‘High profile health facilities can add to your trouble’: Women, stigma and un/safe abortion in Kenya

Abstract

Public health discourses on safe abortion assume the term to be unambiguous. However, qualitative evidence elicited from Kenyan women treated for complications of unsafe abortion contrasted sharply with public health views of abortion safety. For these women, safe abortion implied pregnancy termination procedures and services that concealed their abortions, shielded them from the law, were cheap and identified through dependable social networks. Participants contested the notion that poor quality abortion procedures and providers are inherently dangerous, asserting them as key to women's preservation of a good self, management of stigma, and protection of their reputation, respect, social relationships, and livelihoods. Greater public health attention to the social dimensions of abortion safety is urgent.

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

“…This is not surprising in a context where harassment of health providers by police and others is on the rise (Center for Reproductive Rights ; Evens, Otieno‐Masaba et al. ; Izugbara, Egesa, and Okelo ).…”

“…Arrests, harassment, and penalization of health providers suspected of offering safe abortion service also continue against a background of an unresolved lawsuit instituted by a consortium of human rights groups and activists in Kenya against the country's Ministry of Health over the non‐release of official guidelines for offering abortion care (Marlow, Wamugi et al. ; Izugbara, Egesa, and Okelo ).…”

“…Evidence shows a continuing trend among Kenyan women and girls to obtain abortions outside formal facilities or with the support of unqualified providers, and to present at formal facilities for the management of the consequent complications (Evens, Otieno‐Masaba et al. ; Izugbara, Egesa, and Okelo ). Available data indicate that the induced abortion ratio in Kenya is 30 abortions per 100 live births (APHRC et al.…”

“…However, reports of providers’ violation and mistreatment of young abortion care‐seekers remain widespread (Dressler, Maughn et al. ; Ndunyu ; Izugbara, Egesa, and Okelo ). In Kenya, abortion care providers reportedly continue to act and relate inhospitably to young abortion patients, deliberately manage abortion patients without pain killers, abuse them sexually, and sometimes threaten to have the police arrest them (Center for Reproductive Rights ; Ndunyu ; Izugbara, Egesa, and Okelo ).…”

“…Within this context, doubts have been expressed, not only about providers’ appreciation of the challenges young women face in relation to abortion services but also about their capacity to offer empathic and quality unprejudiced care to young abortion patients (Steele and Chiarotti ; Evens, Otieno‐Masaba et al. ; Izugbara, Egesa, and Okelo ).…”