Barriers to Access of Medical Abortion in Brazil: The Role of Resistance by Obstetricians and Gynaecologists

Abstract

Objective: According the WHO, not only gynaecologists but also other physicians, midwives and nurses can provide abortion services as safe and effectively as specialist. Considering the number of willing providers of legal abortion is limited, it is important to know the opinion of Ob & Gyn specialists regarding prescription of misoprostol for voluntary termination of pregnancy (VTP) by other professionals. Study Design: A multicenter cross-sectional study carried out in 21 teaching hospitals in Brazil, aiming to determine who should be allowed to prescribe misoprostol for voluntary termination of pregnancy from the perspective of 407 residents in Obstetrics and Gynaecology who returned a self-responded questionnaire, 404 completed and three blank. Result(s): Less than 8% of residents stated that other doctors besides specialists should be allowed to prescribe misoprostol for VTP. The proportion of residents who agreed to allow any physician to prescribe misoprostol for VTP was twice as large for those who had received information about the use of misoprostol in medical residency (15.1%). The logistic regression indicated that being male, in stable marital union and not giving very much importance to religion were significantly associated with agreement to allow any physician to prescribe misoprostol for voluntary termination of pregnancy. Conclusion(s): The results showed an extremely low acceptance of non-specialist or midwives and nurses to prescribe misoprostol for VTP, which is against the WHO recommendations and world experience. We believe that contrasting such behavior with evidence-based recommendations may help to change such restrictive positions in a not so distant future.