Importance and Necessity of Training the Medical Team Regarding Religious-moral Doctrines Related to Abortion, A Narrative Review

Author(s): Ghodrati Fatemeh*

Journal Name: Current Women`s Health Reviews

Volume 16 , Issue 4 , 2020

Become EABM
Become Reviewer

Graphical Abstract:


Abstract:

Background: Treatment team’s lack of knowledge about legal-religious doctrines of abortion can put mothers’ health at great risk.

Objective: Importance and necessity of training the medical team regarding religious-moral doctrines related to abortion.

Data Sources: The moral abortion studies conducted by Iranian authors between 2000 and 2018 can be found at SID, Iran Medex, PubMed, Google Scholar, and CINAHL search engines. In this review study, 20 out of 146 studies on legal and jurisprudence issues of various aspects of abortion were reviewed.

Methods: The present study is a review of published evidence about knowledge and the attitudes of gynecologists, midwives, medical and midwifery students, and the views of senior planners on legal and abortion laws and pertinent issues of legal and religious education.

Results: The study population had moderate knowledge about the laws and regulations of moral abortion (15.4-53.3%) and negative attitude towards criminal abortions (78.3%). Besides, 64.7% of the participants agreed about abortion in unwanted pregnancies. Moreover, the majority of executive managers considered abortion to be legal in case if mother or fetus’s life was in danger. However, a small number of participants agreed about abortion due to sexual harassment, unwanted pregnancy, pregnancy without proper interval between babies, unmarried pregnancies, and pregnancy out of temporary marriage.

Conclusion: Medical team’s lack of spiritual awareness and positive attitude towards criminal abortion can increase the risk of hidden abortions. Thus, an increase in medical team’s knowledge about legal, moral, and religious aspects of abortion and penalties for criminal abortion should be considered as a health-treatment priority.

Keywords: Knowledge, attitude, gynecologists, midwife, abortion, spiritual, awareness, pregnancy.

[1]
Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Sponge CY. Abortion.In: Cunningham FG, Williams JW, (eds.) William's obstetrics. 24th ed. New York (NY): McGraw-Hill; 2014. Chapter 18;. 350-76.
[2]
Grimes DA, Stuart G. Abortion jabberwocky: the need for better terminology. Contraception 2010; 81(2): 93-6.
[http://dx.doi.org/10.1016/j.contraception.2009.09.005] [PMID: 20103443]
[3]
Abbasi M, Shamsi Gooshki E, Allahbedashti N. Abortion in Iranian legal system: a review. Iran J Allergy Asthma Immunol 2014; 13(1): 71-84.
[PMID: 24338232]
[4]
Ghodrati F, Saadatmand N, Gholamzadeh S, Akbarzadeh M. Investigation of the prevalence and causes and of legal abortion of teenage married mothers in Iran. Int J Adolesc Med Health 2018; 32(1)/j/ijamh.2020.32.issue-1/ijamh-2017-0091/ijamh-2017-0091.xml
[http://dx.doi.org/10.1515/ijamh-2017-0091] [PMID: 29397381]
[5]
Godrati F, Saadatmand N, Dinpazhoh M, Akbarzadeh M. Epidemiological study of legal abortion due to fetal defects in the files referred to Fars province forensic medicine centers from 2007 to 2013. Shiraz E Med J 2016; 17(11)e40023
[http://dx.doi.org/10.17795/semj40023]
[6]
Gholamzadeh S, Godrati F, Saadatmand N, Akbarzadeh M. The obstetrics and gynecology and genetic counseling of mother with legal abortion had been referred to in Fars Province Center since 2007-2013. Shiraz E Med J 2016; 17(2)e35271
[http://dx.doi.org/10.17795/semj35271]
[7]
Soler A, Morales C, Mademont-Soler I, et al. Overview of chromosome abnormalities in first trimester miscarriages: A series of 1,011 consecutive chorionic villi sample karyotypes. Cytogenet Genome Res 2017; 152(2): 81-9.
[http://dx.doi.org/10.1159/000477707] [PMID: 28662500]
[8]
Levy B, Sigurjonsson S, Pettersen B, et al. Genomic imbalance in products of conception: single-nucleotide polymorphism chromosomal microarray analysis. Obstet Gynecol 2014; 124(2 Pt 1): 202-9.
[http://dx.doi.org/10.1097/AOG.0000000000000325] [PMID: 25004334]
[9]
Clement EG, Horvath S, McAllister A, Koelper NC, Sammel MD, Schreiber CA. The language of first-trimester nonviable pregnancy: Patient-reported preferences and clarity. Obstet Gynecol 2019; 133(1): 149-54.
[http://dx.doi.org/10.1097/AOG.0000000000002997] [PMID: 30531561]
[10]
Magnus MC, Wilcox AJ, Morken NH, Weinberg CR, Håberg SE. Role of maternal age and pregnancy history in risk of miscarriage: prospective register based study. BMJ 2019; 364: l869.
[http://dx.doi.org/10.1136/bmj.l869] [PMID: 30894356]
[11]
Frazier T, Hogue CJR, Bonney EA, Yount KM, Pearce BD. Weathering the storm; a review of pre-pregnancy stress and risk of spontaneous abortion. Psychoneuroendocrinology 2018; 92: 142-54.
[http://dx.doi.org/10.1016/j.psyneuen.2018.03.001] [PMID: 29628283]
[12]
Rasti S, Ghasemi FS, Abdoli A, Piroozmand A, Mousavi SG, Fakhrie-Kashan Z. ToRCH “co-infections” are associated with increased risk of abortion in pregnant women. Congenit Anom (Kyoto) 2016; 56(2): 73-8.
[http://dx.doi.org/10.1111/cga.12138] [PMID: 26499091]
[13]
Li Y, Margerison-Zilko C, Strutz KL, Holzman C. Life course adversity and prior miscarriage in a pregnancy cohort. Womens Health Issues 2018; 28(3): 232-8.
[http://dx.doi.org/10.1016/j.whi.2018.02.001] [PMID: 29530382]
[14]
Qu F, Wu Y, Zhu YH, et al. The association between psychological stress and miscarriage: A systematic review and meta-analysis. Sci Rep 2017; 7(1): 1731.
[http://dx.doi.org/10.1038/s41598-017-01792-3]
[15]
Avalos LA, Roberts SC, Kaskutas LA, Block G, Li DK. Volume and type of alcohol during early pregnancy and the risk of miscarriage. Subst Use Misuse 2014; 49(11): 1437-45.
[http://dx.doi.org/10.3109/10826084.2014.912228] [PMID: 24810392]
[16]
Chen LW, Wu Y, Neelakantan N, Chong MF, Pan A, van Dam RM. Maternal caffeine intake during pregnancy and risk of pregnancy loss: a categorical and dose-response meta-analysis of prospective studies. Public Health Nutr 2016; 19(7): 1233-44.
[http://dx.doi.org/10.1017/S1368980015002463] [PMID: 26329421]
[17]
Tavafian S, Ramazanzadeh F. Socioeconomic characteristics and induced abortion: a cross sectional study based on health belief model. Payesh 2007; 6(2): 157-64.
[18]
Uygur D, Erkaya S. Reasons why women have induced abortions in a developing country. Eur J Obstet Gynecol Reprod Biol 2001; 96(2): 211-4.
[http://dx.doi.org/10.1016/S0301-2115(00)00475-9] [PMID: 11384810]
[19]
Aghayari Hir T, Mehryar AH. Indirect estimation of the total induced abortion using the proximate determinants of fertility in Iran by province Family Health Hafslnamh. J Popul Assoc Iran 2007; 2(3): 61-91.
[20]
Taylor M. Women’s right to health and Ireland’s abortion laws. Int J Gynaecol Obstet 2015; 130(1): 93-7.
[http://dx.doi.org/10.1016/j.ijgo.2015.04.020] [PMID: 25939525]
[21]
Rocchi B. Why should the baby live? Human right to life and the precautionary principle. J Med Ethics 2013; 39(5): e6-e10.
[http://dx.doi.org/10.1136/medethics-2012-100735] [PMID: 23637458]
[22]
Zúñiga-Fajuri A. Human rights and the right to abortion in Latin America. Cien Saude Colet 2014; 19(3): 841-6.
[http://dx.doi.org/10.1590/1413-81232014193.11032013] [PMID: 24714897]
[23]
Sedgh G, Henshaw S, Singh S, Ahman E, Shah IH. Induced abortion: estimated rates and trends worldwide. Lancet 2007; 370(9595): 1338-45.
[http://dx.doi.org/10.1016/S0140-6736(07)61575-X] [PMID: 17933648]
[24]
Shah I, Ahman E. Unsafe abortion in 2008: global and regional levels and trends. Reprod Health Matters 2010; 18(36): 90-101.
[http://dx.doi.org/10.1016/S0968-8080(10)36537-2] [PMID: 21111353]
[25]
Ghodrati F, Saadatmand N, Gholamzadeh S, Akbarzadeh M. The seven-year epidemiological study of legal abortion caused by heart disease, blood disorders, diabetes and hypertension as referred to forensic medicine centers in Fars province. Fam Med Prim Care Rev 2019; 21(1): 23-9.
[http://dx.doi.org/10.5114/fmpcr.2019.82975]
[26]
Department of Reproductive Health and Research, World Health Organization. Unsafe Abortion: Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality World Health Organization Geneva 2011. Available from: https://www.who.int/reproductivehealth/publications/unsafe_abortion/9789241501118/en/ [Accessed on: Jan 15, 2020]
[27]
Singh S, Darroch J, Ashford L, Vlassoff M. Adding It Up: The Costs and Benefi ts of Investing in Family Planning and Maternal and Newborn Health. New York: Guttmacher Institute and United Nations Population Fund 2009. Available from: https://www.who.int/pmnch/media/news/2009/UNFPA_AIU2009/ [Accessed on: Jan 15, 2020]
[28]
Singh S. Hospital admissions resulting from unsafe abortion: estimates from 13 developing countries. Lancet 2006; 368(9550): 1887-92.
[http://dx.doi.org/10.1016/S0140-6736(06)69778-X] [PMID: 17126721]
[29]
Behjati A, Akhoundi MM, Sadeghi MR, Sadriardekani H. The necessity of a comprehensive study on abortion in Iran. J Reprod Infertil 2005; 4(24): 299-320.
[30]
Rustamnezhad M, Asadzadeh F, Mustafazadeh F, Karami R, Kazemzadeh R. Study on abortion cases referred to the Forensic Medicine Center of Ardebil city. Health Care J 2011; 11(4): 38-42.
[31]
Shaikh Z, Abbassi RM, Rizwan N, Abbasi S. Morbidity and mortality due to unsafe abortion in Pakistan. Int J Gynaecol Obstet 2010; 110(1): 47-9.
[http://dx.doi.org/10.1016/j.ijgo.2010.01.028] [PMID: 20394922]
[32]
Agha Yari T, Mehryar AH. Estimation of induced abortion rates in Iran: Application of proximate determinants model. J Popul Assoc Iran 2007; 2(3): 1-10.
[33]
Erfani A, McQuillan K. Rates of induced abortion in Iran: the roles of contraceptive use and religiosity. Stud Fam Plann 2008; 39(2): 111-22.
[http://dx.doi.org/10.1111/j.1728-4465.2008.00158.x] [PMID: 18678175]
[34]
Nikpour B, Majlessi F, Tol A, Eshraghi N. Assessment of induced abortions and its effective factors in comparison with spontaneous abortions among women refer to hospitals in south of Tehran. J Fam Health 2013; 1(3): 14-20.
[35]
Haddad LB, Nour NM. Unsafe abortion: unnecessary maternal mortality. Rev Obstet Gynecol 2009; 2(2): 122-6.
[PMID: 19609407]
[36]
Mohammad-Alizadeh CS, Wahlstrom R, Vahidi R, Nikniaz A, Marions L, Johansson A. Barriers to high-quality primary reproductive health services in an urban area of Iran: views of public health providers. Midwifery 2009; 25(6): 721-30.
[http://dx.doi.org/10.1016/j.midw.2008.01.002] [PMID: 18325645]
[37]
Roberts LW, Warner TD, Hammond KA, Geppert CM, Heinrich T. Becoming a good doctor: perceived need for ethics training focused on practical and professional development topics. Acad Psychiatry 2005; 29(3): 301-9.
[http://dx.doi.org/10.1176/appi.ap.29.3.301] [PMID: 16141129]
[38]
Lurry Ventis W. The relationships between religion and mental health. J Soc Issues 1995; 15: 33-48.https://spssi.onlinelibrary. wiley.com/doi/abs/10.1111/j.1540-4560.1995.tb01322.x
[http://dx.doi.org/10.1111/j.1540-4560.1995.tb01322.x]
[39]
Mueller PS, Plevak DJ, Rummans TA. Religious involvement, spirituality, and medicine: implications for clinical practice. Mayo Clin Proc 2001; 76(12): 1225-35.
[http://dx.doi.org/10.4065/76.12.1225] [PMID: 11761504]
[40]
Park M, Kjervik D, Crandell J, Oermann MH. The relationship of ethics education to moral sensitivity and moral reasoning skills of nursing students. Nurs Ethics 2012; 19(4): 568-80.
[http://dx.doi.org/10.1177/0969733011433922] [PMID: 22691600]
[41]
Ghaderi R, Dastjerdi R, Sorush Z, Mouhebati M. Influential factors in medical students. Attitudes towards studying medicine in 2002. Iran J Med Educ 2003; 3(2): 47-55.
[42]
Jalili Z, Rohani AA, Mohammad Alizadeh S, Jafari S, Sharifi M. The study of knowledge of gynecologists and midwives in Kerman concerning the abortion rules and regulationis Ir. J Forensic Med 2009; 15(3): 176-81.
[http://dx.doi.org/sjfm.ir/article-1-217-en.html]
[43]
Kazemzade N, Shabannejadkhas Z, Bahadouri N. Tehran University of Medical Students' awareness about abortion laws in 2011 Ir J Forensic Med 2014; 19(2 and 3): 301-6.http://sjfm.ir/article-1-524-en.html
[44]
Naghizadeh S, Ebrahimpour M, Rahmani A, Rostami H, Dehgani S. Assessment of knowledge and viewpoint of midwifery students of Tabriz Azad Islamic University and Tabriz University of Medical Sciences toward abortion IJME 2013; 6(4): 89-99.http://ijme.tums.ac.ir/browse.php?a_id=5189&sid=1&slc_lang=en
[45]
Ghadipasha M, Bashardoost N. samaderad B. Assessment of knowledge and viewpoint of midwifery students of Tabriz Azad Islamic University and Tabriz University of Medical Sciences toward abortion. JSSU 2011; 19(2): 141-7.
[http://dx.doi.org/jssu.ssu.ac.ir/browse. php?a_code=A-10-1-1075&slc_lang=en&sid=1]
[46]
Asadzadeh T, Homayunfar N, Rostamnejad M, Mustafazadeh F, Kazemzadeh R. Sufficient knowledge of the penal code abortion in alavi hospital in Ardabil in 2008. J Nurs Midwifery Ardabil 2009; 11(4): 144.
[http://dx.doi.org/eprints.arums.ac.ir/1441/]
[47]
Azimi N, Tadayon Najafabadi M, Ziagham S, Kiani M. Knowledge of students of medical science schools about retributive legal midwifery in field of medicine, Ahvaz Jundishapur University in 2013 Sci J Forensic Med 2013; 19(2,3): 320-8.https://www.sid.ir/En/Journal/ViewPaper.aspx?ID=400545
[48]
Banaeian S, Sereshti M. Knowledge of midwives, from Chaharmahal and Bakhtiary province to ward midwifery legal and religious commandments and some of the relevant factors in 2006. Shahrekord Univ Med Sci J 2007; 9(3): 37-44.
[http://dx.doi.org/journal.skums.ac.ir/article-1-424-en.html]
[49]
Vasegh Rahimparvar SF, Noghani F, Mehran A. The necessity of learning religious rules of abortion to midwifery students. IJME 2009; 2(3): 71-9.
[http://dx.doi.org/ijme.tums.ac.ir/article-1-274-en.html]
[50]
Hourieh SM, Abolghasem P, Feizollah A. Knowledge and attitudes of a number of Iranian Policy-makers towards abortion. J Reprod Infertil 2010; 11(3): 189-95.
[PMID: 23926489]
[51]
White ML, Peters R, Schim SM. Spirituality and spiritual self-care: expanding self-care deficit nursing theory. Nurs Sci Q 2011; 24(1): 48-56.
[http://dx.doi.org/10.1177/0894318410389059] [PMID: 21220576]
[52]
Astrow AB, Sulmasy DP. STUDENTJAMA. Spirituality and the patient-physician relationship. JAMA 2004; 291(23): 2884.
[http://dx.doi.org/10.1001/jama.291.23.2884] [PMID: 15199045]
[53]
Eichelman B. Religion, spirituality, and medicine. Am J Psychiatry 2007; 164(12): 1774-5.
[http://dx.doi.org/10.1176/appi.ajp.2007.07091483] [PMID: 18056227]
[54]
Monroe MH, Bynum D, Susi B, et al. Primary care physician preferences regarding spiritual behavior in medical practice. Arch Intern Med 2003; 163(22): 2751-6.
[http://dx.doi.org/10.1001/archinte.163.22.2751] [PMID: 14662629]
[55]
McCord G, Gilchrist VJ, Grossman SD, et al. Discussing spirituality with patients: a rational and ethical approach. Ann Fam Med 2004; 2(4): 356-61.
[http://dx.doi.org/10.1370/afm.71] [PMID: 15335136]
[56]
Darvall L, McMahon M, Piterman L. Medico-legal knowledge of general practitioners: disjunctions, errors and uncertainties. J Law Med 2001; 9(2): 167-84.
[PMID: 12375499]
[57]
Goldman LA, García SG, Díaz J, Yam EA. Brazilian obstetrician-gynecologists and abortion: a survey of knowledge, opinions and practices. Reprod Health 2005; 2: 10.
[http://dx.doi.org/10.1186/1742-4755-2-10] [PMID: 16288647]
[58]
Feuillet-Le Mintier B. Ethics education in medical schools: the role of jurists. Med Law 2000; 19(3): 403-7.
[PMID: 11143876]
[59]
Dodge LE, Haider S, Hacker MR. Knowledge of state-level abortion laws and regulations among reproductive health care providers. Womens Health Issues 2013; 23(5): e281-6.
[http://dx.doi.org/10.1016/j.whi.2013.06.003] [PMID: 23910426]
[60]
Ahmadi Tabatabaei S, Taghdisi M, Nakheei N, Balali F. Effect of educational intervention based on the theory of planned behaviour on the physical activities of Kerman Health Center’s Staff (2008). JBUMS 2010; 12(2): 62-9.
[http://dx.doi.org/jbums.org/article-1-3528-en.html]
[61]
Abdel-Aziz E, Arch BN, Al-Taher H. The influence of religious beliefs on general practitioners’ attitudes towards termination of pregnancy--a pilot study. J Obstet Gynaecol 2004; 24(5): 557-61.
[http://dx.doi.org/10.1080/01443610410001722644] [PMID: 15369940]
[62]
Butler MH, Stout JA, Gradner BC. Prayer as a conflict resolution ritual: Clinical implication of religious couple’s report of relationship softening, healing, perspective, and change responsibility. J Fam Ther 2004; 30(1): 19-37.
[http://dx.doi.org/10.1080/019261802753455624]
[63]
Arslan C, Hamarta E, Uslu M. The relationship between conflict communication, selfesteem and life satisfaction in university students Educ Res Rev 2010; 5(01): 031-4.
[64]
Morton KR, Worthley JS, Testerman JK, Mahoney ML. Defining features of moral sensitivity and moral motivation: pathways to moral reasoning in medical students 1. J Moral Educ 2006; 35(3): 387-406.
[http://dx.doi.org/10.1080/03057240600874653]
[65]
Walker LJ, Pitts RC. Naturalistic conceptions of moral maturity. Dev Psychol 1998; 34(3): 403-19.
[http://dx.doi.org/10.1037/0012-1649.34.3.403] [PMID: 9597350]
[66]
Shakour M, Yousefi A, Bazrafkan L, Jouhari Z, Taheri S, Omid A. The ethical aspects of abortion in medical education. IJME 2013; 6(5): 24-34.
[http://dx.doi.org/ijme.tums.ac.ir/article-1-5216-en.html]
[67]
Storeng KT, Ouattara F. The politics of unsafe abortion in Burkina Faso: the interface of local norms and global public health practice. Glob Public Health 2014; 9(8): 946-59.
[http://dx.doi.org/10.1080/17441692.2014.937828] [PMID: 25132157]
[68]
Health ministry's plans for abortion prevention / "planned pregnancy" in the Health Network. Available from: http://webda.behdasht.gov.ir/?siteid=326&pageid=32629&newsview=125890 [Accessed on: May 20, 2019]
[69]
The right to life of the fetus. Available from: http://www.rasekhoon.net/article/print-21072.aspx [Accessed on: April 14, 2019].
[70]
Goldie JG. The detrimental ethical shift towards cynicism: can medical educators help prevent it? Med Educ 2004; 38(3): 232-4.
[http://dx.doi.org/10.1046/j.1365-2923.2004.01759.x] [PMID: 14996329]


Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 16
ISSUE: 4
Year: 2020
Published on: 09 September, 2020
Page: [277 - 284]
Pages: 8
DOI: 10.2174/1573404816666200210122049
Price: $65

Article Metrics

PDF: 22
HTML: 1