gms | German Medical Science

5th International Conference of the German Society of Midwifery Science (DGHWi)

Deutsche Gesellschaft für Hebammenwissenschaft e. V.

13. - 14.02.2020, Bochum

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Conscientious objection to abortion-related care – insights in midwifery research within a complex research field

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  • corresponding author Beate Ramsayer - Liverpool John Moores University, Liverpool, United Kingdom
  • Valerie Fleming - Liverpool John Moores University, Liverpool, United Kingdom

German Association of Midwifery Science. 5th International Conference of the German Association of Midwifery Science (DGHWi). Bochum, 13.-14.02.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. Doc20dghwiP22

doi: 10.3205/20dghwi38, urn:nbn:de:0183-20dghwi389

This is the English version of the article.
The German version can be found at: http://www.egms.de/de/meetings/dghwi2020/20dghwi38.shtml

Published: February 11, 2020

© 2020 Ramsayer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Background: Approximately 56 million induced terminations of pregnancy (abortion) take place every year [1]. Due to a shortage of medical practitioners, it is to midwives and nurses that many countries are turning to provide safe abortion services [2]. This is strongly supported by the World Health Organization (WHO) which recommends midwives or nurses should be the key providers in the provision of abortion care [1].

Aim: Developing a midwifery perspective on conscientious objection to abortion related care

Methods:

1.
Documentary analysis: A documentary analysis of examples of conscientious objection to participating in abortion by midwives in three European Countries (Scotland, Croatia, Sweden)as conducted [3], [4]
2.
Systematic review of reasons: A systematic review of arguments was conducted focussing on reasons that have been reported in academic literature from a philosophical, legal, medical, nursing and midwifery perspective for or against conscientious objection to abortion provision by nurses or midwives [5].
3.
Evaluation of European statistical data: A data analysis of official data sets of live births, abortions, late abortions and number of midwives in 32 European countries.

Results: The documentary analysis showed that midwives had different individual experiences with conscientious objection to abortion-related care. Many complex factors were impacting on the right to conscientious objection to abortion that differed between European countries. It became obvious that various aspects and different jurisdictions within the different countries were impacting on midwifery professional practices. The systematic review of reasons showed that various arguments exist both for and against conscientious objection. An invisibility of midwives and nurses exists in the whole debate concerning conscientious objection reflecting a gap between literature and practice as it is midwives whom WHO recommend as providers of this service. The evaluation of European statistical data showed for the year 2016 that late abortion made less than 1% of the whole midwifery workload in the countries studied.

Relevance: Conscientious objection to abortion-related care is relevant to midwifery because midwives are confronted in practice with the decision either to provide or to object to abortion-related care.

Recommendations/Conclusions: Conscientious objection to abortion-related care should be explored further from a midwifery perspective because of its relevance to practice under consideration that the debate was previously mainly conducted by other professional groups.

Ethics and conflicts of interest:

  • No ethics vote was obtained.
  • Documentary analysis: Data were collected from material in public available sources.
  • Systematic Review of reasons: Data were used from published articles.
  • Secondary data analysis: Data were used from accessible sources. The research was financed by own resources.
  • There are no conflicts of interest.
Outline

References

1.
World Health Organization (WHO). Health worker roles in providing safe abortion care and post-abortion contraception. 2015 [Zugriff Apr 2019]. Verfügbar unter: https://apps.who.int/iris/bitstream/handle/10665/181041/9789241549264_eng.pdf;jsessionid=89BD200DB7D402F19A527C03FF12C70B?sequence=1 External link
2.
Bundesministerium der Justiz und für den Verbraucherschutz. Gesetz zur Vermeidung und Bewältigung von Schwangerschaftskonflikten (Schwangerschaftskonfliktgesetz). 1992 [Zugriff Jun 2019]. Verfügbar unter: https://www.gesetze-im-internet.de/beratungsg/index.html ; https://www.destatis.de/DE/Methoden/Rechtsgrundlagen/Statistikbereiche/Inhalte/565_SchKG.pdf?__blob=publicationFile External link
3.
Fleming V, Ramsayer B, Škodič Zakšek T. Freedom of conscience in Europe? An analysis of three cases of midwives with conscientious objection to abortion. J Med Ethics. 2018; 44(2):104-8. DOI: 10.1136/medethics-2016-103529 External link
4.
Fleming V, Frith L, Ramsayer B. Tensions Between Ethics and the Law: Examination of a Legal Case by Two Midwives Invoking a Conscientious Objection to Abortion in Scotland. HEC Forum. 2019. DOI: 10.1007/s10730-019-09378-4 External link
5.
Fleming V, Frith L, Luyben A, Ramsayer B. Conscientious objection to participation in abortion by midwives and nurses: A systematic review of reasons. BMC Medical Ethics. 2018 Apr 27;19(1):31. DOI: 10.1186/s12910-018-0268-3 External link