Title: Reproductive healthcare
Course: Health Management, Ethics and Research - Ethiopia (Full)

Reproductive healthcare

One of the primary healthcare services that Health Extension Practitioners are expected to provide is reproductive healthcare. During this part of your work it is essential to develop trust with each individual and with the community as a whole. This service requires appropriate levels of care, confidentiality and truth-telling– possibly more than any other part of the health services. However, you may face conflicting situations and ethical issues that hinder you from providing appropriate reproductive healthcare services.

Case Study 8.6 Conflict in the family

Leila, a Health Extension Practitioner, works in a Health Post within the Southern Nations, Nationalities and People's Region (SNNPR) and provides community health services including family planning support. One Friday she had made a visit to Ato Olano's family to discuss family planning issues with Ato Olano's wife, W/ro Abebech. When she finished her discussion, Ato Olano's oldest daughter, Bekelech (aged 15), came over to Leila and talked about something that was obviously worrying her. She confided in Leila that she has started a loving relationship with Wajo, a student, over the last six months. She says that she really likes him a lot. However she has not started sexual relations, but she has been thinking about it. She is wondering if she could start taking birth control pills. Bekelech also explained that her parents do not know anything about this relationship. She says her mother would be very upset if she knew about it, and asked that this information should not be told to her parents. At the doorway on the way out Abebech and Olano ask Leila what their daughter has been talking about with her.

Although this is a potentially difficult situation for Leila to deal with, this is a common problem and Leila will be able to use some ethical principles to work out the way that she should act in these circumstances. There is definitely a conflict of ethical principles involved in this situation. Ato Olano and his wife Abebech need to be sure that Leila, their healthcare worker, will always tell the truth. Truthfulness is a very important part of all health work. However, Bekelech has been discussing issues that she wants to keep secret from her parents who might be angry. Confidentiality should be expected of all health workers. If Leila tells Bekelech's parents about the content of the discussion then this is a clear breach of confidentiality whatever the age of the client. Bekelech is exhibiting her own autonomy that is separate from that of her parents.

In this situation how should Leila react? Explain your reasons.

1. Say nothing and just walk past Bekelech's parents at the door.
2. Tell the parents the truth about the discussions she has been having with their daughter.
3. Tell the parents that they will have to find out what the conversation has been about from their daughter themselves.
4. Tell the parents that their daughter was worried about some spots on her face or some other common problem to avoid telling them the truth.

Show answer

Each Health Extension Practitioner will find ways for themselves of dealing with difficult situations. Some people may think that d. is an acceptable solution because they feel that telling a lie (about the spots) will cause less damage for Bekelech than telling the truth in this situation. Solution a. is almost certainly going to lose Leila her good reputation as an approachable healthworker, while b. involves a breakdown in trust between her and her patient, Bekelech. If Leila tells the parents that they will have to find out the subject of the discussion from their own daughter (answer c.), this accepts the autonomy of the daughter herself. Bekelech will be put in a situation of having to decide for herself whether to tell her own parents what she has been thinking about and the reality of her relationship with Wajo. In an ideal world, of course, the parents would come to accept that asking advice about family planning has been a responsible thing for Bekelech to do and support her decision to ask before starting a sexual relationship.