Abstract
BackgroundIn August 2017, Chile lifted its complete ban on abortion by permitting abortion in three limited circumstances: 1) to save a woman’s life, 2) lethal fetal anomaly, and 3) rape. The new law allows regulated use of conscientious objection (CO) in abortion care, including allowing institutions to register as objectors. This study assesses medical and midwifery students’ support for CO, following legal reform.MethodsFrom October 2017 to May 2018, we surveyed medical and midwifery students from seven universities located in Santiago, Chile. Universities included 4 secular (2 public and 2 private) and 3 private religiously-affiliated universities; all offering medical degrees with a specialization in obstetrics and gynecology (ob-gyn) and five offering midwifery degrees. We used generalized estimating equations (GEE) to identify characteristics associated with student support for CO, intentions to use CO to refuse to care for someone seeking abortion, and support for CO at the institutional level.Results333 of the 413 eligible students who opened the survey, completed the questions on conscientious objection; 26% were seeking medical degrees with an ob-gyn specialty, 25% were seeking midwifery degrees, and 49% were seeking medical degrees and had not yet decided their specialty. While nearly all endorse requirements for conscientious objecting clinicians to inform (92%) and refer (91%) abortion-seeking patients, a minority (18%) would personally use conscientious objection to avoid caring for a patient seeking abortion (12% secular and 39% religious university students). About half of religious-university students (52%) and one-fifth of secular-university (20%) students support objections at the institutional level.ConclusionsMost students support the regulated use of CO which preserves patients’ access to abortion care. Religious-university student views on the use of conscientious objection in abortion care are discordant with those of their institutions which currently support institutional-level objections.
Highlights
In August 2017, Chile lifted its complete ban on abortion by permitting abortion in three limited circumstances: 1) to save a woman’s life, 2) lethal fetal anomaly, and 3) rape
Studies have shown that widespread use of conscientious objection can limit access to abortion care, for those living in rural areas [10, 11]
We examined responses to eight Likert-scaled items required to counsel patients with unwanted pregnancies on all treatment options, including abortion, 2) required to refer patients eligible for a lawful abortion to a willing clinician, or 3) allowed to refuse to provide post-abortion care; whether they support 4) mandatory public registration of objecting providers, 5) allowing universities and other institutions to register as conscientious objectors, and whether they would use conscientious objection to avoid caring for a woman 6) who wanted an abortion, no matter what her reasons, 7) who wanted a lawful abortion, or 8) with post-abortion complications
Summary
In August 2017, Chile lifted its complete ban on abortion by permitting abortion in three limited circumstances: 1) to save a woman’s life, 2) lethal fetal anomaly, and 3) rape. Conscientious objection emerged as a means to allow people to refuse to participate in military service due to personal beliefs. Some contend that it is unethical to deny people access to health care on the basis of non-verifiable personal, non-evidence based beliefs and that when health care professionals choose their profession they are agreeing to the professional obligation to serve their patients, unlike mandatory military service [7]. In Latin America, there is the idea of a “double discourse” where in public, individuals such as health professionals, uphold the prevailing, highly restrictive cultural norms, whereas in private, their views are much less conservative [9] This “double discourse” might compel health professionals in Latin America to publically declare themselves as objectors, even if not in accordance with their private views. Studies have shown that widespread use of conscientious objection can limit access to abortion care, for those living in rural areas [10, 11]. It is widely accepted that health professionals have the professional responsibility to treat patients seeking post-abortion care, irrespective of their personal views about abortion [15]
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