Safe abortions in an illegal context: perceptions from service providers in Belgium

Abstract

Until April 1990 abortion was illegal in Belgium all circumstances. However, a small group of health professionals had long provided high-quality abortion services in outpatient facilities and in hospitals. This study is a qualitative analysis of perceptions among providers of safe abortion in Belgium before and after it was made legal there. The providers' personal, psychological, and ethical reactions to abortion are investigated, as well as their opinions on how their activities should be organized in order to minimize problems. Standardized questionnaires with closed and open questions were used; 143 questionnaires were completed. Emotional reactions were reported as being the most difficult aspects of practicing abortion. The experience of Belgian practitioners is of value for health professionals working in a legally restricted setting who are willing to assume some judicial risks to facilitate legal change while demonstrating the public health utility of low-cost, safe abortion.

PIP: Until April 1990, abortion was illegal in Belgium; still, in 1982, researchers estimated that 13,400-15,900 abortions were performed each year in public and private hospitals, abortion clinics, and family planning and abortion centers in Brussels and Wallonia. Recent estimates indicate that around 60% of abortions are performed in outpatient facilities, 32% in hospitals, and about 8% in private clinics in Belgium. The providers' personal, psychological, and ethical reactions to abortion were investigated in Belgium before and after abortion was made legal. 143 standardized questionnaires were completed: 86 by women and 57 by men. Nearly half of the respondents were physicians. The questionnaires covered aspects of the provision of medical abortion: 1) providers' objective reactions to the organization of services; 2) providers' subjective reactions to abortion service, including self-image, perception of legal restrictions, perception of clients attitudes, personal values, personal motivations, and feelings about their own role in the practice. Many of those who had decided to work in abortion services initially considered doing so to be a normal part of their job to help women cope with unwanted pregnancies. Nearly two-thirds of the respondents expressed a negative emotional reaction to requests for repeat abortions; one-third were accepting or neutral. 70% of physicians appeared to be emotionally affected by repeat abortions compared to 47% of nonphysicians. The providers believed that various factors affect the quality of abortion services, as reported by 109 providers, including the high number of abortions performed (reported by 36% of providers in hospitals and 23% in outpatient clinics); a high turnover of personnel (22% and 41%, respectively); lack of staff collaboration (20% and 11%); and the legal situation (4% and 8%). 95% of all 143 respondents expressed the view that conscientious objection to performing abortion is legitimate.