title: Women's perceptions about abortion in their communities: perspectives from western Kenya.
abstract: Unsafe abortion in Kenya is a leading cause of maternal morbidity and mortality. In October 2012, we sought to understand the methods married women aged 24-49 and young, unmarried women aged ≤ 20 used to induce abortion, the providers they utilized and the social, economic and cultural norms that influenced women's access to safe abortion services in Bungoma and Trans Nzoia counties in western Kenya. We conducted five focus groups with young women and five with married women in rural and urban communities in each county. We trained local facilitators to conduct the focus groups in Swahili or English. All focus groups were audiotaped, transcribed, translated, computerized, and coded for analysis. Abortion outside public health facilities was mentioned frequently. Because of the need for secrecy to avoid condemnation, uncertainty about the law, and perceived higher cost of safer abortion methods, women sought unsafe abortions from community midwives, drug sellers and/or untrained providers at lower cost. Many groups believed that abortion was safer at higher gestational ages, but that there was no such thing as a safe abortion method. Our aim was to inform the design of a community-based intervention on safe abortion for women. Barriers to seeking safe services such as high cost, perceived illegality, and fear of insults and abuse at public facilities among both age groups must be addressed.
authors.affiliation: Senior Associate, Research and Evaluation, Ipas, Chapel Hill, NC, USA. Electronic address: marlowh@ipas.org.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Marlow
authors.affiliation: Communications Associate, Programs, Africa Alliance Regional Policy, Ipas Africa Alliance, Nairobi, Kenya.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Wamugi
authors.affiliation: Senior Research and Evaluation Associate, Programs, East Africa Region, Ipas Africa Alliance, Nairobi, Kenya.
authors.forename: Erick
authors.initials: E
authors.lastname: Yegon
authors.affiliation: Senior Associate, Research and Evaluation, Ipas, Chapel Hill, NC, USA.
authors.forename: Tamara
authors.initials: T
authors.lastname: Fetters
authors.affiliation: Community Access Associate, Programs, East Africa Region, Ipas Africa Alliance, Nairobi, Kenya.
authors.forename: Leah
authors.initials: L
authors.lastname: Wanaswa
authors.affiliation: Senior Community Access Associate, Programs, East Africa Region, Ipas, Chapel Hill, NC, USA.
authors.forename: Sinikiwe
authors.initials: S
authors.lastname: Msipa-Ndebele
mesh_terms: D000024:Abortion, Illegal / Q000191:economics / Q000523:psychology*; D000028:Abortion, Induced / Q000191:economics / Q000523:psychology*; D000328:Adult; D055812:Community-Based Participatory Research; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006297:Health Services Accessibility; D006801:Humans; D007630:Kenya; D017533:Marital Status; D008427:Maternal Health Services; D008875:Middle Aged; D061214:Patient Safety; D011247:Pregnancy; D016387:Women's Health; D055815:Young Adult
keywords: Kenya; abortion law and policy; abortion methods; community-based research; cost of abortion; unsafe abortion