Factors contributing to unsafe abortion among women in Ngami sub-district, Botswana

Abstract

Unintended pregnancies are the root cause of unsafe abortions which place a major financial strain on the health care system. Access to comprehensive safe abortion care service packages by all women who need the service prevents complications of unsafe abortions. In countries where abortion is legally restricted like Botswana, women with unintended pregnancies opt for illegal and unsafe procedures which lead to maternal morbidity and mortality associated with sepsis, septic abortion and haemorrhage. As for the Ngami sub-district, little is known regarding the circumstances that lead to unsafe abortions among women, hence the need for research to gain a deeper understanding of the contributory factors to unsafe abortion and the development of measures to curb unsafe abortion. Aim: The purpose of the study is to gain in-depth understanding of the contributing factors to unsafe abortions in order to develop possible measures to reduce unsafe abortions among women in the Ngami sub-district. Methodology: In this study, a qualitative, descriptive, and exploratory phenomenology research approach was used. Relevant permissions and consent to conduct the study were obtained for the study to be ethical. COVID-19 pandemic preventative measures were also adhered to ensure continuous mitigation of potential harm to participants. The population included women of all ages who resided in the Ngami sub-district and were admitted to the gynaecological ward for unsafe abortions during the data collection period from June 2021 to August 2021. Convenience sampling technique was applied. Collection of data was through audio-taped face-to-face semi-structured interviews and analysis was done using the five steps of content analysis. Data saturation was reached with the 12th participant. Study findings: Three themes and 18 sub-themes emerged from the interviews conducted. The major themes are participants' reasons for unsafe abortions, effects of unsafe abortions and interventions to reduce unsafe abortions. Factors contributing to unsafe abortion include fear of violating family values and women's lack of autonomy; family planning concerns; perceived lack of options; political viewpoint and human rights components; economic reasons; unstable relationships; and a desire to continue studying. Contribution to the body of knowledge: The insights that the study has brought out are a steppingstone to interventions that the district health management team (DHMT) in the Ngami sub district should consider going forward to mitigate the prevalence of unsafe abortions. Conclusion: Women in the Ngami sub-district have proposed psychosocial counseling, youth-friendly services, economic empowerment, and legalize abortion to reduce unsafe abortions and prevent unintended pregnancies. Life skills can help women gain confidence, advocate for their sexual rights, and avoid unexpected pregnancies. The policy implication brought out in this study is the need to review the laws on abortion in Botswana.