The compromise of providing abortion among physicians in Jimma, Ethiopia

Background: Ethiopia changed its abortion law in 2005 in order to reduce their maternal mortality. Termination of pregnancy is legal if the pregnancy results from rape or incest, when the health or life of the woman and the foetus are in danger, in cases of foetal abnormalities and when the woman have a physical or mental disability or age below 18 years. The abortion care providers play a crucial role in securing access to safe abortion care. The physicians providing abortion must negotiate sometimes conflicting interests considering their responsibility towards the patients, the society, the hospital and their religious and personal beliefs. Methods: The objectives of the study was to examine the physicians’ attitude towards induced abortion, how the physicians understood and practiced the abortion law, ethical questions arising and to consider if the physicians’ attitude towards abortion and understanding of the law had an impact on women’s abortion seeking journey. 12 in-depth individual semi-structured interviews were conducted at Jimma Medical Centre in western Ethiopia in the period of February-Early April 2019. All the study participants were physicians providing abortion care in the hospital. The data material was transcribed and analysed inspired by grounded theory. Results: The physicians reported conflicts while providing safe abortion care (SAC). This was handled differently among the physicians according to their attitude towards abortion. They possess good knowledge of the abortion law but met several dilemmas in the practice of providing SAC due to different uses of the criteria. Especially the criteria concerning rape could make unfavourable tensions between the patient and the health care provider. All the physicians had what they thought of as the abortion-seeking women’s best interest in mind and were particularly interested in giving advice on family planning and counselling. Conclusion: This study revealed how the physicians must make difficult considerations while providing SAC, due to their responsibility towards the patients, their professionality, the abortion law and their moral and religious beliefs. This could interfere with the provision of SAC to the Ethiopian women. The complexity of induced abortion in Ethiopia should be further studied