Abstract: Background: Since 1978, Croatia has had a tolerant legal framework for abortion access. While tolerant frameworks deter a proportion of unsafe abortions, they do not guarantee access in practice. Barriers such as excessive cost or non-referrals to willing providers can render abortions practically inaccessible and increase the unsafe abortion rate. Minimal research has explored barriers to abortion access in developed countries, especially those in Europe.
Objective: To explore barriers and facilitators influencing women’s abortion access in Croatia.
Methods: This research was an exploratory qualitative study utilizing semi-structured interviews. Topic lists were constructed based on research concerning worldwide barriers to abortion access. Two experts, six obstetrician-gynaecologists (OBGYNs) and eleven abortion receivers were recruited. These 19 interviews (20-40 minutes) were conducted in person, skype or via phone. Data was validated through member checks and analyzed by thematic analysis.
Results: Following analysis, barriers and facilitators in Croatia emerged: 1. Nearly every interviewee shared that abortion is stigmatized. OBGYNs and women mostly discussed external manifestations of stigma such as prayer protests; 2. Several women spoke about difficulty finding reliable information regarding abortion services. They detailed that forums or their support networks helped them find information; 3. Most women said their greatest barrier was negative health professional’s attitudes as demonstrated by non-referral, verbal dissuasion or using ultrasounds to change their mind to abort. Conversely, women found positive health professional’s attitudes greatly facilitated their access and subjective experiences; 4. Most OBGYNs stated that conscientious objection remains insufficiently monitored and regulated. Several considered that conscientious objectors do not refer women to willing providers; 5. OBGYNs noted medical abortion have limited availability. They held relatively positive views of wider distribution. Women also noted the limited methodology choice; 6. Most OBGYNs and women perceived the cost of abortions to be high, especially for lower-income women. However, there was disagreement as to the affordability for women making an average salary.
Conclusion: Croatian women appear to encounter various barriers when accessing abortions. This research concluded that abortion services in Croatia are not synchronized to World Health Organization guidelines. While barriers such as non-referral may be surmountable for women with more resources and time; this could render the procedure inaccessible for more vulnerable populations of women and contribute to unsafe abortions.
Author: Marina Vosika (2017)
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Keywords: ’conscientious objection’, ’abortion access’, ‘qualitative research’, ‘barriers to access’