Human Reproduction Archives
https://www.humanreproductionarchives.com/article/doi/10.4322/hra.000421
Human Reproduction Archives
SYSTEMATIC REVIEW Reproductive Health

Religious implications in the positioning and practice of health professionals and students about induced abortion: systematic review

Jefferson Drezett, Renato de Oliveira, Maria Ines Rosselli Puccia

Downloads: 10
Views: 1183

Abstract

Objective: Review the literature on the relationship between religion and the practices and positions of professionals and students of sexual and reproductive health in relation to induced abortion. Method: Systematic review in SciELO, and LILACS databases, from January 2010 to May 2021, using the descriptors (“Abortion, Induced” [Mesh]) AND “Religion” [Mesh]. Two authors separately evaluated the articles, selecting those that met the eligibility criteria. Disagreements were submitted to the opinion of the third author. 270 articles were identified and 31 articles were selected for qualitative metasynthesis. Study exempted from submission to the Ethics and Research Committee. Results: 23 articles (74.2%) used quantitative designs, six (19.3%) qualitative methods, one (3.2%) case report, and one (3.2%) intervention design. Students and resident physicians were approached in 15 articles (48.4%), physicians in 14 (45.1%), midwives in four (12.9%), and nurses in two (6.5%). In all articles analyzed, the strongest link with religious beliefs showed influence in positions and practices that oppose or restrict induced abortion. Conclusion: Conservative and fundamentalist religious positions on induced abortion persist, which negatively influence students and health professionals, hampering women’s human rights and reproductive rights.

Keywords

Induced abortion, Religion and medicine, Conscientious refusal to treat, Medical education, Nurse’s role.

References

1. World Health Organization. Safe abortion: technical and policy guidance for health systems. 2nd ed. Geneva: WHO; 2012. 132 p.

2. Orozco YP. Religiões em diálogo: violência contra as mulheres. São Paulo: Católicas pelo Direito de Decidir; 2009. 142 p.

3. Drezett J. Religious fundamentalism and sexual violence. Reprod Clim. 2013;28(2):47-50. http://dx.doi.org/10.1016/j.recli.2013.10.001.

4. Vaggione JM, Johnson MC, Wigdor GB. Creer y decidir. Experiencias de abortos en mujeres de Córdoba, Argentina. Relig Soc. 2021;41(1):219-42. ttp://dx.doi.org/10.1590/0100-85872021v41n1cap09.

5. Huang Y, Osborne D, Sibley CG. Sociodemographic factors associated with attitudes towards abortion in New Zealand. N Z Med J. 2019;132(1497):9-20. PMid:31220061.

6. Patton EW, Hall KS, Dalton VK. How does religious affiliation affect women’s attitudes toward reproductive health policy? Implications for the Affordable Care Act. Contraception. 2015;91(6):513-9. http://dx.doi.org/10.1016/j.contraception.2015.02.012. PMid:25727764.

7. Sorhaindo AM, Juárez-Ramírez C, Olavarrieta CD, Aldaz E, Mejía Piñeros MC, Garcia S. Qualitative evidence on abortion stigma from Mexico City and five states in Mexico. Women Health. 2014;54(7):622-40. http://dx.doi.org/10.1080/03630242.2014.919983. PMid:25068848.

8. Guiahi M, Teal S, Kenton K, DeCesare J, Steinauer J. Family planning training at Catholic and other religious hospitals: A national survey. Am J Obstet Gynecol. 2020;222(3):273.e1-9. http://dx.doi.org/10.1016/j.ajog.2019.09.012. PMid:31526788.

9. Harrison A, Montgomery ET, Lurie M, Wilkinson D. Barriers to implementing south Africa’s termination of pregnancy act in rural KwaZulu/natal. Health Policy Plan. 2000;15(4):424-31. http://dx.doi.org/10.1093/heapol/15.4.424. PMid:11124246.

10. Rehnström Loi U, Gemzell-Danielsson K, Faxelid E, Klingberg-Allvin M. Health care providers’ perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia: a systematic literature review of qualitative and quantitative data. BMC Public Health. 2015;15(1):139. http://dx.doi.org/10.1186/s12889-015-1502-2. PMid:25886459.

11. Heino A, Gissler M, Apter D, Fiala C. Conscientious objection and induced abortion in Europe. Eur J Contracept Reprod Health Care. 2013;18(4):231-3. http://dx.doi.org/10.3109/13625187.2013.819848. PMid:23848269.

12. Wicclair MR. Conscientious objection, moral integrity, and professional obligations. Perspect Biol Med. 2019;62(3):543-59. http://dx.doi.org/10.1353/pbm.2019.0032. PMid:31495797.

13. Wicclair MR. Conscientious refusals by hospitals and emergency contraception. Camb Q Healthc Ethics. 2011;20(1):130-8. http://dx.doi.org/10.1017/S0963180110000691.

14. Stulberg DB, Jackson RA, Lori R. Freedman LR. Referrals for services prohibited In Catholic Health Care facilities. Perspect Sex Reprod Health. 2016;48(3):111-7. http://dx.doi.org/10.1363/48e10216. PMID: 27467888.

15. Stulberg DB, Guiahi M, Hebert LE, Freedman LR. Women’s expectation of receiving reproductive health care at Catholic and Non-Catholic hospitals. Perspect Sex Reprod Health. 2019;51(3):135-42. http://dx.doi.org/10.1363/psrh.12118. PMid:31483947.

16. Silveira JR, Lima MM, Costa R, Baigorria J. Perceptions of the multi-professional team given the legal interruption of pregnancy due to sexual violence. Texto Contexto – Enferm. 2021;30:e20190070. https://doi.org/10.1590/1980-265x-tce-2019-0070.

17. Baba CF, Casas L, Ramm A, Correa S, Biggs MA. Medical and midwifery student attitudes toward moral acceptability and legality of abortion, following decriminalization of abortion in Chile. Sex Reprod Healthc. 2020;24:100502. http://dx.doi.org/10.1016/j.srhc.2020.100502. PMid:32234666.

18. Enyew MM Willingness to perform induced abortion and associated factors among graduating midwifery, medical, nursing, and public health officer students of University of Gondar, Northwest Ethiopia: institution based cross sectional study. BMC Pregnancy Childbirth. 2020;20(1):676. http://dx.doi.org/10.1186/s12884-020-03382-0. PMID: 33167922.

19. Ewnetu DB, Thorsen VC, Solbakk JH, Magelssen M. Still a moral dilemma: how Ethiopian professionals providing abortion come to terms with conflicting norms and demands. BMC Med Ethics. 2020;21:16. http://dx.doi.org/10.1186/s12910-020-0458-7. PMID:32046695.

20. Brown KS, Steinauer JE, Turk J, Landy U, Jackson AV. Racial diversity in abortion education and intention to provide abortion in postresidency practice: Data from the Ryan Program. Am J Obstet Gynecol. 2020;222(3):271.e1-8. http://dx.doi.org/10.1016/j.ajog.2019.09.009. PMid:31526793.

21. Bento SF, Pacagnella RC, Faúndes A, de Pádua KS, Fernandes KG, Araújo DM, et al. The abstract versus the concrete: differing opinions of medical residents in obstetrics and gynaecology about abortion and punishment of abortion. Eur J Contracept Reprod Health Care. 2019;24(6):494-500. http://dx.doi.org/10.1080/13625187.2019.1682135. PMid:31670994.

22. Biggs MA, Casas L, Ramm A, Baba CF, Correa SV, Grossman D. Future health providers’ willingness to provide abortion services following decriminalisation of abortion in Chile: a cross-sectional survey. BMJ Open. 2019;9(10):e030797. http://dx.doi.org/10.1136/bmjopen-2019-030797. PMid:31666266.

23. 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. http://dx.doi.org/10.1136/medethics-2016-103529. PMid:28756398.

24. Darze OISP, Barroso Jr U. Uma proposta educativa para abordar objeção de consciência em saúde reprodutiva durante o ensino médico. Rev Bras Educ Med. 2018;42(4):155-64. http://dx.doi.org/10.1590/1981-52712015v42n4rb20180021.

25. Darzé OISP, Barroso Jr U. Prevalence, attitudes, and factors motivating conscientious objection toward reproductive health among medical students. Rev Bras Ginecol Obstet. 2018;40(10):599-605. http://dx.doi.org/10.1055/s-0038-1673367. PMid:30352457.

26. Lavado Landeo L. Religiosidad de los médicos peruanos y su influencia en las decisiones bioéticas controversiales. Horiz Med. 2018;18(3):57-70. http://dx.doi.org/10.24265/horizmed.2018.v18n3.09.

27. Guiahi M, Hoover J, Swartz M, Teal S. Impact of catholic hospital affiliation during obstetrics and gynecology residency on the provision of family planning. J Grad Med Educ. 2017;9(4):440-6. http://dx.doi.org/10.4300/JGME-D-16-00496.1. PMid:28824755.

28. Oppong-Darko P, Amponsa-Achiano K, Darj E. “I am ready and willing to provide the service … Though my religion frowns on abortion” - Ghanaian midwives’ mixed attitudes to abortion services: a qualitative study. Int J Environ Res Public Health. 2017;14(12):1501. http://dx.doi.org/10.3390/ijerph14121501. PMid:29207521.

29. Dodge LE, Haider S, Hacker MR. Attitudes toward abortion among Providers of Reproductive Health Care. Womens Health Issues. 2016;26(5):511-6. http://dx.doi.org/10.1016/j.whi.2016.06.005. PMid:27522117.

30. Madeiro A, Rufino A, Santos P, Bandeira G, Freitas I. Objeção de consciência e aborto legal: atitudes de estudantes de medicina. Rev Bras Educ Med. 2016;40(1):86-92. http://dx.doi.org/10.1590/1981-52712015v40n1e02382014.

31. Holcombe SJ, Berhe A, Cherie A. Personal beliefs and professional responsibilities: Ethiopian Midwives’ attitudes toward providing abortion services after legal reform. Stud Fam Plann. 2015;46(1):73-95. http://dx.doi.org/10.1111/j.1728-4465.2015.00016.x.PMid:25753060.

32. Appiah-Agyekum NN, Sorkpor C, Ofori-Mensah S. Determinants of abortion decisions among Ghanaian university students. Int J Adolesc Med Health. 2015;27(1):79-84. http://dx.doi.org/10.1515/ijamh-2014-0011. PMid:25153553.

33. Lucchetti G, Oliveira LR, Leite JR, Alessandra Lamas Granero Lucchetti for the SBRAME Collaborators. Medical students and controversial ethical issues: results from the multicenter study SBRAME. BMC Med Ethics. 2014;15:85. http://dx.doi.org/10.1186/1472-6939-15-85. PMID: 25511565.

34. Nordberg EM, Skirbekk H, Magelssen M. Conscientious objection to referrals for abortion: pragmatic solution or threat to women’s rights? BMC Med Ethics. 2014;15(1):15. http://dx.doi.org/10.1186/1472-6939-15-15. PMid:24571955.

35. Marván ML, Álvarez del Río A, Campos Z. On abortion: exploring psychological meaning and attitudes in a sample of Mexican gynecologists. Dev World Bioeth. 2014;14(1):29-36. http://dx.doi.org/10.1111/dewb.12005. PMid:23170806.

36. Ngim CF, Lai NM, Ibrahim H. Counseling for prenatal diagnosis and termination of pregnancy due to thalassemia major: a survey of health care workers’ practices in Malaysia. Prenat Diagn. 2013;33(13):1226-32. http://dx.doi.org/10.1002/pd.4233.PMid:24014379.

37. Aniteye P, Mayhew SH. Shaping legal abortion provision in Ghana: using policy theory to understand provider-related obstacles to policy implementation. Health Res Policy Syst. 2013;11(1):23. http://dx.doi.org/10.1186/1478-4505-11-23. PMid:23829555.

38. Osis MJD, Faúndes A, Duarte GA, Makuch MY. The role of religiosity on Brazilian gynecologists’ perspective and conduct regarding induced abortion. Bagoa. 2013;7(9):87-108.

39. Pawlikowski J, Sak JJ, Marczewski K. Polish physicians’opinions concerning morally controversial medical practices. Wiad Lek. 2012;65(2):90-6. PMid:23289253.

40. Adeola Animasahun B, Nwodo U, Njokanma OF. Prenatal screening for sickle cell anemia: awareness among health professionals and medical students at the Lagos University Teaching Hospital and the concept of prevention by termination. J Pediatr Hematol Oncol. 2012;34(4):252-6. http://dx.doi.org/10.1097/MPH.0b013e31824e3109. PMid:22538322.

41. Strickland SL. Conscientious objection in medical students: a questionnaire survey. J Med Ethics. 2012;38(1):22-5. http://dx.doi.org/10.1136/jme.2011.042770. PMid:21768618.

42. Stulberg DB, Dude AM, Dahlquist I, Curlin FA. Abortion provision among practicing obstetrician-gynecologists. Obstet Gynecol. 2011;118(3):609-14. http://dx.doi.org/10.1097/AOG.0b013e31822ad973. PMid:21860290.

43. Ben Natan M, Melitz O. Nurses’ and nursing students’ attitudes towards late abortions. Int Nurs Rev. 2011;58(1):68-73. http://dx.doi.org/10.1111/j.1466-7657.2010.00840.x. PMid:21281296.

44. Rivarola Espinoza JM. Conocimientos y actitudes de los profesionales de la salud, sobre el aborto provocado en Paraguay. An Fac Cienc Med (Asuncion). 2010;43(1):35-46.

45. Rosado-Nunes MJ. O tema do aborto na Igreja Católica: divergências silenciadas. Cienc Cult. 2012;64(2):23-31. http://dx.doi.org/10.21800/S0009-67252012000200012.

46. Faúndes A, Barzelatto J, editors. O drama do aborto. Em busca de um consenso. Campinas: Komedi; 2004. 304 p.

47. Dombrowski DA, Deltete R. A brief, liberal, catholic defense of abortion. Chicago: University of Illinois Press; 2000. 168 p.

48. Ford NM. When did I begin? Conception of the human individual in history, philosophy and science. New York: Cambridge University Press; 1988. 240 p. http://dx.doi.org/10.1017/CBO9780511623554.

49. Hurst J. The history of abortion in the Catholic Church. The untold story. Conscience. 1991;12(2):1, 3-17. PMid:16180299.

50. Aguirre LP. Aspectos Religiosos do Aborto Induzido. São Paulo: Católicas pelo Direito de Decidir; 2006. 56 p.

51. Germain GG. El aborto: Mitos, realidades y argumentos. Salamanca: Sígueme; 1972. 717 p.

52. General Board of the American Baptist Churches. American Baptist resolution concerning abortion and Ministry in the local Church [Internet]. General Board of the American Baptist Churches; 1988 [cited 2021 Jul 29]. Available from: http://religiousinstitute.org/denom_statements/american-baptist-resolution-concerning-abortion-and-ministry-in-the-local-church/

53. Dozier JL, Hennink M, Mosley E, Narasimhan S, Pringle J, Clarke L, et al. Abortion attitudes, religious and moral beliefs, and pastoral care among Protestant religious leaders in Georgia. PLoS One. 2020;15(7):e0235971. http://dx.doi.org/10.1371/journal.pone.0235971. PMid:32678861.

54. Albrecht GH. Contraception and abortion within Protestant Christianity. In: Maguire DC. Sacred rights: the case for contraception and abortion in world religions. New York: Oxford Scholarship; 2003. p. 79-103. http://dx.doi.org/10.1093/acprof:oso/9780195160017.003.0004.

55. Gomes EC. “Rational faith” and “Abundance”: family and abortion from the point of view of the Universal Church of the Kingdom of God. Sex Salud Soc (Rio J). 2009;2:97-120.

56. Zoloth L. Each one an entire world. A Jewish perspective on family planning. In: Maguire DC. Sacred rights: the case for contraception and abortion in world religions. New York: Oxford Scholarship; 2003. p. 21-53. http://dx.doi.org/10.1093/acprof:oso/9780195160017.003.0002.

57. Shaikh S. Family Planning, Contraception, and Abortion in Islam. Undertaking Khilafah. In: Maguire DC. Sacred rights: the case for contraception and abortion in world religions. New York: Oxford Scholarship; 2003. p105-128. http://dx.doi.org/10.1093/acprof:oso/9780195160017.003.0005.

58. Ilyas M, Alam M, Ahmad H, Ghafoor SUL. Abortion and protection of the human fetus: religious and legal problems in Pakistan. Hum Reprod Genet Ethics. 2009;15(2):55-9. http://dx.doi.org/10.1558/hrge.v15i2.55. PMid:19957496.

59. Jain S. The right to family planning, contraception, and abortion. The Hindu view. In: Maguire DC. Sacred rights: the case for contraception and abortion in world religions. New York: Oxford Scholarship; 2003. p. 129-43. http://dx.doi.org/10.1093/acprof:oso/9780195160017.003.0006.

60. Suwanbubbha P. The right to family planning, contraception, and abortion in Thai Buddhism. In: Maguire DC. Sacred rights: the case for contraception and abortion in world religions. New York: Oxford Scholarship; 2003. p. 129-43. http://dx.doi.org/10.1093/acprof:oso/9780195160017.003.0007.

61. Brown HJ. Key Tenets of classical Buddhist Dharma leave apace for the practice of abortion and are upheld by contemporary Japanese Buddhist Mizuko Kuyo Remembrance Rituals. J Relig Health. 2019;58(2):476-89. http://dx.doi.org/10.1007/s10943-019-00763-4. PMid:30673995.

62. Barbosa AWS. The spiritist construction of the problem of abortion: spiritual order and public discourse. Relig Soc. 2019;39(3):152-72. http://dx.doi.org/10.1590/0100-85872019v39n3cap07.

63. Jones RK, Dreweke J. Countering conventional wisdom: new evidence on religion and contraceptive use. New York: Guttmacher Institute; 2011.

64. Scott J, Onyango MA, Burkhardt G, Mullen C, Rouhani S, Haider S, et al. A qualitative analysis of decision-making among women with sexual violence-related pregnancies in conflict-affected eastern Democratic Republic of the Congo. BMC Pregnancy Childbirth. 2018;18(1):322. http://dx.doi.org/10.1186/s12884-018-1942-7. PMid:30089448.

65. Palermo T, Infante Erazo M, Hurtado Pinochet V. Women’s opinions on the legalisation of abortion in Chile 2009-2013. Cult Health Sex. 2015;17(7):873-90. http://dx.doi.org/10.1080/13691058.2015.1005138. PMid:25703034.

66. Mosley EA, Schulz AJ, Harris LH, Anderson BA. South African abortion attitudes from 2007-2016: The roles of religiosity and attitudes toward sexuality and gender equality. Women Health. 2020;60(7):806-20. http://dx.doi.org/10.1080/03630242.2020.1746951. PMid:32252606.

67. Cooper D, Dickson K, Blanchard K, Cullingworth L, Mavimbela N, von Mollendorf C, et al. Medical abortion: the possibilities for introduction in the public sector in South Africa. Reprod Health Matters. 2005;13(26):35-43. http://dx.doi.org/10.1016/S0968-8080(05)26203-1. PMid:16291484.

68. Perković R, Hrkać A, Dujić G, Ćurlin M, Krišto B. The influence of religiosity and personality dimensions on the attitudes about abortion. Psychiatr Danub. 2019;31(Suppl 5):805-13. PMid:32160176.

69. Marván ML, Orihuela-Cortés F, Río AÁD. Young Mexicans’ attitudes towards voluntary interruption of pregnancy and opinions on unsafe abortion as a public health problem. Cad Saude Publica. 2018;34(10):e00192717. http://dx.doi.org/10.1590/0102-311X00192717. PMid:30365747.

70. Selebalo-Bereng L, Patel CJ. Reasons for Abortion: Religion, Religiosity/Spirituality and Attitudes of Male Secondary School Youth in South Africa. J Relig Health. 2019;58(6):2298-312. http://dx.doi.org/10.1007/s10943-017-0547-1. PMid:29344842.

71. Pedroso D, Juliano Y, De Souza PC, Drezett J. Gravidez decorrente de violência sexual: Caracterização sociodemográfica das mulheres e desfechos do aborto em um serviço público de referência, São Paulo, Brasil. LAJD. 2021;3(3):1455-71. http://dx.doi.org/10.46814/lajdv3n3-035.

72. Drezett J, Pedroso D, Vertamatti MA, Macedo-Júnior H, Blake MT, Gebrim LH, et al. Pregnancy resulting from sexual abuse: reasons alleged by Brazilian women for carrying out the abortion - pregnancy and violence. HealthMED. 2012;6(3):819-25.

73. Alves RR, Alves HN, Barboza RR, Souto WM. The influence of religiosity on health. Cien Saude Colet. 2010;15(4):2105-11. http://dx.doi.org/10.1590/S1413-81232010000400024. PMid:20694332.

74. Santos DLA. Mulheres na busca pelo aborto legal: rota crítica percorrida e necessidades em saúde suscitadas [tese doutorado]. São Paulo: Universidade de São Paulo; 2019.

75. Duarte GA, Osis MJD, Faúndes A, Sousa MH. Brazilian abortion law: the opinion of judges and prosecutors. Rev Saude Publica. 2010;44(3):406-20. http://dx.doi.org/10.1590/S0034-89102010005000006. PMid:20464265.

76. Melo G. Problemática religiosa de la mujer que aborta. Bogotá: Tonos & Medios; 2006. 363 p.

77. Zaręba K, Ciebiera M, Bińkowska M, Jakiel G. Moral dilemmas of women undergoing pregnancy termination for medical reasons in Poland. Eur J Contracept Reprod Health Care. 2017;22(4):305-9. http://dx.doi.org/10.1080/13625187.2017.1326095. PMid:28524793.

78. Fiala C, Özogul J, Kernreiter J. Experiences of women accessing an abortion clinic confronted by religiously motivated demonstrators: a pilot study. Eur J Contracept Reprod Health Care. 2020;25(3):228-30. http://dx.doi.org/10.1080/13625187.2020.1748185. PMid:32312140.

79. Lowe P, Page S. Rights-based claims made by UK anti-abortion activists. Health Hum Rights. 2019;21(2):133-44. PMid:31885443. 

80. Guiahi M, Teal SB, Swartz M, Huynh S, Schiller G, Sheeder J. What are women told when requesting family planning services at clinics associated with Catholic hospitals? A mystery caller study. Perspect Sex Reprod Health. 2017;49(4):207-12. http://dx.doi.org/10.1363/psrh.12040. PMid:29024351.

81. Bryant AG, Swartz JJ. Why Crisis Pregnancy Centers are legal but unethical. AMA J Ethics. 2018;20(1):269-77. http://dx.doi.org/10.1001/journalofethics.2018.20.3.pfor1-1803. PMid:29542437.

82. Borrero S, Frietsche S, Dehlendorf C. Crisis Pregnancy Centers: faith centers operating in bad faith. J Gen Intern Med. 2019;34(1):144-5. http://dx.doi.org/10.1007/s11606-018-4703-4. PMid:30338473.


Submitted date:
07/29/2021

Accepted date:
09/07/2021

62d19af2a95395753d424724 hra Articles
Links & Downloads

Hum Reprod Arch

Share this page
Page Sections