“I just have to hope that this abortion should go well”: Perceptions, fears, and experiences of abortion clients in Nigeria

Abstract

This qualitative study aimed to examine how abortion clients in Nigeria perceive abortion and explore the role their beliefs and fears play in their care-seeking experiences and interactions with providers. Abortion is severely legally restricted in Nigeria but remains common. We conducted in-depth interviews with 25 people who obtained abortion services through three distinct models of care. We coded interview transcripts and conducted thematic analysis. Clients perceived negative attitudes toward abortion in their communities, though clients’ own beliefs were more nuanced. Clients recounted a range of fears, and nearly all mentioned worrying that they might die as a result of their abortion. Despite their concerns, clients relied on social networks and word-of-mouth recommendations to identify providers they perceived as trustworthy and safe. Kind and non-judgmental treatment, clear instructions, open communication, and reassurance of privacy and confidentiality by providers alleviated client fears and helped clients feel supported throughout their abortion process. Within restrictive contexts, the mobilization of information networks, provision of high-quality care through innovative models, and personalization of care to individual needs can assuage fears and contribute to reducing stigma and increasing access to safe abortion services.

How, when and where? A systematic review on abortion decision making in legally restricted settings in sub-Saharan Africa, Latin America, and the Caribbean

“…In the absence of other influencing factors, women strongly preferred medically safe abortion methods and services [ 37 , 48 , 52 , 55 , 56 , 62 ]. Based on a study in Ghana, Esia et al [ 55 ] summarized that ‘ All the respondents indicated that they preferred to have abortion at recognized facilities and by recognized practitioners so as to make it safe ’ However, there was significant variation in what methods women perceived as most safe.…”

“…Women’s perceptions of the quality of care provided at facilities played a role in the decision-making process regarding where to seek abortion services [ 36 , 37 , 43 , 44 , 47 , 51 , 55 – 57 , 59 , 62 ] These perceptions included likelihood of respectful care and willingness of the provider to perform the requested procedure [ 33 , 34 , 57 ]. In Nigeria, perception of care had more to do with having a good reputation, i.e.…”

“…In Nigeria, perception of care had more to do with having a good reputation, i.e. not being a “quack [ 43 , 62 ]”: “ They noted that individuals who seek care from so-called “quacks” suffered from side effects and “regret it,” but for those who obtain services from a qualified provider “there won’t be any problem [ 62 ] .”…”

“…Of all three types of safety concerns—medical, legal, and social—concerns for social safety had the greatest influence on women’s decisions regarding how and where to terminate their pregnancy [ 33 , 36 , 38 , 39 , 41 , 43 , 44 , 47 , 48 , 51 , 53 , 56 , 58 – 62 , 65 ]. Social safety encompasses abortion providers’ and others’ ability to maintain the secrecy of a woman’s abortion experience.…”

“…The majority had finished high school ( n = 25). Nineteen women had zero children and 27 had two or more High Katz et al [ 62 ] Nigeria Examine how abortion clients from a range of care models in Nigeria perceive abortion and explore the role their beliefs and fears play in their care-seeking experiences and interactions with providers Lagos and Ogun states from two healthcare clinics a safe abortion hotline and four proprietary and patent medicine vendors 2018–2019 Qualitative Semi-structured, in-depth interviews (part of a larger study in four countries) ( n = 25) The mean age of participants was 25 years, with a range of 16–41 years. Half of the participants had one or more children and nearly two-thirds were unmarried Medium Kebede et al [ 51 ] Ethiopia Explored abortion-seeking safety considerations in social and cultural detail by exploring the routes to abortion undertaken by young, unmarried women in particular, whose social situation with regard to abortion differs significantly from that of married women with unwanted pregnancies Addis Ababa 2006–2007 2009–2010 Qualitative Interviews: ( n = 25 women) Age: 18 (20 years or younger), 2 housemaids with primary education, 4 day laborers with 2–3 years primary education, 3 students in tertiary institutes, 6 high school students, 2 junior high students and waitresses, 3 4–5 years of schools and taking vocational training, 1 assistant cook without formal education, 4 high school graduates looking for a job High Keefe-Oates et al [ 37 ] Colombia Aimed to gain a deeper understanding of women’s concerns before arriving to abortion careas well as describe women’s experiences receiving support for those concerns during their abortion service, particularly through abortion counselling International Planned Parenthood/Western Hemisphere Region (IPPF/WHR): Mexfam in Mexico and Profamilia in Colombia 2015–2016 Qualitative In-depth interviews ( n = 30 women of which 15 were from Colombia) Colombian women age 19—38 years High Lafaurie et al [ 41 ] Mexico ...…”