Background
Access to safe abortion is a human right yet this essential health service may be difficult to access in many humanitarian settings. Displaced and conflict-affected women and girls are at an increased risk of exposure to sexual violence and engagement in transactional sex due to limited economic resources, which can lead to unintended pregnancies. In addition, many are unable to access a full range of contraceptive methods due to resource and capacity constraints.
The Study
Little is known about refugees’ abortion experiences, and a deeper understanding about the barriers and facilitators they encounter could help inform programs and policies. We therefore conducted a mixed methods community-engaged study in two locations: Bidibidi Refugee Settlement in Uganda and Kakuma Refugee Camp in Kenya. Respondent-driven sampling was used to sample a total of 1201 women and girls with recent abortion experiences. In-depth interviews and focus groups were conducted with women and key stakeholders, and a health facility assessment survey measured safe abortion provision in both sites.
Key Findings
- The majority (84%) of participants used abortion methods that are not recommended by the World Health Organization (WHO), including: traditional herbs, misuse of pharmaceutical drugs, and ingestion of toxic substances
- Very few participants used WHO-recommended methods for abortion, such as medication abortion (misoprostol alone or in combination with mifepristone), or procedural abortion methods (manual vacuum aspiration or dilation and evacuation).
- Experiencing signs of potential complications, such as heavy bleeding and signs of infection, was common. Despite this, some participants avoided seeking care due to fear of stigma, mistreatment, or arrest.
- Although a quarter of participants knew about medication abortion, only 1% could name misoprostol.
- Primary reasons for wanting an abortion were economic concerns and having an unsupportive partner
- Of the 28 health facilities surveyed, only 2 reported offering abortion care