Barreiras para o acesso aos serviços de aborto legal na América Latina e Caribe: uma revisão sistemática qualitativa

Abstract

In Latin America and the Caribbean region, abortion is widely restricted and still generates several debates, being considered a crime against life in a large part of the territory. Most of the legal exceptions that allow termination of pregnancy in this setting include pregnancy resulting from rape, risk to the woman's life or fetal abnormalities. Despite being considered a reproductive right, access to legal and safe abortion is still a challenge for women in these countries and may lead them to perform clandestine and unsafe procedures, resulting in a high rate of preventable maternal deaths. In general, the barriers to accessing legal abortion are not entirely unknown. However, systematic reviews have not yet been developed to understand this phenomenon more deeply. Thus, this study aimed to synthesize qualitative evidence about the barriers faced by women in accessing legal abortion services in countries in Latin America and the Caribbean. Seven electronic databases were systematically reviewed (BVS, CINAHL, PsycINFO, PUBMED, Scielo, SCOPUS and Web of Science); other sources included contact with experts and analysis of reference lists. All included studies were critically assessed and the Entreq checklist was used to report the review. In total, 27 studies that addressed the difficulties and barriers for accessing legal abortion services were included, focusing on reports and experiences of adolescents, women and health professionals. During the thematic synthesis, 6 analytical themes were interpreted: (1) Between the sacred and the patriarchal: abortion as a transgressive practice; (2) Loneliness, secrecy and anguish in the course of women who have abortions; (3) Legal abortion as a non-legitimate right; (4) Legal abortion (dis)services: a logic of neglect; (5) Difficulties faced by professionals and the impacts on healthcare; (6) Mistreatment and power maintenance: the role of health professionals. It was observed that the barriers to access legal abortion services are mediated mainly by social and cultural factors, such as the influence of stigma and religion on the way people deal with termination of pregnancy. More tangible and modifiable barriers were also identified and, therefore, there is a need for a targeting of health policies so that these barriers are mitigated: more efforts in expanding services, training of the health team, dissemination of information about the legislation and service points.