Exploring Women’s Experiences with Modern Contraceptives Prior to Induced Abortions: A Qualitative Study in Southern Ethiopia

Session: Impact of Family Planning on Maternal Newborn Health

Presenter: Mahlet Atakilt Woldetsadik, Pardee RAND Graduate School and RAND Corporation

Background: Although Ethiopia has one of Africa’s most progressive abortion laws, unsafe abortions are estimated to account for 32% of maternal deaths in Ethiopia, and the context under which they occur is not fully understood. This study explores women’s experiences with modern contraceptives prior to termination of pregnancy, and aims to identify barriers to accessing and using sexual and reproductive health services.

Methodology: We conducted in-depth interviews with thirty-four women between April and July 2013. Women aged 14 – 44 years with a history of at least one induced abortion within the past twelve months were invited to participate. Participants were recruited from sexual and reproductive health clinics, governmental health posts, and public hospitals in Hawassa, and neighboring rural districts. We used a grounded theory approach to code interview transcripts and identify themes in the data.

Results: Although all of the interviewed women had some knowledge of contraceptive methods, there was a prevailing belief that modern contraceptives cause infertility, abnormalities in subsequent pregnancies, and other side effects. Most of the women suggested that medical or unsafe abortions were a better alternative for terminating unplanned pregnancies. Predominant reasons for not accessing safe abortion services included high costs of services, lack of privacy, and fear of judgment from providers. Women who had multiple experiences with accessing safe abortion care said they did not receive proper counseling after getting services, and were reluctant to return to health facilities. Women who had negative experiences with abortion care providers were more likely to seek unsafe abortion the second time around.

Conclusion: Providers need to address women’s concerns about using modern contraceptives, and educate their clients about the best ways to prevent unwanted pregnancies. In addition, comprehensive counseling services that include contraceptive counseling must be made available to women before, during, and after comprehensive abortion care.