Contextualizing abortion opinions in Kenya: A vignette-based national survey

Abstract

Objectives: Abortion is a deeply controversial public health issue, evoking diverse opinions regardless of the legal context. Policymaking on abortion often relies on generalized public opinion surveys lacking contextual nuance. We examined public opinions in Kenya towards abortion in circumstances of rape, health risks, and fetal anomalies. Methods: We used a nationally representative sample of 8,942 adults in Kenya, drawn from a database of 12 million phone users in Kenya. Using a two-stage sampling approach with random digit dialing, the sample was stratified by location, sex, and age to facilitate proportional representation. We utilized a questionnaire adopted from a vignette-based tool, with scenarios describing threats to the life or health of the pregnant woman, fetal anomaly, and rape. The tool had 14 opinion statements corresponding to each vignette and three questions on whether respondents support women’s abortion rights in these circumstances. Trained interviewers administered the questionnaire through telephone between October and November 2022. We employed multivariable-adjusted linear regression to assess factors influencing abortion opinions. Results: Most respondents (>61%) favored women’s right to abortion when pregnancies threaten their life or health, compared to 29% and 44% who supported it in cases of rape or fetal anomaly. There was significant support for abortion to be performed by the public health system, compared to abortion as a woman’s right. Generally, the liberal constructs had higher mean scores than the conservative constructs, and the women’s reproductive autonomy had the highest mean score (3.44±1.07) among all the constructs, suggesting widespread agreement that abortion decisions should rest solely with the pregnant woman. Conversely, among conservative constructs, the sanctity of life had the highest mean score (2.40±0.89), showing a strong belief in the sanctity of life among abortion opponents. Conclusion: Abortion opinions vary depending on the circumstances, with significant support for legal abortion under diverse contexts. Public policy should reflect these contextualized opinions and address specific impediments to support, especially towards legalization as a public health, gender equality and human rights imperative.