Despite Legal Reforms, Adolescents and Young Women Still Struggle to Access Safe Abortion.

A 22-year-old woman from Nyarugenge nearly died after attempting an unsafe abortion. “I didn’t know about safe abortion services,” she said. “I only knew about traditional methods. I tried it. It didn’t work. It almost killed me. I spent two weeks in a coma.”

She is among 66 people interviewed by the Health Development Initiative(HDI)Rwanda study examining non-legal barriers to safe abortion access for adolescents and young women. In addition to interviewing adolescents and young women who had sought abortion services, researchers also gathered perspectives from parents, teachers, religious leaders, and healthcare service providers across Kigali and the Eastern province. Despite the legal reforms in Rwanda, the research found that the unavailability of safe abortion services, perceived lack of awareness, misinformation about the services, the cost, stigma, and perceived negative influence from parents and peers continue to block access to safe abortion services.

Adolescents and young women highlighted the financial burden as overwhelming. A 25-year-old from Gatsibo explained, “I paid the doctor 60, 000 Frw for the procedure. However, the pregnancy was not fully terminated, and I developed complications. I ended up spending two weeks in the hospital, where I received additional medication and even had to undergo an echography. In total, I spent 310,000 Frw. A 24-year-old interviewee from Kicukiro reported that the costs associated with her abortion were not limited to the procedure fee. Additional expenses, such as transport, meals, and extra medications, raised her total expenditure to approximately 80,000 Frw. This significant amount compelled her to make challenging decisions regarding the allocation of her restricted financial resources.

Stigma within families and communities discouraged many from seeking help. “It’s difficult when everyone is against you, and your situation becomes the talk of the town,” shared a 25-year-old woman from Kicukiro. An 18-year-old from Gatsibo added, “People would talk about me every time they saw me, and at school, everyone would stare. It made me feel very uncomfortable.”

Rwanda’s law permits abortion under certain conditions: when the pregnant person is a child, when the pregnancy results from rape, incest committed with a person to the second degree of kinship, or forced marriage, and when the pregnancy poses a risk to the health of the pregnant person or the fetus. However, the research demonstrates that legal reforms are insufficient on their own. Adolescents and young women still encounter obstacles that keep them from receiving the care they are legally entitled to. The study emphasizes how critical it is to raise awareness and the accessibility of safe abortion services, combat stigma, make them more affordable, and increase community, family, and healthcare professional support.

To read the full publication, access the paper here: https://doi.org/10.2147/IJWH.S555353