Abstract
BackgroundThe abortion law in Uruguay changed in 2012 to allow first trimester abortion on request. Implementation of the law in Uruguay has been lauded, but barriers to care, including abortion stigma, remain. This study aimed to assess women’s experiences seeking abortion services and related attitudes and knowledge following implementation of the law in Uruguay.MethodsWe interviewed 207 eligible women seeking abortion services at a high-volume public hospital in Montevideo in 2014. We generated univariate frequencies to describe women’s experiences in care. We conducted regression analysis to examine variations in experiences of stigma by women’s age and number of abortions.ResultsMost of the women felt that abortion was a right, were satisfied with the services they received, and agreed with the abortion law. However, 70% found the five-day waiting period unnecessary. Women experienced greater self-judgement than worries about being judged by others. Younger women in the sample (ages 18–21) reported being more worried about judgment than women 22 years or older (1.02 vs. 0.71 on the ILAS sub-scale). One quarter of participants reported feeling judged while obtaining services. Women with more than one abortion had nearly three times the odds of reporting feeling judged.ConclusionsThese findings highlight the need to address abortion stigma even after the law is changed. Some considerations from Uruguay that may be relevant to other jurisdictions reforming abortion laws include: the need for strategies to reduce judgmental behavior from staff and clinicians towards women seeking abortions, including training in counseling skills and empathic communication; addressing stigmatizing attitudes about abortion through community outreach or communications campaigns; mitigating the potential stigma that may be perpetuated through policies to prevent “repeat” abortions; ensuring that younger women and those with more than one abortion feel welcome and are not mistreated during care; and assessing the necessity of a waiting period. The rapid implementation of legal, voluntary abortion services in Uruguay can serve in many ways as an exemplar, and these findings may inform the process of abortion law reform in other countries.
Highlights
The abortion law in Uruguay changed in 2012 to allow first trimester abortion on request
The “repeat abortion prevention policy” implemented at the Centro Hospitalario Pereira Rossell (CHPR), which promotes post-abortion contraception [18], could have unintentionally contributed to abortion stigma towards women who have more than one abortion
This study examined the experiences of women who obtained legal abortion care through the public sector in Uruguay following decriminalization
Summary
The abortion law in Uruguay changed in 2012 to allow first trimester abortion on request. As more countries reform their abortion laws and implement legal services, lessons can be learned from recently decriminalized contexts. These experiences can provide information about how to structure and implement laws in ways conducive to highquality, accessible, and non-judgmental abortion service provision. In Uruguay, considered one of the most liberal and least religious countries in Latin America [3], the abortion law changed in 2012 to allow abortion on request in the first trimester [4, 5]. Unsafe abortion was the primary cause of maternal mortality in Uruguay. It was responsible for 28% of maternal deaths nationally from 1995 to 1999 and even higher rates of maternal death among socially and economically vulnerable women, who were more likely to access higher-risk clandestine abortion methods [6]
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