Demanding doctorability for abortion on request: a conversation analysis of pre-abortion counselling in public hospitals in the Eastern Cape, South Africa.

IF 3.4 3区 医学 Q1 FAMILY STUDIES BMJ Sexual & Reproductive Health Pub Date : 2024-10-15 DOI:10.1136/bmjsrh-2023-202020
Ryan du Toit, Catriona Ida Macleod
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Abstract

Background: Research on abortion counselling generally uses retrospective interviewing regarding providers' and users' experiences. In this article we explore how requests for abortion are made and received in real time in (officially non-mandatory) pre-abortion counselling conducted by nurses and counsellors in South African public abortion clinics.

Methods: To capture turn-by-turn interactions, we recorded, using consecutive sampling, 28 sessions at three abortion clinics in 2017/2018. No researcher was present. Conversation analysis, based on an ethnomethodological paradigm, was used to understand the conversational projects of the sessions and to outline how the provider and user oriented to the request for an abortion as a conversational task.

Results: Establishing reasons for the abortion featured in most individual counselling sessions. Through posing directive questions, providers required users to justify their request to access abortion. Users complied by providing multiple reasons. These reasons were often followed by a provider question demanding accountability in relation to contraceptive (non)use, thus establishing poor usage as the real reason.

Conclusions: As abortion is legal on request in the first trimester in South Africa, no reason for presenting for an abortion is needed. The demand for users to perform 'doctorability' - that is, to present their situation as worthy of a health professional's (in this case abortion provider's) time - served as a precursor to discipline the abortion seeker for assumed poor contraceptive usage. Providers should be trained in user-centred care that supports pregnant people's autonomy in accessing legally induced abortion. A limitation of this study is its restriction to three abortion clinics in one region of South Africa.

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要求医生可应要求堕胎:对南非东开普省公立医院堕胎前咨询的对话分析。
背景:有关人工流产咨询的研究通常采用对提供者和使用者经验的回顾性访谈。在本文中,我们探讨了南非公立堕胎诊所的护士和咨询师如何在(官方非强制性的)堕胎前咨询中实时提出和接收堕胎请求:为了捕捉逐一进行的互动,我们采用连续取样的方式记录了 2017/2018 年在三家人工流产诊所进行的 28 次咨询。没有研究人员在场。我们采用基于人种学范式的会话分析来了解会话项目,并概述提供者和用户如何将堕胎请求作为一项会话任务:结果:确定堕胎原因是大多数个体咨询的重点。通过提出指令性问题,服务提供者要求用户说明其堕胎请求的理由。用户提供了多个理由。在这些理由之后,服务提供者往往会提出一个问题,要求就(不)使用避孕药具承担责任,从而确定使用率低才是真正的原因:结论:在南非,怀孕前三个月的人工流产是合法的,因此不需要任何理由就可以进行人工流产。要求使用者表现出 "可医性"--即把自己的情况说成值得保健专业人员(此处指人工流产提供者)花费时间--是对假定避孕药具使用不佳的人工流产寻求者进行惩戒的先兆。提供者应接受以用户为中心的护理培训,支持孕妇自主选择合法人工流产。本研究的局限性在于它仅限于南非一个地区的三家人工流产诊所。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMJ Sexual & Reproductive Health
BMJ Sexual & Reproductive Health Medicine-Reproductive Medicine
CiteScore
5.10
自引率
6.10%
发文量
38
期刊介绍: BMJ Sexual & Reproductive Health is a multiprofessional journal that promotes sexual and reproductive health and wellbeing, and best contraceptive practice, worldwide. It publishes research, debate and comment to inform policy and practice, and recognises the importance of professional-patient partnership.
期刊最新文献
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