Abstract

Universal Health Coverage (UHC) forces governments to consider not only how services will be provided – but which services – and to whom, when, where, how and at what cost. This paper considers the implications for achieving UHC through the lens of abortion-related care for adolescents. Our comparative study design includes three countries purposively selected to represent varying levels of restriction on access to abortion: Ethiopia (abortion is legal and services implemented); Zambia (legal, complex services with numerous barriers to implementations and provision of information); Malawi (legally highly restricted). Our policy and legal analyses are supplemented by comparative vignettes based on interviews (n = 330) in 2018/2019 with adolescents aged 10–19 who have sought abortion-related care in each country. We focus on an under-considered but critical legal framing for adolescents – the age of consent. We compare legal and political commitments to advancing adolescent sexual and reproductive health and rights, including abortion-related care. Ethiopia appears to approach UHC for safe abortion care, and the legal provision for under 18-year-olds appears to be critical. In Malawi, the most restrictive legal environment for abortion, little progress appears to have been made towards UHC for adolescents. In Zambia, despite longstanding legal provision for safe abortion on a wide range of grounds, the limited services combined with low levels of knowledge of the law mean that the combined rights and technical agendas of UHC have not yet been realised. Our comparative analyses showing how policies and laws are framed have critical implications for equity and justice.

摘要

全民健康覆盖 (UHC) 迫使政府不仅要考虑如何提供服务——还要考虑提供哪些服务——以及向谁、何时、何地、如何以及以什么成本提供服务。本文从青少年堕胎相关护理的角度考虑了实现全民健康覆盖的意义。我们的比较研究设计包括有目的地选择的三个国家，以代表不同程度的堕胎限制：埃塞俄比亚（堕胎是合法的，服务得到实施）；赞比亚（法律、复杂的服务，在实施和提供信息方面存在诸多障碍）；马拉维（法律上严格限制）。我们的政策和法律分析补充了基于访谈的比较小插曲 ( n = 330) 在 2018/2019 年，在每个国家/地区寻求堕胎相关护理的 10-19 岁青少年。我们专注于青少年的一个考虑不足但至关重要的法律框架——同意年龄。我们比较了促进青少年性健康和生殖健康及权利的法律和政治承诺，包括与堕胎相关的护理。埃塞俄比亚似乎正在寻求全民健康覆盖以提供安全的堕胎护理，而对 18 岁以下儿童的法律规定似乎至关重要。在马拉维这个对堕胎限制最严的法律环境中，青少年的全民健康覆盖似乎没有取得什么进展。在赞比亚，尽管长期以来对安全堕胎的法律规定范围广泛，但有限的服务加上法律知识水平低意味着 UHC 的综合权利和技术议程尚未实现。