Access to safe abortion services in Kibera informal settlements, Nairobi city county, Kenya

Abstract

This thesis focused on access to safe abortion services in Kibera informal settlements in Nairobi City County. The main objective of the study was to explore the factors influencing access to safe abortion services in Kibera informal settlements. The specific objectives were to investigate the women’s understanding of the abortion provisions in the Kenyan constitution; to determine the availability and accessibility of safe abortion services in Kibera informal settlements and to examine how women’s attitudes influence their access to available abortion services in Kibera informal settlements. The study design was cross-sectional, combining both qualitative and quantitative methods of data collection. The qualitative methods that were used included case studies, focused group discussions and key informants interviews. Quantitative data was collected in a survey using a semi-structured questionnaire. Non-probability sampling methods were used to draw the study participants. A total of 50 women of reproductive age (15-49 years) were sampled to participate in the study using convenience sampling technique. These women participated in the survey. Three (3) FGDs were conducted with a sub-sample of the women who had participated in the survey. The focus group participants were conveniently selected on the basis of who had time to participate in the discussion. Key informants were selected purposively and case studies were drawn using the snow-ball technique. Data were analyzed using different techniques. Qualitative data was analyzed using content analysis whereby; data was read and re-read to identify the main themes related to the study objectives. Narrative and verbatim quotations were used to explain the trends exhaustively. Quantitative data was analyzed by SPSS version 21. The findings suggested that majority of the women in Kibera (80%) were not aware of what the constitution says about abortion in Kenya. All they said was that abortion was illegal from both the state and religious perspectives. The study found out that lack of adequate health facilities that offered safe abortion services and the high cost of safe abortion in Kibera drove women to procure unsafe abortions from unqualified providers. The study also revealed that women’s attitudes towards abortion influenced their practices; women who viewed abortion as a sin were against abortion (safe or unsafe abortion). For others, the stigma that is associated with abortions in Kibera made them to procure unsafe abortions from backstreet providers. Women who suffered a lot of pain from unsafe abortions reported that they would only procure abortions from safe providers in the future. It is concluded at that lack of knowledge on the provisions of the constitution on abortion in Kenya is a barrier for most women and girls in Kibera who want to terminate their pregnancies safely. Few healthcare providers are knowledgeable on the full content of the law and most women remain unaware of provisions of the law. A lack of clarity about legal access to abortion has produced widespread misinformation among women, adolescents, and medical providers. In addition, women’s access to safe abortion is determined largely by their ability to afford the procedure and to identify and reach a provider who offers safe abortion services. This study recommends that there is need to create more awareness among public on what the constitution says about abortion and especially women need to be educated on their rights and the legal issues around abortion. The government should ensure that there are sufficient facilities that offer safe abortion services to women (both public and private) and to ensure that the cost of safe abortion is affordable to women.