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Relationship of Knowledge and Attitude Towards Legal Abortion Laws with the Performance of Midwives in Qazvin, Iran

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Relationship of Knowledge and Attitude Towards Legal Abortion Laws with the Performance of Midwives in Qazvin, Iran Original Article Health, Spirituality and Medical Ethics. 2019;6(2):17-23 Relationship of Knowledge and Attitude Towards Legal Abortion Laws with the Performance of Midwives in Qazvin, Iran Received 7 Oct 2018; Accepted 12 May 2019 http://dx.doi.org/10.29252/jhsme.6.2.17 Samira Romina1 , Masomeh Alamshahi1 , Farnoosh Moafi2 , Maryam Mafi2 , Hamideh Hajnasiri2* 2. Student research committee, Qazvin University of Medical Sciences, Qazvin, Iran. 3. Midwifery Department, Nursing & Midwifery School, Qazvin University of Medical Sciences, Qazvin, Iran. Abstract Background and Objectives: Abortion is one of the main causes of maternal mortality. The lack of knowledge of physicians and midwives about the abortion laws can lead to the deficiency of presenting accurate information to pregnant women, and consequently to increase unsafe abortions. The purpose of this study was to assess the relationship of knowledge and attitude towards legal abortion laws with the performance of midwives in Qazvin, Iran. Methods: This descriptive-correlational study was conducted on 122 midwives with private offices in Qazvin, Iran, from May to September 2012. The subjects were chosen according to the convenience sampling method. After obtaining informed consent for participation in the study, four questionnaires, including demographic characteristics, knowledge, attitude, and performance questionnaires were distributed by the researcher among the referrals. Results: The obtained results showed that approximately half of the midwives had good knowledge about abortion laws (55.7%); however, their attitude towards abortion laws was mostly negative (86.9%). In addition, their performance of abortion was reported as average (60.7%). There was no significant relationship between the knowledge and midwifes’ performance; however, a significant statistical relationship was observed between their attitude and performance. Conclusion: Regarding the fact that providing abortion services is one of the healthcare strategies for preventing the complications of unsafe abortion, it is advised to increase the knowledge level of medical personnel by including the relevant courses in the university, holding retraining courses and congresses on the issue of abortion, and informing new guidelines. Keywords: Attitude, Knowledge, Legal abortion, Midwife, Performance. *Correspondence: Should be addressed to Ms. Hamideh This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Hajnasiri. Email: [email protected] Commercial 4.0 International License Please Cite This Article As: Romina S, Alamshahi M, Moafi F, Mafi M, Hajnasiri H. Relationship of Knowledge and Attitude Towards Legal Abortion Laws with the Performance of Midwives in Qazvin, Iran. Health Spiritual Med Ethics. 2019;6(2):17-23. Introduction Archive of SID bortion is the termination of pregnancy complications of illegal abortion are among the before 20 weeks of gestation or with most common causes of hospitalization in A the fetus weight less than 500 g at developing countries (4). birth (1). Generally, abortion falls into three Most mothers placed in an unsafe abortion categories, including spontaneous or habitual situation refer to the hospital only after serious abortion, criminal or illegal abortion, and complications; therefore, many cases of therapeutic or legal abortion (2). The World induced abortion are never recorded and Health Organization estimates that reported. An estimated assessment provided by approximately 50,000,000 pregnancies (25%) the Ministry of Health and Medical Education annually lead to abortion (3). In this regard, the indicated that 80,000 abortions annually occur complications of illegal abortion are more than in Iran (5). those of other abortions. Moreover, the 17 Health, Spirituality and Medical Ethics - Vol.6, No.2, Jun 2019 www.SID.ir Romina S, et al Today, due to medical necessity, a pregnancy In this regard, the importance of several issues can be intentionally terminated that is called should be considered, including the knowledge therapeutic abortion. In general, the reasons for and attitude of midwives about legal abortion issuing the therapeutic abortion license in laws, their performance to prevent illegal different parts of the world include economic abortions, and their right approach to the situation, individual's request, protection of timely referral of pregnant mothers with mother's life, rape-induced abortion, and difficulty, for receiving legal abortion license congenital abnormalities (6). However, the law and preventing abnormal births. Therefore, of abortion was legalized in Iran in 2005. informing healthcare staff especially midwives According to this article, "therapeutic abortion and obstetricians regarding therapeutic through definitive diagnosis of three specialists abortion laws is one of the Ministry of Health's and the confirmation of the National Forensic strategies to reduce illegal abortion. Medicine Center based on fetal illness that due However, it seems that training courses have to retardation or malformation causes maternal not been effective enough in this field and suffering or maternal illness associated with requires more training. The purpose of this maternal physical threat is legalized before the study was to assess the relationship between existence of soul (4 months of gestation) with the knowledge and attitude towards legal the woman permission. Moreover, no penalty abortion laws with the performance of or responsibility will be considered for the midwives in Qazvin, Iran, in order to sensitize specialist or supervisor". According to the the authorities to plan for further training and aforementioned article, any kind of embryonic improve the quality of healthcare services at anomalies, which causes maternal intolerable both prevention and treatment levels that lead suffering after birth, or any maternal illness to the promotion of maternal health's level in that accompanies the pregnancy with maternal the community. physical threat will be subject to this law (6). Currently, the Ministry of Health and Medical Methods Education has been trying to control the illegal In this descriptive-analytic study, the abortion statistics by issuing legal abortion researcher referred to the Deputy of Treatment indications emphasizing the timely and provided a list of the midwives with identification of pregnant mothers, their private offices in Qazvin (Qazvin, referral for routine screening, and referral of Mohammadi-Alvand, Boyin Zahra, and mothers with difficulty to relevant Takestan), Iran. The number of active offices obstetricians. On the other hand, legal and at the time of study was reported around 160 in religious restrictions regarding abortion are the entire province. among the ways for the prevention of social Then, the subjects were selected according to anomalies. entry criteria, including the midwives with at In a study conducted by Masoud GhadiPasha least a midwifery bachelor’s degree, a medical et al. it was demonstratedArchive that only 25% of system of number, SID midwifery license in Qazvin, obstetricians and midwives have acceptable and employed at the office. Moreover, the information about therapeutic abortion laws convenient sampling was performed by (7). Furthermore, in another study performed referring to the chosen midwives’ offices from in Kerman, Iran, only 7.6% of midwives have May to September 2012. a good knowledge of abortion laws (8), which The exclusion criteria were the midwives is indicative of healthcare staff's insufficient unwilling for the cooperation and those information. On the other hand, in addition to prohibited due to violation by the country's law the level of knowledge, it seems that enforcement authorities or country's medical healthcare staff's attitude towards therapeutic system organization (whether temporarily or abortion laws is effective in providing permanently). The studied variables included therapeutic abortion services (9). knowledge, performance, attitude, age, education, work experience, as well as Health, Spirituality and Medical Ethics - Vol.6, No.2, Jun 2019 18 www.SID.ir Relationship of Knowledge and Attitude Towards Legal participation in retraining courses and inappropriate performance that causes congresses. irreparable complications for the patient. The data collection tools were four Performance scoring was based good (21-30), questionnaires, including demographic average (20-3), and poor (2-0) levels. characteristics, knowledge, attitude, and The researcher after introducing performance questionnaires. The three herself/himself, explaining the importance of questionnaires related to the evaluation of the the study, and obtaining informed consent, knowledge, attitude, and performance were provided the midwives with four developed according to a questionnaire applied questionnaires (demographic characteristics, by Ahmadi (2012). The reliability of the knowledge, attitude, and performance aforementioned questionnaires was confirmed questionnaires) via sending e-mail and rendering Cronbach's alpha coefficients of referring to the office. 0.86, 0.79, and 0.79, respectively (10). After collecting the questionnaires, data The knowledge questionnaire consisted of 30 analysis was performed by SPSS software questions in which the studied subjects (version 24). Data analysis was conducted expressed their opinion using the 3-point using descriptive statistics, such as Likert scale of "Yes/No/I Do not Know". The percentages, frequencies, and mean
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