Midwifery abortion care provision after the enactment of the Chilean abortion law: A feminist constructivist grounded theory study

Abstract

Background: In 2017, Chile enacted an abortion law repealing the previous lack of access to legal abortion. Now abortion is allowed for pregnant women with a life-threatening condition, due to fetal unviability and when pregnancy resulted from rape. Abortion conducted in any other circumstance is punished with incarceration. Among others, midwives will provide direct care for women undergoing abortion, including pre- and post-abortion care. Providers may use their discretion to prevent policy implementation when they do not agree with the policy. Midwives can feel challenged when providing abortion care. Part of this challenge is explained by midwives’ traditional role of caring for women undergoing pregnancy, as well as fetal well-being and newborns. It is unclear how midwives in Chile understand abortion and make sense of it within their role and professional identity. Aim: To elucidate how Chilean midwives understand and provide abortion care and how they have (re)defined their professional identity to include abortion care. Methodology and Methods: Qualitative study using semi-structured interviews underpinned by a constructivist grounded theory and feminist methodologies. With their consent, midwives from Chile were interviewed online between February and October 2022. Purposive sampling included five midwives. Theoretical sampling was stopped on reaching data saturation. Interviews were conducted and transcribed into Spanish and then translated into English. Data were analysed using a constant comparison method. Data were managed using NVivo 12 Plus. Findings: Fifteen midwives were interviewed. Nine of them had provided direct abortion care. Midwives have challenging experiences when providing abortion care. Among these challenges is the difficulty of defining a clear position on abortion and the emotional labour it entails. Midwives’ share a woman-centred ethos. However, abortion puts this into tension with their traditional role of protecting life. The professional identity of midwives results from and is influenced by their practice in a context shaped by midwifery regulation. This suggests that the professional identity of midwives’ is dynamic. Conclusion: The challenges that abortion poses to the professional identity of midwives do not currently seem to endanger the policy implementation process. However, midwives are keen to highlight abortion care as challenging. Attention should be paid to the emotional labour abortion involves in order to prevent occupational stress and burnout among midwives. The woman-centred ethos of midwives has been challenged by the current abortion law. This tension should be explored further to seek a resolution.

Date of Award	15 Mar 2024
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Jane Brooks (Supervisor), Alison Cooke (Supervisor) & Helen White (Supervisor)