Health system reform and safe abortion: a case study of Mongolia.
Unsafe abortion serves as a marker of global inequity as it is concentrated in the developing world where the poorest and most vulnerable women live. While liberalisation of abortion law is essential to the reduction of unsafe abortion, a number of challenges exist beyond this important step. This paper investigates how popular health system reforms consonant with neoliberal agendas can challenge access to safe abortion. We use Mongolia, a country that has liberalised abortion law, yet, limited access to safe abortion, as a case study. Mongolia embraced market reforms in 1990 and subsequently reformed its health system. We document how common reforms in the areas of finance and regulation can compromise the safety of abortions as they foster challenges that include inconsistencies in service delivery that further foment health inequities, adoption of reproductive health programmes that are incompatible with the local sociocultural context, unregulated growth of the private sector and poor enforcement of standards and technical guidelines for safe abortion. We then discuss how this case study suggests the conversations that reproductive health policy-makers must have with those engineering health sector reform to ensure access to safe abortion in a liberalised environment.
Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada. christinabeck@hotmail.com
Christina
C
Beck
Nicole S
NS
Berry
Semjidmaa
S
Choijil
D000023:Abortion Applicants / Q000523:psychology / Q000706:statistics & numerical data; D000028:Abortion, Induced / Q000191:economics / Q000331:legislation & jurisprudence* / Q000639:trends; D001723:Birth Rate / Q000639:trends; D005260:Female; D005381:Financing, Organized / Q000379:methods / Q000639:trends; D018166:Health Care Reform / Q000191:economics / Q000331:legislation & jurisprudence* / Q000592:standards; D019981:Health Care Sector / Q000191:economics / Q000639:trends; D006297:Health Services Accessibility / Q000191:economics / Q000592:standards*; D054625:Healthcare Disparities / Q000191:economics* / Q000639:trends; D006801:Humans; D008986:Mongolia; D019982:Organizational Case Studies; D061214:Patient Safety; D011057:Politics; D011247:Pregnancy; D034121:Reproductive Health Services / Q000191:economics / Q000331:legislation & jurisprudence* / Q000639:trends; D019035:Rural Health Services / Q000191:economics / Q000639:trends; D057545:Social Stigma; D019037:Urban Health Services / Q000191:economics / Q000639:trends; D014944:World Health Organization