Abortion-related stigma and unsafe abortions: perspectives of women seeking abortion care in Machakos and Trans-Nzoia Counties, Kenya

Abstract

Background: The rate of unsafe abortions in Kenya increased from 32 per 1000 women of reproductive age in 2002 to 48 per 1000 women in 2012-- one of the highest in Sub- Saharan Africa. Abortion-related stigma has been linked to high levels of unsafe abortions.

Objective: To explore the perspectives of women seeking abortion services in public and private health facilities in regions with high as well as low incidence of unsafe abortions in Kenya on abortion-related stigma.

Design: A comparative qualitative study.

Setting: Selected public and private health facilities offering post abortion care services in Machakos and Trans Nzoia Counties

Subjects: Women seeking abortion related services in private and public health facilities in Machakos and Trans Nzoia Counties.

Results: Abortion-related stigma manifested in various forms including verbal abuse such as ridicule and name calling, isolation, physical abuse and denial of services. The stigma was in form of self-stigma, from the community and from health providers. Due to stigma, women preferred to seek information on abortion only from trusted friends and close relatives, regardless of their reliability so as to keep abortion confidential. Private facilities were reported as the main facilities where women could get an abortion confidentially, but costly compared to public facilities. As a result, women who could not afford private facilities chose to self-induce and present in a health facility to seek post abortion (PAC) care as the only way to access services, regardless of the dangers. Young single women seeking abortion services reported higher levels of stigma from health providers compared to older married women. Perception that abortion was illegal in Kenya perpetuated stigma and prevented women from seeking safe abortion services due to fear of being arrested.

Conclusion: Stigma associated with abortion is a major barrier to women seeking and receiving safe, comprehensive abortion care. Therefore, understanding abortion-related stigma is a critical step to designing measures to address barriers to women accessing safe reproductive health services.