Main barriers to services linked to voluntary pregnancy termination on three grounds in Chile

Adela Montero; Mirliana Ramirez-Pereira; Paz Robledo; Lidia Casas; Lieta Vivaldi; Daniela González

doi:10.3389/fpubh.2023.1164049

Main barriers to services linked to voluntary pregnancy termination on three grounds in Chile

Front Public Health. 2023 Jun 29:11:1164049. doi: 10.3389/fpubh.2023.1164049. eCollection 2023.

Authors

Adela Montero¹, Mirliana Ramirez-Pereira², Paz Robledo³, Lidia Casas⁴, Lieta Vivaldi⁵, Daniela González¹

Affiliations

¹ Faculty of Medicine, Center for Reproductive Medicine and Integral Development of Adolescence, University of Chile, Santiago, Chile.
² Department of Nursing, Faculty of Medicine, University of Chile, Santiago, Chile.
³ Medium Care Unit, Pediatrics and Pediatric Surgery Service, Hospital La Florida, Dr. Eloisa Díaz., Santiago, Chile.
⁴ Faculty of Law, Center for Human Rights, Diego Portales University, Santiago, Chile.
⁵ Department of Law Sciences, Faculty of Law, Alberto Hurtado University, Santiago, Chile.

Abstract

Introduction: After decades of absolute criminalization, on September 14, 2017, Chile decriminalized voluntary termination of pregnancy (VTP) when there is a life risk to the pregnant woman, lethal incompatibility of the embryo or fetus of genetic or chromosomal nature, and pregnancy due to rape. The implementation of the law reveals multiple barriers hindering access to the services provided by the law.

Objectives: To identify and analyze, using the Tanahashi Model, the main barriers to the implementation of law 21,030 in public health institutions. This article contributes to the follow-up of this public policy, making visible the obstacles that violate women's rights of women to have dignified access to abortion and that affect the quality of health care in Chile.

Material and method: Qualitative design, following the postpositivist paradigm. The sample consisted of relevant actors directly related to pregnancy termination. Snowball sampling and semi-structured interviews were used. Grounded theory was used through inductive coding, originating categories regrouped into meta-categories following Tanahashi's model. The rigor criteria of transferability, dependability, credibility, authenticity, and epistemological theoretical adequacy were used. The identity of the participants and the confidentiality of the information were protected.

Results: From January 2021 to October 2022, 62 interviews were conducted with 20 members of the psychosocial support team; 18 managers; 17 members of the biomedical health team; 4 participants from of civil society, and three women users. The main obstacles correspond to availability barriers, accessibility barriers, acceptability barriers, contact barriers, and effectiveness barriers.

Conclusions: Barriers to access abortion under three grounds violate the exercise of women's sexual and reproductive rights. It is urgent to carry out actions of control and follow-up of this public policy to the corresponding entities.

Keywords: abortion; barriers in healthcare; conscientious objection; health policies; obstetric violence; sexual and reproductive rights; stigma.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Abortion, Induced*
Attitude of Health Personnel
Chile
Female
Health Services Accessibility*
Humans
Pregnancy
Women's Rights

Grants and funding

This article presents the results obtained from the research project Fondecyt Regular Project No. 1200374: Social representations of relevant actors linked to the main barriers to the benefits guaranteed by Law 21.030, which decriminalizes the termination of pregnancy on three grounds in Chile, funded by the National Fund for Scientific and Technological Development (FONDECYT) of the National Agency for Research and Development (ANID) of the Ministry of Science, Technology, Knowledge, and Innovation of the Government of Chile.