Abstract
BackgroundSafe and legal abortions are rarely practiced in the public health sector in Kenya, and rates of maternal mortality and morbidity from unsafe abortion is high. Little is known about women’s experiences seeking and accessing abortion in informal settlements in Nairobi, Kenya.MethodsSeven focus group discussions were conducted with a total of 71 women and girls recruited from an informal settlement in Nairobi. The interview guide explored participants’ perceptions of unplanned pregnancy, abortion, and access to sexual and reproductive health information in their community. Thematic analysis of the focus group transcripts was conducted using MAX QDA Release 12.ResultsParticipants described a variety of factors that influence women’s experiences with abortion in their communities. According to participants, limited knowledge of sexual and reproductive health information and lack of access to contraception led to unplanned pregnancy among women in their community. Participants cited stigma and loss of opportunities that women with unplanned pregnancies face as the primary reasons why women seek abortions. Participants articulated stigma as the predominant barrier women in their communities face to safe abortion. Other barriers, which were often interrelated to stigma, included lack of education about safe methods of abortion, perceived illegality of abortion, as well as limited access to services, fear of mistreatment, and mistrust of health providers and facilities.ConclusionsWomen in informal settlements in Nairobi, Kenya face substantial barriers to regulating their fertility and lack access to safe abortion. Policy makers and reproductive health advocates should support programs that employ harm reduction strategies and increase women’s knowledge of and access to medication abortion outside the formal healthcare system.
Highlights
Unsafe abortion continues to be a persistent public health problem, and is responsible for 13% of all maternal deaths globally [1]
According to participants, limited knowledge of sexual and reproductive health information and lack of access to contraception led to unplanned pregnancy among women in their community
The World Health Organization reported that 21.6 million unsafe abortions occurred in 2008, with the majority of these occurring in developing regions [1]
Summary
Unsafe abortion continues to be a persistent public health problem, and is responsible for 13% of all maternal deaths globally [1]. In countries like Kenya, where abortion is restricted and rates of unintended pregnancy are high (40%) [2], women are often unable to access safe abortion [3]. In Kenya, incidence of induced abortion and maternal mortality from unsafe abortion is estimated to be much higher: a recent study in Kenya on induced abortion estimated an annual abortion incidence of 48 abortions per 1,000 women of reproductive age [5], compared to an estimated annual abortion incidence of 34 per 1,000 in the East Africa region [6]. Safe and legal abortions are rarely practiced in the public health sector in Kenya, and rates of maternal mortality and morbidity from unsafe abortion is high. Little is known about women’s experiences seeking and accessing abortion in informal settlements in Nairobi, Kenya
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