BackgroundThe Ethiopian law on abortion was liberalized in 2005. However, as a strongly religious country, the new law has remained controversial from the outset. Many abortion providers have religious allegiances, which begs the question how to negotiate the conflicting demands of their jobs and their commitment to their patients on the one hand, and their religious convictions and moral values on the other.MethodA qualitative study based on in-depth interviews with 30 healthcare professionals involved in abortion services in either private/non-governmental clinics (...) or in public hospitals in Addis Ababa, Ethiopia. Transcripts were analyzed using systematic text condensation, a qualitative analysis framework.ResultsFor the participants, religious norms and the view that the early fetus has a moral right to life count against providing abortion; while the interests and needs of the pregnant woman supports providing abortion services. The professionals weighed these value considerations differently and reached different conclusions. One group appears to have experienced genuine conflicts of conscience, while another group attempted to reconcile religious norms and values with their work, especially through framing provision of abortion as helping and preventing harm and suffering. The professionals handle this moral balancing act on their own. In general, participants working in the private sector reported less moral dilemma with abortion than did their colleagues from public hospitals.ConclusionsThis study highlights the difficulties in reconciling tensions between religious convictions and moral norms and values, and professional duties. Such insights might inform guidelines and healthcare ethics education. (shrink)

BackgroundEthiopia’s 2005 abortion law improved access to legal abortion. In this study we examine the experiences of abortion providers with the revised abortion law, including how they view and resolve perceived moral challenges.MethodsThirty healthcare professionals involved in abortion provisions in Addis Ababa were interviewed. Transcripts were analyzed using systematic text condensation, a qualitative analysis framework.ResultsMost participants considered the 2005 abortion law a clear improvement—yet it does not solve all problems and has led to new dilemmas. As a main finding, the (...) law appears to have opened a large space for professionals’ individual interpretation and discretion concerning whether criteria for abortion are met or not. Regarding abortion for fetal abnormalities, participants support the woman’s authority in deciding whether to choose abortion or not, although several saw these decisions as moral dilemmas. All thought that abortion was a justified choice when a diagnosis of fetal abnormality had been made.ConclusionEthiopian practitioners experience moral dilemmas in connection with abortion. The law places significant authority, burden and responsibility on each practitioner. (shrink)

In Ethiopia, conscientious objection (CO) to abortion provision is not allowed due to government regulations. We here report findings from a qualitative interview study of 30 healthcare professionals from different professions working with abortion in Addis Ababa, Ethiopia. CO is practised despite the regulations forbidding it. Most informants appeared to be unfamiliar with the prohibition or else did not accord it weight in their moral reasoning. Proponents of institutionalization/toleration of CO claimed that accommodation was often feasible in a hospital setting (...) because colleagues could take over. Opponents pointed to threats to patient access in rural settings especially. Both proponents and opponents invoked tenets of professional ethics, viz., the right not to be coerced into actions one deems unacceptable, or the duty to provide care, respectively. More societal and professional discussion of the ethics and regulation of CO, and a clearer link between legal regulation and ethical guidance for professionals, are called for. (shrink)