Abortion discourse in Bolivian hospital contexts: doctors’ repertoire conflicts and the Saving Women device

Rance, Susanna

doi:10.1111/j.1467-9566.2005.00439.x

Cited by 20 publications

(7 citation statements)

References 14 publications

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“…Physicians around the world have exercised authority over abortion through medical gatekeeping practices that both enhance and curtail women’s access to this intervention across a variety of legal contexts (Amir & Biniamin, 1992; Carranza, 2007; Joffe, 1996; McNaughton, Blandón, & Altamirano, 2002; McNaughton et al, 2004; Reagan, 1998). Another boundary work strategy includes the deployment of rhetorical framing devices such as ‘saving women’ or ‘menstrual regulation’ to euphemize abortion in restrictive legal contexts (Amin, 2003; Dixon-Mueller, 1988; Pheterson & Azize, 2005; Rance, 2005). In the US, physicians deployed images of ‘back-alley butchers’ or ‘criminal abortionists’ to obtain legislative and public support for medical monopolies over abortion practice (Joffe, 1996; Reagan, 1998).…”

Section: Literature Reviewmentioning

confidence: 99%

Rewriting abortion: Deploying medical records in jurisdictional negotiation over a forbidden practice in Senegal

Suh

2014

Social Science & Medicine

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Boundary work refers to the strategies deployed by professionals in the arenas of the public, the law and the workplace to define and defend jurisdictional authority. Little attention has been directed to the role of documents in negotiating professional claims. While boundary work over induced abortion has been extensively documented, few studies have examined jurisdictional disputes over the treatment of abortion complications, or post-abortion care (PAC). This study explores how medical providers deploy medical records in boundary work over the treatment of complications of spontaneous and induced abortion in Senegal, where induced abortion is prohibited under any circumstance. Findings are based on an institutional ethnography of Senegal’s national PAC program over a period of 13 months between 2010 and 2011. Data collection methods included in-depth interviews with 36 health care professionals, observation of PAC services at three hospitals, a review of abortion records at each hospital, and a case review of illegal abortions prosecuted by the state. Findings show that health providers produce a particular account of the type of abortion treated through a series of practices such as the patient interview and the clinical exam. Providers obscure induced abortion in medical documents in three ways: the use of terminology that does not differentiate between induced and spontaneous abortion in PAC registers, the omission of data on the type of abortion altogether in PAC registers, and reporting the total number but not the type of abortions treated in hospital data transmitted to state health authorities. The obscuration of suspected induced abortion in the record permits providers to circumvent police inquiry at the hospital. PAC has been implemented in nearly 50 countries worldwide. This study demonstrates the need for additional research on how medical professionals negotiate conflicting medical and legal obligations in the daily practice of treating abortion complications.

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Section: Literature Reviewmentioning

confidence: 99%

Rewriting abortion: Deploying medical records in jurisdictional negotiation over a forbidden practice in Senegal

Suh

2014

Social Science & Medicine

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“…In Bolivia, physicians carefully refer to MVA technology as the ‘saving women’ device to maintain the political respectability of post-abortion care in a country with restrictive abortion laws. Such discursive strategies simultaneously reinforce professional expertise in obstetric care and align post-abortion care practices in hospitals with national and global Safe Motherhood policies (Rance, 2005). …”

Section: Discussionmentioning

confidence: 99%

Accounting for abortion: Accomplishing transnational reproductive governance through post-abortion care in Senegal

Suh

2017

Global Public Health

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Reproductive governance operates through calculating demographic statistics that offer selective truths about reproductive events, bodies, and subjectivities. Post-abortion care, a global reproductive health intervention, represents a transnational reproductive regime that establishes motherhood as women’s primary legitimate reproductive status. Drawing on ethnographic fieldwork conducted in Senegal between 2010 and 2011, I illustrate how post-abortion care accomplishes reproductive governance in a context where abortion is prohibited altogether and the United States is the primary bilateral donor of population aid. Reproductive governance unfolds in two sites—hospital gynecological wards and the national health information system—through the mobilization and interpretation of post-abortion care data. Health workers police the boundaries of appropriate sexuality by searching women’s bodies and behavior for signs of illegal abortion. They minimize police intervention in the hospital by classifying most post-abortion care cases as miscarriage. Health authorities deploy this account of post-abortion care to align the intervention with national and global maternal health policies that valorize motherhood and reject safe abortion. Although post-abortion care offers life-saving care to women with complications of illegal abortion, it institutionalizes abortion stigma through the surveillance of women’s bodies and the masking of induced abortion within and beyond the hospital. Post-abortion care reinforces reproductive inequities by withholding safe, affordable obstetric care from women until after they have resorted to unsafe abortion.

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“…In Burkina Faso, state health officials and providers support PAC as a matter of medical ethics, but do not favor the revision of legal restrictions on abortion (Storeng and Ouattara 2014). In Bolivia, physicians refer to MVA as “the saving women device” to strengthen the technical and normative alignment between their PAC activities and the national Safe Motherhood initiative (Rance 2005). …”

Section: Discussionmentioning

confidence: 99%

“Right tool,” wrong “job”: Manual vacuum aspiration, post-abortion care and transnational population politics in Senegal

Suh¹

2015

Social Science & Medicine

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The “rightness” of a technology for completing a particular task is negotiated by medical professionals, patients, state institutions, manufacturing companies, and non-governmental organizations. This paper shows how certain technologies may challenge the meaning of the “job” they are designed to accomplish. Manual vacuum aspiration (MVA) is a syringe device for uterine evacuation that can be used to treat complications of incomplete abortion, known as post-abortion care (PAC), or to terminate pregnancy. I explore how negotiations over the rightness of MVA as well as PAC unfold at the intersection of national and global reproductive politics during the daily treatment of abortion complications at three hospitals in Senegal, where PAC is permitted but induced abortion is legally prohibited. Although state health authorities have championed MVA as the “preferred” PAC technology, the primary donor for PAC, the United States Agency for International Development, does not support the purchase of abortifacient technologies. I conducted an ethnography of Senegal's PAC program between 2010 and 2011. Data collection methods included interviews with 49 health professionals, observation of PAC treatment and review of abortion records at three hospitals, and a review of transnational literature on MVA and PAC. While MVA was the most frequently employed form of uterine evacuation in hospitals, concerns about off-label MVA practices contributed to the persistence of less effective methods such as dilation and curettage (D&C) and digital curettage. Anxieties about MVA's capacity to induce abortion have constrained its integration into routine obstetric care. This capacity also raises questions about what the “job,” PAC, represents in Senegalese hospitals. The prioritization of MVA's security over women's access to the preferred technology reinforces gendered inequalities in health care.

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Abortion discourse in Bolivian hospital contexts: doctors’ repertoire conflicts and the Saving Women device

Cited by 20 publications

References 14 publications

Rewriting abortion: Deploying medical records in jurisdictional negotiation over a forbidden practice in Senegal

Rewriting abortion: Deploying medical records in jurisdictional negotiation over a forbidden practice in Senegal

Accounting for abortion: Accomplishing transnational reproductive governance through post-abortion care in Senegal

“Right tool,” wrong “job”: Manual vacuum aspiration, post-abortion care and transnational population politics in Senegal

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