Abstract:
We report on a comparative situational analysis of comprehensive abortion care (CAC) in Botswana, Eswatini, Lesotho and Namibia. We conducted systematic literature searches and country consultations and used a reparative health justice approach (with four dimensions) for the analysis. The following findings pertain to all four countries, except where indicated. Individual material dimension: pervasive gender-based violence (GBV); unmet need for contraception (15-17%); high HIV prevalence; poor abortion access for rape survivors; fees for sexual and reproductive health (SRH) services (Eswatini). Collective material dimension: no clear national budgeting for SRH; over-reliance on donor funding (Eswatini; Lesotho); no national CAC guidelines or guidance on legal abortion access; poor data collection and management systems; shortage and inequitable distribution of staff; few facilities providing abortion care. Individual symbolic dimension: gender norms justify GBV; stigma attached to both abortion and unwed or early pregnancies. Collective symbolic dimension: policy commitments to reducing unsafe abortion and to post-abortion care, but not to increasing access to legal abortion; inadequate research; contradictions in abortion legislation (Botswana); inadequate staff training in CAC. Political will to ensure CAC within the country\'s legislation is required. Reparative health justice comparisons provide a powerful tool for foregrounding necessary policy and practice change.
摘要:
我们报告了博茨瓦纳综合堕胎护理(CAC)的比较情况分析,埃斯瓦蒂尼,莱索托和纳米比亚。我们进行了系统的文献检索和国家咨询,并使用了恢复性健康正义方法(具有四个维度)进行了分析。以下调查结果涉及所有四个国家,除非另有说明。个人物质层面:普遍存在的基于性别的暴力(GBV);未满足的避孕需求(15-17%);艾滋病毒感染率高;强奸幸存者堕胎机会差;性健康和生殖健康(SRH)服务费(Eswatini)。集体物质层面:没有明确的生殖健康国家预算;过度依赖捐助者资金(埃斯瓦蒂尼;莱索托);没有关于合法堕胎的国家CAC准则或指导;数据收集和管理系统差;工作人员短缺和分配不均;提供堕胎护理的设施很少。个人象征意义:性别规范为性别暴力辩护;堕胎和未婚或早孕都受到污名化。集体象征层面:减少不安全堕胎和堕胎后护理的政策承诺,但不增加获得合法堕胎的机会;研究不足;堕胎立法中的矛盾(博茨瓦纳);CAC的人员培训不足。需要确保CAC在该国立法范围内的政治意愿。恢复性健康正义比较为必要的政策和实践变革提供了有力的工具。