Motivations for using misoprostol for abortion outside the formal healthcare system in Colombia: A qualitative study of women seeking postabortion care in Bogotá and the Coffee Axis

Abstract

Background Throughout the 2000’s, Colombia progressively adopted more liberal abortion laws. In 2006, Colombia went from completely prohibiting abortion to allowing the procedure in cases of rape, risk to the health or life of the woman, and fetal malformations incompatible with life. In 2022, Colombia finally permitted abortion on request until the 24th week of pregnancy. Despite these changes, illegal, and probably unsafe, abortion has remained. Knowing the reasons why women turn to illegal sources to interrupt their pregnancies may inform strategies to increase knowledge of the abortion law and improve access to legal services. Methods In-depth interviews were conducted in 2018 with 47 women aged 18 and older who used misoprostol obtained outside of health facilities to induce an abortion, and who were receiving postabortion care in two private clinics. Interviews explored what women knew about the 2006 abortion law which was then in effect, and the reasons why they preferred informal channels for abortion care over formal healthcare services. Results Women’s motivations to use misoprostol obtained outside the formal healthcare system were influenced by incomplete and inaccurate knowledge of the abortion law, fear of legal consequences, fear of ill-treatment from healthcare professionals, and concerns about judgment and privacy. Misoprostol also offered effectiveness and affordability and appeared easier to access. Conclusions Obtaining misoprostol outside the formal healthcare system was a more appealing prospect for some women given fears of legal repercussion and stigma toward abortion. This preference may continue despite the more liberal abortion law. Strategies must be implemented to improve awareness of the abortion law while combating misinformation and stigma to ensure that women access quality abortion care.