Abortion, contraception and associated social stigma : consequences and solutions in a low-resource setting in western Kenya

Background: Complications of unsafe abortion is one of the top causes of maternal morbidity and mortality among women and adolescent girls globally. Stigmatising attitudes and behaviour seem to directly impact women’s and girls’ reproductive decision-making but are rarely explored. Enhanced understanding of the stigmatisation of abortion and contraceptive use is needed to reduce its impact on affected individuals and increase access to quality abortion care and contraceptive counselling and provision. Aim: The overall aim of this doctoral thesis was to increase knowledge on the constituents and consequences of, and solutions to, social stigma surrounding abortion and contraceptive use among women seeking post-abortion care, as well as secondary school students, in Kisumu, Kenya. Materials, Methods, and Findings: Study I was a qualitative study with individual, face- to-face interviews with nine women seeking post-abortion care. The objective was to analyse decision-making processes preceding abortion among women and adolescent girls with unwanted pregnancies. Method: Over all, 15 in-depth interviews using open-ended questions and a non-judgmental approach were conducted among women aged 19–32 years, with experienced induced abortion. All interviews were coded manually using inductive content analysis. Findings: The main findings showed poor social support and deviation from family- and gender-based norms determined abortion decision-making among women and girls. Strategic choices concerning whom to trust were made to avoid ignominy, which contributed to a culture of silence. The study found that abortion stigma hindered access to safe abortion services. Study II was a sub-study nested in a randomised, controlled trial on women seeking post- abortion care, focusing on pregnancy intentions in order to investigate contraceptive uptake and identify factors associated with unplanned pregnancy. Method: The analysis was based on follow-ups with 807 women and adolescent girls, aged 14–45 years, seven to ten days after ...