Abortion In Kenya And Benin: Medical Safety Isnt Enough Women And Girls Need To Feel Safe Socially Too

Safe abortion and post-abortion care are important public health services. But until the World Health Organization (WHO) published abortion guidelines in 2022, there was a narrow definition of safe abortion. In previous WHO guidelines, physician safety was a key principle of safe abortion. According to the World Health Organization, a safe abortion is an abortion performed by a person with the necessary skills using recommended methods or in an environment that meets minimum medical standards, or both.

But research shows that many girls and young women do not seek medical attention when they have an abortion. Priority is given to "socialists". This is true whether they live in a context with restrictive or more liberal laws. Avoiding accusations and social stigma is a priority for women.

The need for privacy is one of the reasons why women and girls continue to use safe abortion methods.

Recent WHO guidelines take a more holistic approach. They promote not only medical safety, but also quality abortion care. These guidelines respect the right to non-discrimination and the right to equal access to abortion services. But will this change affect girls and young women living in rural areas or countries with restricted abortion laws where social security remains mandatory?

Social security goes beyond physical health. This includes emotional and financial well-being, social status, reputation, and female relationships. In the context of abortion, this means finding an affordable provider, concealing the abortion, and being protected by law enforcement.

We conducted research in Kenya and Benin to learn more about how girls and young women feel safe (or unsafe) when seeking an abortion. Both study sites have high rates of unplanned pregnancies and medically unsafe abortions. Abortion is not accepted in society.

Research has shown that social security is achieved only when abortion is performed judiciously in these situations.

Social security

We conducted a six-month study in the Kilifi region (Kenya) and the Atlantic department (Benin). We studied girls and young women recruited from health centers and surrounding communities. We also conducted informal and in-depth interviews.

Our research showed that women are aware of safe abortion methods such as medical abortion and surgical abortion in medical facilities.

But medical facilities were not the first choice for women and girls seeking abortions. This happened because privacy was not guaranteed. Support is provided in the delivery room or emergency room, without a dedicated area for procedures. Additionally, women and girls were afraid to report information to providers or confront facility residents. Trial health workers were also subjected to emotional or physical abuse.

Instead, the girls and women in our study will begin the abortion process by trying local, inexpensive, alternative methods used to treat other conditions. These include herbal decoctions and large doses of antimalarial drugs, analgesics or antibiotics. She hid her abortions, but only temporarily. Many cases can develop into complications requiring emergency treatment or death. A study in Benin found that almost half of post-abortion treatment cases for women were related to complications from unsafe abortions. Almost 30% of abortions in Kenya end with complications treated in health facilities.

When abortion-seekers' understanding of safety conflicts with that of public health, a solution may be found in some self-care contexts.

Social security self-care

In recent years, and especially after the COVID-19 pandemic, the idea of ​​self-care in healthcare has emerged. WHO defines self-care as:

the ability to promote the health of individuals, families, and communities, prevent disease, maintain health, and manage illness and disability with or without the assistance of a health professional.

A self-care abortion means being able to schedule as many abortions as you want. This includes access to medical information and over-the-counter birth control pills. It also includes using digital platforms to support access and use of abortion pills.

In liberalized and high-income countries, self-care success rates exceed 93%, according to research.

Post-abortion self-care helps women and girls feel more confident about abortion and improves their independence and control. So, in theory, self-care abortion can provide social security. This allows for discretion and avoids the risk of incarceration with impatient providers or lack of privacy and medical facilities.

In practice, however, it is difficult to see how this will reach mobile women and girls who are poorly educated, or who do not have the money to use these devices, let alone smartphones or the Internet.

Disparities in digital access, gender, social class and literacy prevent many poor girls and women from obtaining abortions themselves. For them, self-abortion is still not a solution. Social protection for abortion can only be obtained by having an abortion at home, which can lead to serious consequences. Therefore, efforts to increase access to safe abortion must continue.

One way is to invest in personalized, user-centered abortion services through medical intermediaries. But provider biases, community attitudes, and law enforcement agencies and authorities need to better understand existing laws and, if necessary, improve them.

Research findings have shown that coworkers, family members, and community supporters can also act as mediators. Therefore, another avenue may be a gender transformation intervention. Male partners and other family members will participate in self-protective abortions. Men often have abortions and often have better access to digital technology. If they are well informed, they can help women take care of themselves.

Family medicine and abortion. Responding to the evolving crisis in access to reproductive health care