Independent Consultant, Ibis Reproductive Health , Oakland , CA , USA.
Head, Global Comprehensive Abortion Care Initiative, International Planned Parenthood Federation , London , UK.
Sex Reprod Health Matters. 2019 Nov;27(3):1661753. doi: 10.1080/26410397.2019.1661753.
Abortion is a common and essential component of sexual and reproductive health care, yet social norms and stigma influence women's decision-making and create barriers to safe abortion care. This qualitative study in Kenya and India explores abortion-related fears, expectations and perceptions of stigma among women who have obtained abortion services. In 2017, we conducted 34 semi-structured interviews and 2 focus groups with women who had obtained abortion services in Maharashtra state in India and Thika and Eldoret in Kenya. Thematic analysis was informed by the individual-level abortion stigma framework and theory of normative conduct. We aimed to learn about the diversity of women's experiences, analysing pooled data from the two countries. Most participants reported that before seeking abortion they had little prior knowledge about the service, expected to be judged during care, and feared the service would be ineffective or have negative health consequences. Many reported that community members disapprove of abortion and that a woman's age or marital status could exacerbate judgement. Some reported limiting disclosure of their abortion to avoid judgement. Negative stories, the secrecy around abortion, perceived stigma, social norms, and fear of sanctions all contributed to women's fears and low expectations. These findings elucidate the relationship between social norms and stigma and how expectations and concerns affect women's experiences seeking care. The results have implications for practice, with potential to inform improvements to services and help organisations address stigma as a barrier to care. This may be particularly relevant for younger or unmarried women.
人工流产是性健康和生殖健康护理中常见且必不可少的一部分，但社会规范和污名将影响妇女的决策，并对安全的人工流产护理造成障碍。这项在肯尼亚和印度进行的定性研究探讨了获得人工流产服务的妇女对与人工流产相关的恐惧、期望和污名的看法。2017 年，我们在印度马哈拉施特拉邦、肯尼亚的蒂卡和埃尔多雷特进行了 34 次半结构化访谈和 2 次焦点小组讨论，参与者均为获得过人工流产服务的妇女。主题分析以个体层面的人工流产污名框架和规范行为理论为依据。我们旨在了解妇女经历的多样性，对来自这两个国家的 pooled 数据进行分析。大多数参与者表示，在寻求人工流产之前，她们对这项服务知之甚少，预计在护理过程中会受到评判，并担心服务无效或会对健康产生负面影响。许多人表示，社区成员反对人工流产，妇女的年龄或婚姻状况可能会加剧评判。一些人表示，她们会限制透露自己的人工流产情况，以避免受到评判。负面故事、围绕人工流产的秘密、感知到的污名、社会规范以及对制裁的恐惧，都导致了妇女的恐惧和低期望。这些发现阐明了社会规范和污名之间的关系，以及期望和担忧如何影响妇女寻求护理的体验。研究结果对实践具有启示意义，有可能为改善服务提供信息，并帮助组织解决污名这一护理障碍。这对于年轻或未婚妇女来说可能尤为相关。
