PDF(Pubmed)
Abstract：
Costa Rica prohibits abortion except under narrow circumstances to save the pregnant person\'s life. The country boasts historically strong support for social policy and human rights, while also presenting a complex and restrictive abortion access landscape. From September 2021 to March 2022, we conducted 23 interviews with obstetrician-gynecologist (OB/GYN) physicians, OB/GYN medical residents, and policy stakeholders to explore the socio-ecological influences on abortion access in Costa Rica. We sampled clinicians and policy stakeholders from the Universidad de Ciencias Médicas listserv through snowball sampling and conducted semi-structured in-depth interviews in Spanish. We identified limited access to comprehensive sexual health education, lack of support from interpersonal networks, inadequate provider knowledge and training, financial and migratory status, and both provider and community stigma as substantial barriers to abortion access. This study addresses a gap in published research around the social determinants of abortion in Costa Rica and sheds light on the attitudes and opinions of the medical and policy stakeholder communities about abortion access. The results highlight the need for expanded access to comprehensive sexual health education, abortion-related training for healthcare providers, and increased programming efforts, such as funding, outreach, and implementation, to ensure comprehensive reproductive health services are available and accessible, especially for vulnerable populations in Costa Rica.
摘要：
哥斯达黎加禁止堕胎，除非在狭窄的情况下挽救孕妇的生命。该国历来大力支持社会政策和人权，同时也呈现出复杂而限制性的堕胎通道景观。从2021年9月到2022年3月，我们对妇产科医生（OB/GYN）进行了23次采访，OB/GYN医疗居民，和政策利益攸关方探讨对哥斯达黎加堕胎机会的社会生态影响。我们通过滚雪球抽样对CienciasMédicaslistserv大学的临床医生和政策利益相关者进行了抽样，并用西班牙语进行了半结构化的深入访谈。我们发现获得全面性健康教育的机会有限，缺乏人际网络的支持，提供者知识和培训不足，财政和移民地位，以及提供者和社区的耻辱都是堕胎获得的实质性障碍。这项研究解决了有关哥斯达黎加堕胎社会决定因素的已发表研究中的空白，并阐明了医疗和政策利益相关者社区对堕胎机会的态度和意见。结果强调需要扩大全面的性健康教育，医疗保健提供者的堕胎相关培训，并加大了编程力度，比如资金，外展，和实施，确保提供全面的生殖健康服务，特别是哥斯达黎加的弱势群体。
