danso A, Tsiri A, et al. Pathways to unsafe abortion in Ghana: the role of male partners, women and health care providers. Contraception. 2013;88:509–17.
Warenius LU, Faxelid EA, Chishimba PN, Musandu JO, Ong’any AA, Nissen EBM. Nurse-midwives’ attitudes towards adolescent sexual and reproductive health needs in Kenya and Zambia. Reprod Health Matters. 2006;14(27):119–28.
Lipp A. Conceding and concealing judgement in termination of pregnancy: a grounded theory study. J Res Nurs. 2009;15(4):365–78.
Silva M, Billings DL, García SG, Lara D. Physicians' agreement with and willingness to provide abortion services in the case of pregnancy from rape in Mexico. Contraception. 2009;79:56–64.
Castañeda MA, Billings DL, Blanco J. Abortion beliefs and practices among midwives (parteras) in a rural Mexican township. Women Health. 2003;37(2):73–87.
Aniteye P, Mayhew S. Shaping legal abortion provision in Ghana: using policy theory to understand provider-related obstacles to policy implementation. Health Res Policy Syst. 2013;11:1–14.
Harries J, Lince N, Constant D, Hargey A, Grossman D. The challenges of offering public second trimester abortion services South Africa: health care providers perspectives. J Biosoc Sci. 2012;44(02):197–208.
Kasule J, Mbizvo MT, Gupta V. Abortion: attitudes and perceptions of health professionals in Zimbabwe. Cent Afr J Med. 1999;45(9):239–44.
Potter J, Wetherell M. Discourse and social psychology: beyond attitudes and behaviour. London: Sage; 1987.
Davies B, Harré R. Positioning: the discursive construction of selves. J Theory Soc Behav. 1990;20:43–63.
Zimbabwe Ministry of Health and Child Welfare. Expanding access to post-abortion care in Zimbabwe through the integration of misoprostol. MOHCW, 2013. http://www.mohcw.gov.zw/publication. Accessed 8 June 2014.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.
Adamczyk A. The effect of personal religiosity on attitudes toward abortion, divorce, and gender equality—does cultural context make a difference? Eur Secur. 2013;43:213–53.
Hess JL, Rueb JD. Factors affecting college students’ opinions regarding the legality of abortion. Curr Psychol. 2005;24:24–42.
Frohwirth L, Coleman M, Moore AM. Managing religion and morality within the abortion decision: Data from qualitative interviews with women obtaining abortions in the U.S. Boston: Population Association of America Annual Meeting; 2014.
Kebede MT, Hilden PK, Middelthon AL. The tale of the hearts: deciding on abortion in Ethiopia. Cult Health Sex. 2012;14:393–405.
Hill ZE, Tawiah-Agyemang C, Kirkwood B. The context of informal abortions in rural Ghana. J Women's Health. 2009;18(12):2017–22.
Chiweshe, M. A narrative-discursive analysis of abortion decision-making in Zimbabwe (Unpublished doctoral dissertation). Grahamstown: Rhodes University; 2015.
Loi UR, Danielsson KG, Faxelid E, Klingberg-Allvin M. Health care providers’ perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia: a systematic literature review of qualitative and quantitative data. BMC Public Health. 2015;15:139–52.
Turner KL, Page KC. Abortion attitude transformation: a values clarification toolkit for global audiences. Ipas: Chapel Hill; 2008.
Acknowledgements
We thank the health service providers who participated in this study. Thank you to the CSSR members for input on our work.
Funding
This work is based on research supported by the South African Research Chairs initiative of the Department of Science and Technology and National Research Foundation of South Africa (grant no. 87582) and Andrew W Mellon (grant no. 11100695).
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The authors declare that they have no conflict of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Medical Research Council of Zimbabwe and the Rhodes University Psychology Department Research Projects and Ethics Review Committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Chiweshe, M., Macleod, C. ‘If You Choose to Abort, You Have Acted As an Instrument of Satan’: Zimbabwean Health Service Providers’ Negative Constructions of Women Presenting for Post Abortion Care. Int.J. Behav. Med. 24, 856–863 (2017). https://doi.org/10.1007/s12529-017-9694-8
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DOI: https://doi.org/10.1007/s12529-017-9694-8