Addressing abortion stigma in service delivery: the experience of Pakistan and Burkina Faso
Rebecca Wilkins1, Asifa Khanum2 1International Planned Parenthood Federation, London, UK, 2Rahnuma Family Planning Association of Pakistan, Lahore, Pakistan - firstname.lastname@example.org
Restrictive legislation and limited service provision remain obstacles to women who seek abortion services. These obstacles are worsened by the impact of abortion stigma and associated secrecy, shame, guilt and fear. Stigma prevents or delays access to safe abortion services as well as making lawmakers reluctant to improve legislation to facilitate access to abortion information and services. As part of its commitment to reducing abortion stigma at all levels, IPPF commissioned research to understand its effect on women accessing services through IPPF Member Association clinics. In-depth qualitative research using semi-structured interviews with abortion clients, service providers and client partners was conducted at Member Association clinics in Pakistan and Burkina Faso. The research aimed to identify the specific causes and manifestations of abortion stigma and to inform interventions designed to reduce abortion stigma. The research found commonalities in abortion stigma in Pakistan and Burkina Faso, as well as some issues that were unique to each country setting. The clinic client pathways, misconceptions and lack of knowledge about abortion, pre-abortion counselling, and the timeliness of seeking medical care were among some of the issues found to have an impact on, or were impacted by clients' experience of stigma. In both countries women who accessed abortion services had a high level of self-stigma which impacted on their expectations of quality of care in the clinics. Abortion stigma is an unspoken reality that significantly impacts both the attitudes and practices of medical professionals and women who access abortion services. However, the nature of abortion and the stigma surrounding it makes this a challenging topic to collect data and information on. The research findings illustrate the need for the pilot testing of interventions at both the community and service delivery levels in order to address abortion stigma through a more comprehensive and systematic approach.
Stigma associated with abortion is influencing choice to provide or sidestep abortion services
Asifa Khanum1, Syed Kamal Shah1, Nadeem Mahmood1, syed Mustafa Ali2
1Rahnuma FPAP, Lahore, Pakistan, 2Individual Consultant, Lahore, Pakistan
There is little evidence available on the manifestation of abortion stigma in Pakistan. There is marginalisation of abortion services within medical settings through its negligible inclusion in curriculum, knowledge about abortion law in Pakistan, perceptions about abortion and religion, socio-cultural disapproval, etc. These factors all contribute in the decision of healthcare providers to provide or sidestep abortion services. A research study was designed to understand the expression of stigma associated with abortion by service providers providing abortion services and those not providing these services.
Methods: A mixed method exploratory study was designed to understand perspectives of both types of service providers. Due to restrictive abortion law and taboos that are stigmatising abortion services and its providers, data was collected from 40 providers providing abortion services and 40 non-providers of these services from reference facilities in 4 districts of Pakistan. Basic descriptive analysis was carried out using SPSS.
Results: It is evident from analytical findings that the knowledge base of service providers on abortion law in Pakistan, perceptions about its religious permissibility, internalisation of negative community perceptions about abortion service providers and stigmatisation of women seeking abortion services are pertinent attributes influencing provider choice of extending abortion services or not.
Conclusion: In an effort to de-stigmatise abortion, immediate measures are required at various levels such as: integration/institutionalisation of essential contraceptive services including safe abortion services, formal/informal education and knowledge about abortion laws as explained by Shariat Court of Pakistan, Value Clarification and Attitudes Transformation (VCAT) workshops for providers, and behaviour change communications and education strategies for sensitising communities.