Ouedraogo Ramatou, Wanjiru Shelmith, Zan Moussa L, Rossier Clementine, Owolabi Onikepe, Athero Sherine, Oduor Clement, Bangha Martin
African Population and Health Research Center, Nairobi, Kenya.
Graduate Institute of International and Development Studies, Geneva, Switzerland.
PLOS Glob Public Health. 2024 Jul 17;4(7):e0003252. doi: 10.1371/journal.pgph.0003252. eCollection 2024.
Despite abortion being stigmatized and legally restricted in Kenya, women still disclose their abortions within their network. Evidence has shown how stigma can influence and regulate individual abortion disclosure decisions and behaviors. This paper seeks to understand why and how women make the decisions to disclose their abortion and the associated methods used. The data are from a qualitative formative study and a respondent-driven sampling survey conducted between 2020 and 2021 in two informal settlements in Nairobi, Kenya. The data were analyzed using a descriptive analysis approach for the quantitative data, and thematic analysis for the qualitative data. Our findings reveal that information sharing about abortion is enclosed in a social dynamic of secrecy. This dynamic contributes to making abortion a secret that respondents decided to share with confidants in 81% of the abortion cases. These confidants include intimate relationships such as trusted friends (62%), followed by female relatives. Information was shared in many cases either to get support (i.e. method to use), or because participants had close ties with the confidants. Regarding the methods used, unidentified pills were the most used regardless of the confidant; followed by traditional methods especially among those who sought help with their mothers/aunts/grandmothers (33%), while Medical Abortion and Manual Vacuum Aspiration were rarely used, mostly by those who confided in friends or sisters/cousins. Our findings show that the disclosure of abortion is a complex process embedded in existing codes regarding the circulation of information on sensitive issues and "help" seeking. Our findings show that the need for information on safe abortion and lack of financial resources frequently empowers them to overcome the fear of stigma and disclose their abortion. However, this often resulted in use of unsafe procedures. The findings suggest the need for strengthening the circulation of information on safe methods within communities, using community champions and intermediaries to increase the likelihood of women being directed through safe methods to enhance their use.
尽管在肯尼亚堕胎受到污名化且受到法律限制，但女性仍会在自己的社交圈子内透露她们的堕胎经历。有证据表明，污名化如何影响和规范个人堕胎披露的决定和行为。本文旨在了解女性为何以及如何做出披露堕胎经历的决定以及所采用的相关方法。数据来自2020年至2021年在肯尼亚内罗毕两个非正式定居点进行的定性形成性研究和应答驱动抽样调查。定量数据采用描述性分析方法进行分析，定性数据采用主题分析方法进行分析。我们的研究结果表明，关于堕胎的信息共享被笼罩在一种保密的社会动态之中。这种动态使得堕胎成为一个秘密，在81%的堕胎案例中，受访者决定与知己分享这个秘密。这些知己包括亲密关系，如值得信赖的朋友（62%），其次是女性亲属。在许多情况下，分享信息要么是为了获得支持（即使用的方法），要么是因为参与者与知己关系密切。关于所采用的方法，无论知己是谁，未识别的药丸是最常用的；其次是传统方法，尤其是在那些向母亲/阿姨/祖母寻求帮助的人中（33%），而药物流产和手动真空吸引术很少使用，主要是那些向朋友或姐妹/表亲倾诉的人。我们的研究结果表明，堕胎披露是一个复杂的过程，嵌入在关于敏感问题信息传播和寻求“帮助”的现有规范之中。我们的研究结果表明，对安全堕胎信息的需求和缺乏资金资源常常使她们有勇气克服对污名化的恐惧并披露自己的堕胎经历。然而，这往往导致使用不安全的程序。研究结果表明，需要通过社区倡导者和中间人加强社区内安全方法信息的传播，以增加女性通过安全方法获得指导从而更多使用这些方法的可能性。
