The Paradox of Post-Abortion Care

Sociologists have used boundary work theory to explore the strategies deployed by professionals to define and defend jurisdictional authority in the arenas of the public, the law and the workplace. My dissertation investigates how medical providers and public health professionals negotiate authority over abortion in Senegal. Although induced abortion is prohibited in Senegal, medical providers are permitted to treat complications of spontaneous and induced abortion, known as post-abortion care (PAC). Introduced to Senegal in the late 1990s, the national PAC program is primarily supported by American development aid. This study explores how medical providers manage complications of abortion and in particular, how they circumvent the involvement of criminal justice authorities when they encounter suspected cases of illegal abortion. I also study how boundary work is accomplished transnationally through the practice of PAC within the policy framework of American anti-abortion population assistance and the national prohibition on abortion. Findings are based on an institutional ethnography of Senegal's national PAC program conducted over a period of 19 months between 2009 and 2011. Data collection methods included in-depth interviews with 89 individuals, observation of PAC services, and review of PAC records at three hospitals. I also conducted an archival review of abortion and PAC in court records, the media, and public health literature. Findings show that medical providers and public health professionals perform discursive, technical and written boundary work strategies to maintain authority over PAC. Although these strategies have successfully integrated PAC into maternal health care, they have reinforced the stigma of abortion for women and health professionals. They have also reproduced gendered disparities in access to quality reproductive health care. PAC has been implemented in nearly 50 countries worldwide with varying legal restrictions on abortion. This study illustrates not only how medical professionals practice abortion care in such settings, but also how they navigate a precarious array of medical, legal and global health obligations.