Posted by Nicole Moran on October 24, 2019 at 12:10 am
Despite being a common procedure and an essential component of sexual and reproductive health care, many women still face barriers to safe abortion, and their pathway to care is influenced by a number of social, cultural and legal factors. Social norms are generally characterised in the global health literature as people’s beliefs about (1) what others in a group do (descriptive norms) and (2) what others in a group approve or disapprove of (injunctive norms). Among these, social norms — the unwritten rules of acceptable behaviour in a group have been found to play a key role. Globally, abortion services are annually accessed by an estimated 35 of 1000 women aged 15–44. 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.