Women Leaders Perceived Barriers and Consequences of Safe Abortion in Rwanda: A Qualitative Study

Abstract Background: Between 2010 and 2014, approximately 25 million unsafe abortions were performed annually across the globe. Africa alone accounted for 29% of all unsafe abortions, and 62% of the related deaths. Women living in poverty, especially adolescents, lack information about where and how to access safe abortion services. They often do not have the power to make informed decisions on the subject. The purpose of this study is to explore the barriers and consequences of safe abortion as perceived by women leaders in Rwanda. Method: In this qualitative study, seven focus group discussions and seven key informant interviews were performed in October 2019. A total of 51 women leaders participated, their age ranging from 38 to 60 years. Participants were drawn from three districts, namely Gasabo, Kicukiro, and Nyarugenge. For variability of data, participants came from parliament, government ministries, government parastatals, and civil society organizations. All interviews were conducted in Kinyarwanda and later translated into English. Data were analyzed using qualitative content analysis. Results: The emerging theme “strong barriers and numerous consequences of safe abortion” illustrates how women leaders perceive barriers to safe abortion and its related consequences in Rwanda. The theme is divided into two categories: 1) “Perceived barriers of safe abortion” and 2) “Consequences of providing safe abortion”. The sub-categories for the first category are “Reluctance to fully support safe abortion due to perceived unjustified abortions”, “Abortion-related stigma, “Abortion is against cultural and religious beliefs”, and “Emotional attachment to the unborn”. The sub-categories for the second category are “Perceived physiological trauma”, “cause for barrenness/infertility”, “increase in services abuse by adolescents/women”, “increase of workload for healthcare providers”, “increase in sexual activities and STIs”, and “Abortion-related physiological trauma”. Conclusion: The subject of safe abortion evokes mixed reactions among participants, and is entangled with unsafe abortion in most cases. Participants stress that the word ‘abortion’ disturbs, regardless of whether it relates to being safe or unsafe. Participants believe the word ‘abortion’ outweighs the word ‘safe’. Societal expectations play a major role in the decision-making process of any adolescent or a family member faced with a pregnant adolescent regardless of the existing safe abortion law. Community mobilization and sensitization are crucial if safe abortion in accordance with abortion law is to be embraced. Messages that reinforce safe abortion as acceptable and address stigma, fears of trauma, and barrenness should be developed to educate adolescents, parents, and women leaders about safe abortion, to mitigate unsafe abortion-related complications.