Seeking clandestine abortion safely: Unwanted pregnancy and medical abortion among young women in Dar es Salaam
Ingrid H. Solheim1 ,2, Catherine Kalabuka3, Karen-Marie Moland1 ,2, Andrea B. Pembe4, Astrid Blystad1 ,2
1Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway, 2Centre for International Health, University of Bergen, Bergen, Norway, 3CSK Research Solutions, Dar es Salaam, Tanzania, 4Muhimbili University of Health and Associated Sciences, Dar es Salaam, Tanzania
Objective: The aim of this project was to enhance knowledge about the challenges faced by young women with unwanted pregnancies living in an urban, low-income settings where abortion is criminalised but assumed to be performed clandestinely with increasing off-label use of the recently registered drug misoprostol.
Methods: The study was explorative, involving the use of in-depth interviews with women ≤ 25 years having performed medical abortion (n = 15), postabortion care providers (n = 16) and pharmacy workers (n = 10) and informative interviews with different stakeholders (n = 15). Focus group discussions (FGDs) were performed with women from low-income areas and students ≤ 25 years (n of FGDs = 10).
Results: To induce abortion is viewed as a common practice by young women in Dar es Salaam. While hospitals are often considered the safest providers of abortion, misoprostol is viewed by many as the best method. Misoprostol is perceived to be more accessible, simple to use, private, cheap and less dangerous compared to surgical hospital procedures. Many health workers experience fewer and more manageable complications among their postabortion care patients related to misoprostol use for abortion. However, girls often view the procedure as a ‘matter of chancing'. Low drug doses are typically used, and there is little follow-up and lack of information from vendors concerning potential complications. Finally, even though ‘miso' is commonly known among young women, traditional methods are still the cheapest and therefore the only option for some.
Conclusion: In Dar es Salaam misoprostol can be accessed clandestinely for pregnancy termination through drug stores or health facilities offering different levels of safety and costs. For many young women this is the preferred abortion method but use, and especially safe use, is limited to those who can afford it.