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

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 CountiesSubjects: 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

Abortion related stigma: a case study of abortion stigma in regions with high and low incidences of unsafe abortion

Background: Abortion accounts for 35% of maternal mortality in Kenya. Kenya has reported an increase in the rate of unsafe abortions from 32 to 48 per 1000 women of reproductive age in 2002 and 2012 respectively. During the same period, women presented in public health facilities with severe complications indicating that women were having unsafe abortions.Objective: To investigate the association between incidences of unsafe abortion and stigma attitudes and beliefs about abortion among community member’s in two counties located in regions with either high or low incidences of unsafe abortion.Design: A cross-sectional comparative study.Settings: General community members in Trans Nzoia and Machakos Counties.Subjects: Men and women of reproductive age in Trans Nzoia and Machakos Counties.Results: Respondents in Trans Nzoia County reported the highest full-scale abortion stigma levels (μ=55.4) compared to those from Machakos County (μ=53.07). The mean differences in SABAS scores for all the four subscales were significant for fear of contagion, exclusion and discrimination and Negative stereotyping (p-value <0.000). Incidence region, educational attainment and marital status were all significantly associated with stigmatising attitudes. Respondents in the 35-49 age group showed more stigmatising attitudes than younger respondents, and married individuals showed more stigmatising attitudes than single respondents, and lower education levels were associated with higher levels of stigma.Conclusions: Mean stigma scores for counties with high incidence of unsafe abortions were higher than those from regions with a low incidences of unsafe abortion. Male community members, those with lower levels of education were more likely to report higher levels of stigma at the community level. The majority of women seeking abortion were viewed negatively by general community members, and this could explain women’s decision to seek an unsafe abortion

Improving the standards-based management: recognition initiative to provide high-quality, equitable maternal health services in Malawi. An implementation research protocol: Table 1

Background: The Government of Malawi is seeking evidence to improve implementation of its flagship quality of care improvement initiative — the Standards Based Management-Recognition for Reproductive Health (SBM-R(RH)). Objective: This implementation study will assess the quality of maternal healthcare in facilities where the SBM-R(RH) initiative has been employed, identify factors that support or undermine effectiveness of the initiative and develop strategies to further enhance its operation. Methods: Data will be collected in 4 interlinked modules using quantitative and qualitative research methods. Module 1 will develop the programme theory underlying the SBM-R(RH) initiative, using document review and in-depth interviews with policymakers and programme managers. Module 2 will quantitatively assess the quality and equity of maternal healthcare provided in facilities where the SBM-R(RH) initiative has been implemented, using the Malawi Integrated Performance Standards for Reproductive Health. Module 3 will conduct an organisational ethnography to explore the structures and processes through which SBM-R(RH) is currently operationalised. Barriers and facilitators will be identified. Module 4 will involve coordinated co-production of knowledge by researchers, policymakers and the public, to identify and test strategies to improve implementation of the initiative. Potential impact: The research outcomes will provide empirical evidence of strategies that will enhance the facilitators and address the barriers to effective implementation of the initiative. It will also contribute to the theoretical advances in the emerging science of implementation research

Social Networks and Decision Making for Clandestine Unsafe Abortions: Evidence from Kenya

Little is known about the role of social networks in promoting clandestine abortions. This study investigated the role social networks play in decision making for and facilitation of clandestine abortions. It was a mixed method study in which 320 women treated for complications of unsafe abortions were interviewed in a cross sectional survey to determine their consultation with social networks and how this ended up in clandestine abortions. Information obtained was supplemented with information from focus group discussions, case studies and key informant interviews. It was found that 95% of women consulted their social networks as part of decision making before aborting clandestinely and unsafely. The man responsible for pregnancy, friend of same sex and woman’s mother were the most consulted at 64%, 32% and 23% respectively. 92% of advice was for the woman to abort. The man responsible for pregnancy and the woman’s mother were the most influential advisors (p˂0.05). Intermediaries linked the woman to clandestine and unsafe abortion and included agents and previous clients of clandestine abortion providers and the woman’s friends and relatives. Decision making and seeking for clandestine abortion were therefore found to be shared responsibilities. It is recommended that programs for reducing unsafe abortions be designed with this fact in mind. Keywords: abortion decisions, social influence, health seeking behavio

Power, Prejudice and Transitional Constitution-Making in Kenya: The Gender of Law and Religious Politics in Reproductive Choice

Kenya has borne memories and scars of colonial hegemonies, repressive and kleptocratic post-independence regimes, and bitter ethnic politicization of inequality, poverty, land issues and exclusion resulting in intermittent strife and volatile politics. Concomitantly, efforts to constitutionally reform and uphold rights and freedoms, especially for more vulnerable groups such as women, have been undertaken unsuccessfully. The 2007 post-election violence created the ultimate conditions for undertaking transitional justice, including reviving a constitutional process that was inclusive, enhanced equality and was effective for achieving sustainable peace, stability and justice in Kenya. Such conditions also allowed Kenya’s strong and very vocal human and women’s rights movements to negotiate aspects critical to their causes and play an important role in the successful 2010 constitutional referendum