Abstract

Unwanted pregnancy and unsafe abortion contribute significantly to the burden of maternal suffering, ill health and death in the Democratic Republic of Congo (DRC). This qualitative study examines the vulnerabilities of women and girls regarding unwanted pregnancy and abortion, to better understand their health-seeking behaviour and to identify barriers that hinder them from accessing care. Data were collected in three different areas in eastern DRC, using in-depth individual interviews, group interviews and focus group discussions. Respondents were purposively sampled. All interviews were audio recorded and transcribed verbatim. Transcriptions were screened for relevant information, manually coded and analysed using qualitative content analysis. Perceptions and attitudes towards unwanted pregnancy and abortion varied across the three study areas. In North Kivu, interviews predominantly reflected the view that abortions are morally reprehensible, which contrasts the widespread practice of abortion. In Ituri many perceive abortions as an appropriate solution for reducing maternal mortality. Legal constraints were cited as a barrier for health professionals to providing adequate medical care. In South Kivu, the general view was one of opposition to abortion, with some tolerance towards breastfeeding women. The main reasons women have abortions are related to stigma and shame, socio-demographics and finances, transactional sex and rape. Contrary to the prevailing critical narrative on abortion, this study highlights a significant need for safe abortion care services. The proverb “Better dead than being mocked” shows that women and girls prefer to risk dying through unsafe abortion, rather than staying pregnant and facing stigma for an unwanted pregnancy.

摘要

在刚果民主共和国 (DRC)，意外怀孕和不安全堕胎大大增加了孕产妇痛苦、健康不佳和死亡的负担。这项定性研究检查了妇女和女孩在意外怀孕和堕胎方面的脆弱性，以更好地了解她们的求医行为并确定阻碍她们获得护理的障碍。通过深入的个人访谈、小组访谈和焦点小组讨论，在刚果民主共和国东部的三个不同地区收集了数据。受访者是有目的地抽样的。所有采访都被录音并逐字转录。对转录内容进行相关信息筛选、人工编码和使用定性内容分析进行分析。三个研究领域对意外怀孕和堕胎的看法和态度各不相同。在北基伍，采访主要反映了堕胎在道德上应受谴责的观点，这与普遍的堕胎做法形成对比。在伊图里，许多人认为堕胎是降低孕产妇死亡率的适当解决方案。法律限制被认为是卫生专业人员提供足够医疗服务的障碍。在南基伍，普遍的观点是反对堕胎，对母乳喂养的妇女有一定的容忍度。女性堕胎的主要原因与耻辱和羞耻感、社会人口统计学和财务状况、性交易和强奸有关。与流行的关于堕胎的批判性叙述相反，这项研究强调了对安全堕胎护理服务的重要需求。谚语“死比被嘲笑好”表明妇女和女孩更愿意冒着因不安全堕胎而死亡的风险，