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

Abstract

IntroductionAfter 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.ObjectivesTo 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 methodQualitative 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.ResultsFrom 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.ConclusionsBarriers 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.

Discriminación interseccional: obstáculos en el acceso de las mujeres a la implementación de la ley de aborto en la atención primaria de la Región Metropolitana de Chile

“…Se menciona que toda persona que trabaje en nivel primario de salud debería tener conocimiento de la ley IVE: Entonces, si la gente que son la puerta de entrada, los administrativos, si ellos no manejan bien la información y dicen "No, aquí no existe, no sabemos", "No, aquí no hacen eso y no tenemos idea", no, no más, y [con esa respuesta] la señora se va de vuelta para su casa. (Matrona 2 APS, comunicación personal, 8 de julio de 2020) Un reciente trabajo encontró que existe una escasa y/o deficiente capacitación de los profesionales de salud, tanto en la atención primaria como en los niveles secundarios y terciarios (Montero et al, 2023). sostienen que cuando el personal encargado de aplicar la ley IVE la interpreta de manera restrictiva o no tiene información al respecto, siendo su deber proporcionarla, se viola una de las responsabilidades fundamentales del Estado en el ámbito de la salud y se incumple su papel como garante de este derecho.…”

“…A la falta de información y formación del personal de APS respecto de la ley IVE se suman la objeción de conciencia y la estigmatización del aborto (Montero et al, 2021(Montero et al, y 2023. Las mujeres que desean o podrían acceder al aborto en tres causales presentan vivencias diferenciadas en el acceso a las prestaciones de salud, las que dependen de factores como su nivel socioeconómico, nacionalidad y etnia.…”

Abortion access in the Americas: a hemispheric and historical approach

“…In the U.S., increasing restrictions at the state level after Planned Parenthood v. Casey (1992), severely constrained abortion access for many pregnant people, particularly the most marginalized, by shifting the legal context to an “undue burden” standard ( 80 ). As abortion providers and pregnant people know best, legal abortion does not equal accessible abortion services ( 71 , 80 – 82 ). For example, the September 2023 Mexican Supreme Court decriminalization of abortion does not automatically equate to full access.…”