背景:尽管在撒哈拉以南非洲地区安全堕胎方法的可获得性增加,妇女和女孩继续使用不安全的堕胎方法和程序来终止其意外怀孕,导致严重的并发症,终身残疾,和死亡。安全堕胎方法的障碍包括限制性法律,对安全流产方法的认识不足,贫穷,以及社会文化和卫生系统的障碍。尽管如此,关于堕胎方法的决策和使用的数据很少。本文旨在为以下问题提供答案:妇女和女孩使用哪种堕胎方法以及为什么?谁和什么影响了他们的决定?我们可以从他们的决策过程中学到什么,以增强对安全堕胎方法的吸收?我们将深入分析肯尼亚基利菲县和贝宁Atlantique省妇女和女孩选择堕胎方法的原因。
方法:我们利用在2021年1月至8月之间进行的人种学研究中收集的数据,以了解生活经历。社会决定因素,和堕胎的途径。数据是通过对最近有堕胎经历的95名女孩和妇女的反复深入访谈收集的。访谈的数据使用关键线人访谈的信息进行了补充,焦点小组讨论,参与者观察。数据分析是通过归纳过程进行的。
结果:我们的研究结果表明,妇女和女孩使用各种方法进行堕胎,包括草药,高剂量的药物,自制调料,药物流产,和手术流产方法。程序可能涉及单一或多次尝试,有时,混合几种方法来达到终止妊娠的目的。各种堕胎方法的使用主要是为了追求社会安全(保守秘密和社会关系,避免羞耻和污名化),而不是医疗安全(这意味着技术安全和质量)。
结论:我们的发现重申了全面获取,和可用性,与堕胎有关的信息和服务,特别是强调医疗和社会安全的安全堕胎和堕胎后护理服务。
尽管在撒哈拉以南非洲有安全的堕胎方法,该地区的妇女和女孩继续诉诸不安全的方法,导致严重的并发症,残疾人,和产妇死亡。这可以归因于限制性堕胎法,缺乏对安全堕胎方法的认识,贫穷,以及社会文化和卫生系统的障碍。本文使用了基利菲县一项更大的人种学研究的数据,肯尼亚,和大西洋部,贝宁,了解妇女和女孩使用的方法,以及为什么,帮助提高使用安全流产方法。数据是通过对最近堕胎的95名女孩和妇女的深入访谈收集的,以及关键线人采访,焦点小组讨论,参与者观察。调查结果显示,妇女和女孩使用各种方法终止怀孕,包括草药,高剂量的药物,自制调料,药物流产,和手术方法。他们经常使用这些方法一次,多次,或组合来实现他们的目标。他们选择方法的主要原因不是医疗安全而是社会安全,包括维护社会关系,避免羞耻和耻辱。我们得出的结论是,迫切需要更多地获得准确的,关于安全堕胎方法的框架良好的信息。堕胎服务不仅应考虑医疗安全,还应考虑减轻在医疗机构堕胎的社会影响的自由裁量权。通过解决这些因素,有可能加强安全堕胎方法的使用,并减少对不安全做法的依赖。
BACKGROUND: Despite the increased availability of safe abortion methods in sub-Saharan Africa, women and girls continue to use unsafe abortion methods and procedures to terminate their unwanted pregnancies, resulting in severe complications, lifelong disabilities, and death. Barriers to safe abortion methods include restrictive laws, low awareness of safe abortion methods, poverty, and sociocultural and health system barriers. Nonetheless, there is a paucity of data on the decision-making around and use of abortion methods. This paper aims to provide answers to the following questions: Which abortion methods do women and girls use and why? Who and what influences their decisions? What can we learn from their decision-making process to enhance the uptake of safe abortion methods? We focus our in-depth analysis on the rationale behind the choice of abortion methods used by women and girls in Kilifi County in Kenya and Atlantique Department in Benin.
METHODS: We draw on data collected as part of an ethnographic study conducted between January and August 2021 on lived experiences, social determinants, and pathways to abortion. Data were collected using repeated in-depth interviews with 95 girls and women who had a recent abortion experience. Data from the interviews were supplemented using information from key informant interviews, focus group discussions, and participant observation. Data analysis was conducted through an inductive process.
RESULTS: Our findings reveal that women and girls use various methods to procure abortions, including herbs, high doses of pharmaceutical drugs, homemade concoctions, medical abortion drugs, and surgical abortion methods. Procedures may involve singular or multiple attempts, and sometimes, mixing several methods to achieve the goal of pregnancy termination. The use of various abortion methods is mainly driven by the pursuit of social safety (preservation of secrecy and social relationships, avoidance of shame and stigmatization) instead of medical safety (which implies technical safety and quality).
CONCLUSIONS: Our findings reaffirm the need for comprehensive access to, and availability of, abortion-related information and services, especially safe abortion and post-abortion care services that emphasize both medical and social safety.
Despite the availability of safe abortion methods in sub-Saharan Africa, women and girls in the region continue to resort to unsafe methods, leading to severe complications, disabilities, and maternal death. This can be attributed to restrictive abortion laws, lack of awareness on safe abortion methods, poverty, and sociocultural and health system barriers. This paper uses data from a larger ethnographic study in Kilifi County, Kenya, and Atlantique Department, Benin, to understand which methods women and girls use, and why, to help improve the use of safe abortion methods.Data were collected through in-depth interviews with 95 girls and women who had recently undergone an abortion, as well as key informant interviews, focus group discussions, and participant observation. The findings reveal that women and girls use various methods to terminate their pregnancies, including herbs, high doses of pharmaceutical drugs, homemade concoctions, medical abortion drugs, and surgical methods. They often use these methods once, multiple times, or in combination to achieve their goal. The main reason for their choice of methods is not medical safety but social safety, including preserving social relationships and avoiding shame and stigma.We conclude that there is a pressing need for greater access to accurate, well-framed information about safe abortion methods. Abortion services should consider not only medical safety but also discretion to mitigate the social implications of having an abortion in a medical facility. By addressing these factors, it is possible to enhance the use of safe abortion methods and reduce the reliance on unsafe practices.