Abortion attitudes, training, and experience among medical students in Jamaica, West Indies

Glenmarie Matthews,Horace Fletcher,Nerys Benfield,Leo Walker,Nathalie Medley,Jessica Atrio

doi:10.1186/s40834-020-00106-9

Abstract

ObjectiveTo define abortion attitudes, training and experience among medical students in Jamaica, a restricted environment for legal abortion.MethodFrom September to November 2017 we conducted an anonymous online cross-sectional survey among medical students enrolled at the University of West Indies (UWI) in Jamaica. An abortion attitudes sum score was used for analysis. Multivariate regression was applied to evaluate the impact of characteristics and experiences on abortion attitudes.ResultsThe primary outcome was a validated composite abortion attitudes sum score, ranging from zero to forty-five. 1404 students completed the survey for a response rate of 88%. 64% had a positive attitude towards abortion. In multivariate analysis, medical students’ attitudes were favorably impacted by a prior personal or family experience with abortion, identifying as non-religious, being older in age and mixed raced. 1321 (94%) agreed that abortion training should be included in the medical school curriculum. 78.8% reported no abortion training and only 17.9% reported miscarriage management training.ConclusionMedical students at UWI had favorable attitudes towards abortion, despite their limited training in a restrictive environment. Prior personal experience with abortion and being non-religious were the strongest predictor of favorable attitudes. Increased training and clinical exposure may prove to be crucial in improving access of safe abortion.

Highlights

Unsafe abortion contributes to maternal mortality in the Caribbean and Latin America
Prior personal experience with abortion and being non-religious were the strongest predictor of favorable attitudes
Of the 1589 enrolled University of West Indies (UWI) medical students 1404 completed the survey for a response rate of 88%

Summary

Introduction

Unsafe abortion contributes to maternal mortality in the Caribbean and Latin America. These regions have the highest estimated annual abortion rates in the world, at 65 per 1000 women of childbearing age in 2014 [1]. In Jamaica, abortion is legally restricted and unsafe abortion is prevalent. Organization more than 22,000 abortions occurred in Jamaica in 2011 and complications ranked as the eighth leading cause of maternal mortality in country [2]. Current interpretation of the law cites that abortion is indicated to preserve the physical and mental health of the mother; but does not include rape or incest, fetal impairment, economic or social indications, or contraceptive failure [2]. In order to obtain a legal abortion two physicians must agree that

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