Ethiopian medical practitioners and abortion provision after 2005: Moral dilemmas, ethical challenges and conscientious objections

Abstract

This PhD thesis studies induced abortion in Addis Ababa, Ethiopia. A main finding is that the abortion legislation gives healthcare personnel plenty of scope for their own interpretations. In practice, it is often up to them to decide whether the criteria for abortion are met. The thesis is based on interviews with 30 health personnel involved in abortion in private and public health institutions. After the liberalization of the abortion law in 2005, induced abortion is now practiced in all regions of Ethiopia. The dissertation contains three articles that deal with healthcare personnel's views and perceived moral dilemmas, and conscientious objection. The first article examines the tension between health professionals' professional obligations and religious-moral convictions when it comes to abortion. Health personnel weighed value considerations and religious norms differently. This gave rise to conflicts of conscience for several. Several had tried to reconcile religious norms and values with offering abortion, by interpreting performing abortion as a way to prevent harm and suffering. The informants emphasize the occurrence of abortion complications because of clandestine abortions and maternal mortality due to unsafe procedures. In the second article, we investigated abortion providers' experiences with the revised abortion law, including how they view and resolve perceived moral challenges. Most participants considered the 2005 abortion law a clear improvement, although it does not solve all problems and has led to new dilemmas. As a main finding, the law seems to have opened a large space for individuals' interpretation and judgment as to whether the criteria for abortion are met. In Ethiopia, health personnel have no lawful right to conscientious objection to abortion. In our third article, it was found that conscientious objection is practiced despite the regulations prohibiting it. Most informants seemed unfamiliar with the ban, or did not give weight to it in their moral considerations.