Providers, Unmarried Young Women, and Post‐Abortion Care in Kenya

Izugbara, Chimaraoke; Egesa, Carolyne; Kabiru, Caroline W.; Sidze, Estelle

doi:10.1111/sifp.12035

Cited by 21 publications

(31 citation statements)

References 47 publications

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“…Additionally, while community beliefs and attitudes contribute to abortion stigma, available evidence indicates that provider bias can also be a powerful careseeking deterrent; as such, future research should include both community members and health providers to better document and understand the impact of abortion stigma in diverse contexts. 12,15,18,19 Limitations While FGD facilitators were not staff of the three partner organisations, participants may have tried to provide the responses they believed the researchers desired. As induced abortion is a taboo subject in DRC, social desirability bias may also have influenced participants' responses, especially in the early negative reactions to women who induce abortion.…”

Section: Discussionmentioning

confidence: 99%

“…10 Although there is limited empirical evidence regarding the health impact of abortion stigma, many researchers have hypothesised that the threat of these social costs and desire for confidentiality could influence women to seek clandestine, unsafe abortion services or delay or avoid life-saving post-abortion care (PAC). 9,10,12,[15][16][17][18][19][20][21] For example, despite recent legislation permitting abortion in certain circumstances, a quarter of maternal deaths in Kenya have been attributed to complications from unsafe abortions. 22 Women in Kenya pursued abortions outside of facilities as they believed the social risk associated with being identified as having induced an abortion outweighed the physical risk of pursuing an unsafe, but potentially more discrete, abortion.…”

Section: Introductionmentioning

confidence: 99%

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“You must first save her life”: community perceptions towards induced abortion and post-abortion care in North and South Kivu, Democratic Republic of the Congo

Casey

Steven

Deitch

et al. 2019

Sexual and Reproductive Health Matters

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Structural barriers such as a restrictive legal environment, limited medical resources, and highcosts inhibit access to safe abortion in the Democratic Republic of the Congo (DRC); these barriers are exacerbated by two decades of conflict. Socio-normative barriers further complicate access to safe abortion and post-abortion care (PAC) in DRC, where fear of abortion-related stigma may lead women to avoid PAC services. Programme partners support the Ministry of Health to provide good quality contraceptive and PAC services in North and South Kivu, DRC. This paper presents results from focus group discussions that explored community members' attitudes towards women who induce abortion and their care-seeking behaviour in programme areas. Results indicate that while abortion stigma was widespread, community members' attitudes towards women who induced abortions were not one-dimensional. Although they initially expressed negative opinions regarding women who induced abortion, beliefs became more nuanced as discussion shifted to the specific situations that could motivate a woman to do so. For example, many considered it understandable that a woman would induce abortion after rape: perhaps unsurprising, given the prevalence of conflict-related sexual violence in this area. While community members believed that fear of stigma or associated negative social consequences dissuaded women from seeking PAC, a majority believed that all women should have access to life-saving PAC. This commitment to ensuring that women who induced abortion have access to PAC, in addition to the professed acceptability of induced abortion in certain situations, indicates that there could be an opening to destigmatise abortion access in this context.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“You must first save her life”: community perceptions towards induced abortion and post-abortion care in North and South Kivu, Democratic Republic of the Congo

Casey

Steven

Deitch

et al. 2019

Sexual and Reproductive Health Matters

View full text Add to dashboard Cite

show abstract

“…While there is evidence that women experience poor person-centered abortion care around the globe, a significant limitation in the literature is the lack of a standardized scale to assess person-centered abortion care (PCAC). In Kenya, there are few studies that focus on patient experiences of care, with most studies qualitative in nature [4,[10][11][12]. Standardized measures are important for quality improvement efforts, designing and evaluating health system and policy improvements, identifying the unmet need of the most vulnerable populations, and for advocacy.…”

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confidence: 99%

Development and validation of a person-centered abortion scale: the experiences of care in private facilities in Kenya

et al. 2020

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Background There is a need for a standardized way to measure person-centered care for abortion. This study developed and validated a measure of person-centered abortion care. Methods Items for person-centered abortion care were developed from literature reviews, expert review, and cognitive interviews, and administered with 371 women who received a safe abortion service from private health clinics in Nairobi, Kenya. Exploratory factor analyses were performed and stratified by surgical abortion procedures and medication abortion. Bivariate linear regressions assessed for criterion validity. Results We developed a 24-item unifying scale for person-centered abortion care including two sub-scales. The two sub-scales identified were: 1) Respectful and Supportive Care (14 items for medication abortion, 15 items for surgical abortion); and 2) Communication and Autonomy (9 items for both medication and surgical abortion). The person-centered abortion care scale had high content, construct, criterion validity, and reliability. Conclusions This validated scale will facilitate measurement and further research to better understand women’s experiences during abortion care and to improve the quality of women’s overall reproductive health experiences to improve health outcomes.

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“…Religious norms and the view that the early fetus has a moral right to life count against providing abortion; the interests of the pregnant woman count for it. This kind of experienced conflict has been described in other developing countries, such as Kenya [20]. Similarly, a study from South Africa indicated that abortion providers formed their views on abortion in light of personal, moral and religious factors [21].…”

Section: Balancing Allegiances and Concernsmentioning

confidence: 94%

Still a moral dilemma: how Ethiopian professionals providing abortion come to terms with conflicting norms and demands

et al. 2020

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Background: The Ethiopian law on abortion was liberalized in 2005. However, as a strongly religious country, the new law has remained controversial from the outset. Many abortion providers have religious allegiances, which begs the question how to negotiate the conflicting demands of their jobs and their commitment to their patients on the one hand, and their religious convictions and moral values on the other. Method: A qualitative study based on in-depth interviews with 30 healthcare professionals involved in abortion services in either private/non-governmental clinics or in public hospitals in Addis Ababa, Ethiopia. Transcripts were analyzed using systematic text condensation, a qualitative analysis framework. Results: For the participants, religious norms and the view that the early fetus has a moral right to life count against providing abortion; while the interests and needs of the pregnant woman supports providing abortion services. The professionals weighed these value considerations differently and reached different conclusions. One group appears to have experienced genuine conflicts of conscience, while another group attempted to reconcile religious norms and values with their work, especially through framing provision of abortion as helping and preventing harm and suffering. The professionals handle this moral balancing act on their own. In general, participants working in the private sector reported less moral dilemma with abortion than did their colleagues from public hospitals. Conclusions: This study highlights the difficulties in reconciling tensions between religious convictions and moral norms and values, and professional duties. Such insights might inform guidelines and healthcare ethics education.

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Providers, Unmarried Young Women, and Post‐Abortion Care in Kenya

Abstract: Young women and girls in

Cited by 21 publications

References 47 publications

“You must first save her life”: community perceptions towards induced abortion and post-abortion care in North and South Kivu, Democratic Republic of the Congo

“You must first save her life”: community perceptions towards induced abortion and post-abortion care in North and South Kivu, Democratic Republic of the Congo

Development and validation of a person-centered abortion scale: the experiences of care in private facilities in Kenya

Still a moral dilemma: how Ethiopian professionals providing abortion come to terms with conflicting norms and demands

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