Attitudes towards abortion in DRC suggest that there are ways to overcome stigma

In the Democratic Republic of the Congo (DRC), restrictive abortion laws, limited medical resources and high costs – all compounded by two decades of conflict – have led to barriers to access to safe abortion.

Despite legal restrictions, abortion is common in DRC although national data is lacking. A study conducted in Kinshasa estimated that 61% of pregnancies in 2016 were unwanted and that there was a rate of 56 abortions per 1,000 women aged 15 to 49. It is estimated that 88% of abortions in Central Africa are unsafe.

When performed according to World Health Organization guidelines, abortion is a safe and low-risk medical procedure. However, when performed in unsanitary conditions, with unsafe methods, or by an insufficiently trained person, abortion is dangerous and ends in poor health outcomes, including death.

An additional challenge is that abortion is highly stigmatized. In many countries, abortion is seen as a repudiation of traditional female roles of motherhood and procreation. To keep their procedure a secret, women who have terminated a pregnancy can avoid seeking potentially life-saving postabortion care. They do this to avoid social exclusion, the loss of marriage prospects or the risk of being abandoned by their spouse and family.

To better understand the barriers to accessing and using postabortion care in North and South Kivu, DRC, my colleagues and I explored community perceptions of women who have terminated pregnancies. We also wanted to better understand attitudes towards their use of postabortion care.

We found that the initial reactions to the abortion were negative. However, there were displays of understanding and empathy when discussing why women have abortions. For example, many considered it understandable for a woman to induce abortion after rape: this is perhaps not surprising, given the prevalence of conflict-related sexual violence in this area.

We also found that a majority believed that all women should have access to life-saving postabortion care.

Our results indicate that there may be an opening to de-stigmatize access to abortion and postabortion care.

First negative perceptions

For our research, we conducted 24 focus groups with married women and men in six rural districts of North and South Kivu. Participants from all groups recognized that induced abortion often occurs in their communities.

In all groups, initial reactions to induced abortion were overwhelmingly negative. Participants said women who terminated pregnancies were prostitutes or murderers and would face criminal repercussions. They said these women would face social costs in their community: abandonment by their husbands or families, loss of marriage prospects, or judgment or gossip from community members.

Many participants believed that inducing an abortion could lead to infertility, injury or death. They said women who terminated a pregnancy might avoid seeing a doctor for fear that her abortion would no longer be a secret or that it could face criminal repercussions.

Less judgment

Despite these negative perceptions, many participants expressed less judgment when discussing the reasons that motivated women to terminate a pregnancy.

Examples of these reasons included that a woman’s husband was not supportive, unfaithful or abusive. They also included situations in which the pregnancy was due to rape or sexual assault perpetrated by various armed groups in the ongoing conflict.

In addition, they mentioned that a woman – or a couple – could choose to terminate a pregnancy because she could not afford to feed another child, or if she had recently given birth or had already had many. children.

Participants expressed some empathy for a single girl who would like to avoid the stigma of becoming a single mother, or who wants to complete her education. Many participants explicitly stated that abortion was allowed in order to save a woman’s life.

As the discussions continued, a few participants concluded that it was inappropriate to try a woman who had induced an abortion. They recognized that the decision to terminate a pregnancy was a personal one. Other participants argued against criminal charges for women who induced abortions.

Despite their initial reactions, many agreed that women should eventually be reintegrated into society after inducing an abortion.

Even among those who strongly opposed abortion, community members almost unanimously agreed that a woman who has terminated a pregnancy should have access to postabortion care. They also said they would help her get treatment. As one man put it:

Even if she does it secretly, you can send her to the health center first despite what she has done. You have to save his life first.

And now?

Our study showed a clear openness to addressing community attitudes and stigma that prevent women from seeking postabortion care.

Attitudes towards women terminating their pregnancies are nuanced and complex, even in places where abortion laws are restrictive. It is therefore important to engage with communities and reduce the stigma of abortion.

An overwhelming majority of participants believed that women who had induced an abortion should have access to postabortion care, even if they disagreed with the woman’s action. It is therefore essential to explore beyond initial negative attitudes to ensure that women who have abortions have access to life-saving care.

Sara E Casey received funding from an anonymous private foundation for this research.

By Sara E Casey, Assistant Professor, Heilbrunn Department of Population and Family Health, Columbia University