Definitions, perspectives, and reasons for conscientious objection among healthcare workers, facility managers, and staff in South Africa: a qualitative study
AbstractConscientious objection (CO) on the part of healthcare providers is a growing threat to safe abortion access. In South Africa, evidence suggests that this legal clause may be manipulated as a justification for public-sector healthcare providers to exempt themselves from their duties to provi...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2023-12-01
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| Series: | Sexual and Reproductive Health Matters |
| Subjects: | |
| Online Access: | https://www.tandfonline.com/doi/10.1080/26410397.2023.2184291 |
| _version_ | 1797857626030080000 |
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| author | Makgoale Magwentshu Rumbidzayi Chingwende Abongile Jim Justine van Rooyen Helen Hajiyiannis Nalini Naidoo Neil Orr Jamie Menzel Erin Pearson |
| author_facet | Makgoale Magwentshu Rumbidzayi Chingwende Abongile Jim Justine van Rooyen Helen Hajiyiannis Nalini Naidoo Neil Orr Jamie Menzel Erin Pearson |
| author_sort | Makgoale Magwentshu |
| collection | DOAJ |
| description | AbstractConscientious objection (CO) on the part of healthcare providers is a growing threat to safe abortion access. In South Africa, evidence suggests that this legal clause may be manipulated as a justification for public-sector healthcare providers to exempt themselves from their duties to provide essential reproductive health services as required by national laws and protocols. This qualitative study improves our understanding of the definitions, perspectives, and use of CO among providers, staff, and facility managers in South Africa, and CO’s effect on public-sector abortion availability. Using 18 focus group discussions and 23 in-depth interviews, we examined CO attitudes and behaviours of staff from health facilities that provide abortion care in Gauteng, Limpopo, KwaZulu-Natal, and Eastern Cape Provinces. We find that CO is invoked for a variety of reasons, some unrelated to the legal basis for objection. There have been progressive shifts in attitudes towards abortion over time, but stigma against women and girls who seek abortion remains substantial among staff at facilities providing abortion. Providers who offer abortion services also report high levels of discrimination and isolation from colleagues. Such factors, combined with operational barriers to offering quality abortion care (such as lack of training support or financial incentives) and lack of clarity on CO definitions and procedures, may incentivise some providers to invoke CO inappropriately. Dissemination of national guidelines on CO should be prioritised to reduce ambiguity, and interventions addressing abortion stigma should be considered for all facility staff to safeguard abortion availability in South Africa. |
| first_indexed | 2024-04-09T20:59:44Z |
| format | Article |
| id | doaj.art-7c2ceb24f6804659b5be97b8e57fa897 |
| institution | Directory Open Access Journal |
| issn | 2641-0397 |
| language | English |
| last_indexed | 2024-04-09T20:59:44Z |
| publishDate | 2023-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Sexual and Reproductive Health Matters |
| spelling | doaj.art-7c2ceb24f6804659b5be97b8e57fa8972023-03-29T11:02:26ZengTaylor & Francis GroupSexual and Reproductive Health Matters2641-03972023-12-0131110.1080/26410397.2023.2184291Definitions, perspectives, and reasons for conscientious objection among healthcare workers, facility managers, and staff in South Africa: a qualitative studyMakgoale Magwentshu0Rumbidzayi Chingwende1Abongile Jim2Justine van Rooyen3Helen Hajiyiannis4Nalini Naidoo5Neil Orr6Jamie Menzel7Erin Pearson8Senior Health Systems Advisor, Ipas South Africa, Johannesburg, South AfricaProgram Manager, Ipas South Africa, Johannesburg, South AfricaResearch, Monitoring and Evaluation Advisor, Ipas South Africa, Johannesburg, South AfricaResearch, Monitoring and Evaluation Advisor, Ipas South Africa, Johannesburg, South AfricaPrinciple Researcher, Centre for AIDS Development, Research and Evaluation, Johannesburg, South AfricaSenior Researcher, Centre for AIDS Development, Research and Evaluation, Johannesburg, South AfricaSenior Researcher, Centre for AIDS Development, Research and Evaluation, Johannesburg, South AfricaResearch, Monitoring and Evaluation Advisor, Ipas, Chapel Hill, NC, USAAssociate Director of Learning and Innovation, Ipas, Chapel Hill, NC, USAAbstractConscientious objection (CO) on the part of healthcare providers is a growing threat to safe abortion access. In South Africa, evidence suggests that this legal clause may be manipulated as a justification for public-sector healthcare providers to exempt themselves from their duties to provide essential reproductive health services as required by national laws and protocols. This qualitative study improves our understanding of the definitions, perspectives, and use of CO among providers, staff, and facility managers in South Africa, and CO’s effect on public-sector abortion availability. Using 18 focus group discussions and 23 in-depth interviews, we examined CO attitudes and behaviours of staff from health facilities that provide abortion care in Gauteng, Limpopo, KwaZulu-Natal, and Eastern Cape Provinces. We find that CO is invoked for a variety of reasons, some unrelated to the legal basis for objection. There have been progressive shifts in attitudes towards abortion over time, but stigma against women and girls who seek abortion remains substantial among staff at facilities providing abortion. Providers who offer abortion services also report high levels of discrimination and isolation from colleagues. Such factors, combined with operational barriers to offering quality abortion care (such as lack of training support or financial incentives) and lack of clarity on CO definitions and procedures, may incentivise some providers to invoke CO inappropriately. Dissemination of national guidelines on CO should be prioritised to reduce ambiguity, and interventions addressing abortion stigma should be considered for all facility staff to safeguard abortion availability in South Africa.https://www.tandfonline.com/doi/10.1080/26410397.2023.2184291conscientious objectionSouth Africaabortionstigmahealth provider attitudes |
| spellingShingle | Makgoale Magwentshu Rumbidzayi Chingwende Abongile Jim Justine van Rooyen Helen Hajiyiannis Nalini Naidoo Neil Orr Jamie Menzel Erin Pearson Definitions, perspectives, and reasons for conscientious objection among healthcare workers, facility managers, and staff in South Africa: a qualitative study Sexual and Reproductive Health Matters conscientious objection South Africa abortion stigma health provider attitudes |
| title | Definitions, perspectives, and reasons for conscientious objection among healthcare workers, facility managers, and staff in South Africa: a qualitative study |
| title_full | Definitions, perspectives, and reasons for conscientious objection among healthcare workers, facility managers, and staff in South Africa: a qualitative study |
| title_fullStr | Definitions, perspectives, and reasons for conscientious objection among healthcare workers, facility managers, and staff in South Africa: a qualitative study |
| title_full_unstemmed | Definitions, perspectives, and reasons for conscientious objection among healthcare workers, facility managers, and staff in South Africa: a qualitative study |
| title_short | Definitions, perspectives, and reasons for conscientious objection among healthcare workers, facility managers, and staff in South Africa: a qualitative study |
| title_sort | definitions perspectives and reasons for conscientious objection among healthcare workers facility managers and staff in south africa a qualitative study |
| topic | conscientious objection South Africa abortion stigma health provider attitudes |
| url | https://www.tandfonline.com/doi/10.1080/26410397.2023.2184291 |
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