Online Program

Best practices amid local realities: Treating abortion complications within the context of Senegal's abortion law

Tuesday, November 5, 2013 : 3:18 p.m. - 3:30 p.m.

Siri Suh, MPH, MPhil, Department of Sociomedical Sciences, Columbia University, New York, NY
Background: In spite of existing evidence of best practices in service organization and technology related to post-abortion care (PAC), little is known about what it means to practice PAC in settings where abortion is restricted. This study explores the daily practice of PAC in state hospitals in Senegal, where induced abortion is prohibited. Findings suggest that even when best practices are in place, the daily practice of PAC is profoundly shaped by the local context of the abortion law. Methods: I conducted a multi-sited, institutional ethnography of Senegal's national PAC program over a period of 13 months between 2010 and 2011. Data collection methods included 88 in-depth interviews, observation of PAC services and records at 3 hospitals, and an archival review of abortion using medical, social science, media and legal sources. I used grounded theory to triangulate multiple sources of data. Findings: Medical providers attempt to differentiate between spontaneous and induced abortion through a calculus of social and physiological indicators. These practices may subject women suspected of induced abortion to extensive interrogations, delays and threats to withhold treatment. Patients participate in this process by divulging or withholding information from providers. Providers manage suspected cases of induced abortion as spontaneous unless the patients confess to inducing abortion. Conclusion: Daily PAC practices may not always align with best practices for PAC as defined by public health experts. In Senegal, PAC practices reflect providers' strategies to avoid the involvement of criminal justice authorities in the hospital.

Learning Areas:

Ethics, professional and legal requirements
Social and behavioral sciences

Learning Objectives:
Differentiate between best practices in post-abortion care, as defined by public health experts, and everyday practices of medical providers in Senegal. Assess how Senegal’s abortion law shapes post-abortion care practices and experiences for medical providers and patients.

Keyword(s): Abortion, Post-Abortion Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As a medical sociologist, I am interested in the negotiation of authority over abortion between the medical profession, criminal justice officials and other social actors. My dissertation research on post-abortion care was supported by federal and private funding. Prior to starting my doctoral program, I provided technical assistance as a University of Michigan Population Fellow to the national post-abortion care program in Senegal.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.