School of Public Health, University of Rwanda, Kigali, Rwanda.
Health Development Initiative, PO Box 3955, Kigali, Rwanda.
BMC Womens Health. 2023 Apr 28;23(1):205. doi: 10.1186/s12905-023-02366-4.
Between 2010 and 2014, approximately 25 million unsafe abortions were performed annually across the globe. Africa alone accounted for 29% of all unsafe abortions, and 62% of the related deaths. Women living in poverty, especially adolescents, lack information about where and how to access safe abortion services. They often lack adequate insight to make informed decisions. The purpose of this study was to explore the empowered perspectives of women leaders in Rwanda about the recent policy change for safe abortion. The study identifies women leaders' perceived barriers and their attitudes about resulting consequences toward safe abortion.
In this qualitative study, seven focus group discussions and eight key informant interviews were performed in October 2019. A total of 51 women leaders participated, their age ranging from 38 to 60 years. Participants were drawn from three districts, namely Gasabo, Kicukiro, and Nyarugenge. For variability of data, participants came from parliament, government ministries, government parastatals, and civil society organizations. All interviews were conducted in Kinyarwanda and later translated into English. Data were analyzed using qualitative content analysis.
The emerging theme Strong barriers and numerous consequences of safe abortion illustrates how women leaders perceive barriers to safe abortion and its related consequences in Rwanda. The theme is divided into two categories: (1) Perceived barriers of safe abortion and (2) Consequences of providing safe abortion. The sub-categories for the first category are Reluctance to fully support safe abortion due to perceived unjustified abortions", Abortion-related stigma, Abortion is against cultural and religious beliefs, Emotional attachment to the unborn and Lack of awareness of abortion. The sub-categories for the second category are Perceived physiological trauma, Cause for barrenness/infertility, Increase in services abuse by adolescents/women, Increase of workload for healthcare providers, "Increase in sexual activities and STIs, and Abortion-related physiological trauma.
The subject of safe abortion evokes mixed reactions among participants, and is entangled with unsafe abortion in most cases. Participants stress that the word 'abortion' disturbs, regardless of whether it relates to being safe or unsafe. Participants believe the word 'abortion' outweighs the word 'safe'. Societal expectations play a major role in the decision-making process of any adolescent or a family member faced with a pregnant adolescent regardless of the existing safe abortion law. Community mobilization and sensitization are crucial if safe abortion in accordance with abortion law is to be embraced. Messages that reinforce safe abortion as acceptable and address stigma, fears of trauma, and barrenness should be developed to educate adolescents, parents, and women leaders about safe abortion, to mitigate unsafe abortion-related complications.
在 2010 年至 2014 年期间，全球每年约有 2500 万例不安全堕胎。仅非洲就占所有不安全堕胎的 29%，相关死亡人数的 62%。生活贫困的妇女，尤其是青少年，缺乏关于在哪里以及如何获得安全堕胎服务的信息。她们往往缺乏足够的洞察力来做出明智的决定。本研究旨在探讨卢旺达妇女领袖对最近安全堕胎政策变化的赋权观点。该研究确定了妇女领袖对安全堕胎的感知障碍以及对由此产生的后果的态度。
在这项定性研究中，2019 年 10 月进行了七次焦点小组讨论和八次关键知情人访谈。共有 51 名妇女领袖参加，年龄在 38 岁至 60 岁之间。参与者来自三个区，即 Gasabo、Kicukiro 和 Nyarugenge。为了数据的多样性，参与者来自议会、政府部委、政府半官方机构和民间社会组织。所有访谈均用法语进行，随后翻译成英语。使用定性内容分析对数据进行分析。
新出现的主题“安全堕胎的强烈障碍和众多后果”说明了妇女领袖如何看待卢旺达安全堕胎的障碍及其相关后果。该主题分为两类：（1）安全堕胎的感知障碍和（2）提供安全堕胎的后果。第一类的子类别是“由于感知到不合理的堕胎，不愿完全支持安全堕胎”、堕胎相关耻辱感、堕胎违反文化和宗教信仰、对未出生婴儿的情感依恋和缺乏堕胎意识。第二类的子类别是感知到的生理创伤、导致不育/不孕、青少年/妇女滥用服务增加、医疗保健提供者工作量增加、“性活动和性传播感染增加”以及与堕胎相关的生理创伤。
安全堕胎的话题引起了参与者的混合反应，并且在大多数情况下与不安全堕胎纠缠在一起。参与者强调，无论是否涉及安全堕胎，“堕胎”一词都会引起不安。参与者认为“堕胎”这个词比“安全”这个词更重要。无论现有的安全堕胎法如何，社会对任何青少年或面临怀孕青少年的家庭成员的决策过程都起着重要作用。如果要接受符合堕胎法的安全堕胎，就必须进行社区动员和宣传。应该制定强化安全堕胎可接受性并解决耻辱感、创伤恐惧和不育症的信息，以教育青少年、父母和妇女领袖有关安全堕胎的知识，减轻与不安全堕胎相关的并发症。
