Post-abortion care (PAC) as paradox: A public health intervention at the crossroads of medicine and law in Senegal

Background: Since its inception in the early 1990s, the post-abortion care (PAC) model has placed abortion care in the hands of medical professionals even in contexts with restrictive abortion laws. In Senegal, the government implemented PAC throughout the country to treat complications of both induced and spontaneous abortion. This study investigates how the Senegalese medical establishment draws on PAC to claim professional jurisdiction over abortion. Methodology: Using institutional ethnography, this study examines the practices and technologies of health providers and authorities involved in PAC over a period of 13 months. Data collection methods include 88 in-depth interviews, observation of PAC services and records at 3 hospitals, and an archival review of 42 abortion cases prosecuted by the state over the last 25 years. Data analysis draws on grounded theory. Findings: PAC transformed abortion care by diffusing abortion technology throughout the health system. Providers are trained to treat complications of both spontaneous and induced abortion without moral or legal distinction. However, stark differences remain between managing spontaneous and suspected induced abortion, including the notification of police in case of the latter. Ironically, by normalizing abortion care within the health system, PAC may stall liberalization of a highly restrictive abortion law. Conclusions: PAC lies at a jurisdictional crossroads between medicine and law where Senegalese providers must navigate between treatment and pursuit of an illegal act. This study highlights the need to understand how the social and political context shapes both daily medical practice and the broader implementation of public health interventions.