Abortion Stigma Correlates:
Comparing Two Kenyan Counties
Erick K. Yegon
Peter Mwaniki
Elizabeth Echokah
Joachim Osur
1st AMREF HEALTH AFRICA INTERNATIONAL CONFERENCE
NAIROBI
NOVEMBER 26, 2014
Background
•
Increase in unsafe abortion
Induced Abortion Rates and Ratios
incidence rate (from 32 to 48 per
1000 WRA) in the last 10 years in
Kenya (APHRC 2013)
•
•
WRA (in
000’s)
Induced
Induced
Abortion Abortion
Rate per Ratio per
1,000 WRA
100
Total
9600
48
30
In 2012, 465,000 women treated
Central & Nairobi
2186
32
20
for complications from incomplete
Coast & N.Eastern
1298
51
32
or unsafe abortions
Eastern
1382
20
13
Nyanza & Western
2329
63
39
Rift Valley
2404
64
40
119,912 women treated for induced
abortion complications
Background
•
Abortion is a very sensitive issue with providers and women treated
as outcasts (Kumaret al., 2014)
•
Abortion often viewed as an abnormal event and women who have
them are deviant (Kumar et al., 2013)
•
Women feel embarrassment, shame, guilt and fear of disclosure
– effectively silencing them from discussing their experience (Cockril
et al., 2013)
•
Women experience rejection, exclusion or discrimination as a
result of seeking an abortion or when their abortion is voluntarily
or involuntarily revealed to others (Shellenberg et al., 2014)
The Social Construct of Stigma
Label
Discriminate
Stereotype
Separate
Study Questions
• What are the levels of abortion stigma at individual
and community levels in Machakos and Trans Nzoia
counties?
• Do counties in regions that report higher incidences
of unsafe abortion also have higher levels of stigma?
• What factors are associated with abortion stigma at
individual- and community-level in these two
counties?
Methodology
• A cross-sectional survey of general community members in
Machakos and Trans Nzoia counties
• Ethical approval from KEMRI
• Administrative approval from County Health Directors in the two
counties
• Population
• All above 18 years old
• 50% of study population were Men (Married 25%; Unmarried 25%)
• 50% of study population were women (Married 25%; Unmarried 25%)
Stigmatizing Attitudes, Beliefs and Actions Scale
(SABAS)
• Measures stigma at the individual and community levels
• 18 items, 3 subscales
• Negative stereotyping
• Discrimination and exclusion
• Potential contagion
• Scoring
• Easy summative scoring of Likert scale responses
• Higher score = more stigmatizing attitudes, beliefs and actions
• Used sub-scale scores and total score
• Published in 2014
(Shellenberg et al..)
Data Analysis
• Data Entry- Epidata
• Analysis Stata SE ver 12
• Regression Analysis
• Relationship between SABAS scores and age,
gender, marital status, educational attainment and
religious affiliation
Community Members’ Gender, by County
(N=718)
57%
56%
52%
49%
48%
44%
Male
51%
43%
Female
Male
Trans Nzoia
Female
Machakos
Single
Married
Community Members’ Level of Education, by
County (N=718)
44%
40%
39%
39%
36%
34%
33%
29%
28%
27%
27%
24%
Male
Female
Male
Trans Nzoia
No Education/Primary
Female
Machakos
Secondary
Post secondary
Community Members’ Religious Affiliation, by
County
80%
70%
60%
75%
67%
75%
78%
50%
77%
71%
40%
23%
30%
19%
17%
20%
17%
20%
6%
18%
3%
10%
3%
4%
3%
0%
Male
2%
3%
Female
Trans nzoia
4%
6%
2%
5%
3%
Male
Female
Machakos
Male
Female
Total
No Religion
Muslim
Catholic
Protestant
Mean Scores for SABAS and its Subscales, by
County
Full scale
Negative
stereotyping
Exclusion and
discrimination
Fear of
contagion
Trans Nzoia Machakos
(N=358)
(N=360)
55.4
53.1
p-value
0.110
29.7
28.5
0.009
18.5
17.6
0.000
7.3
7
0.000
Mean Scores for SABAS and its Subscales, by
County and Population Density
Trans Nzoia
(N=358)
SemiUrban
urban
Rural
Machakos
(N=360)
SemipUrban
urban
Rural value
Full scale
54.9
57.1
54.5
51.3
52.4
55.2
0.004
Negative
stereotyping
30.1
30.4
28.9
28.2
28.5
28.6
0.001
Exclusion
and
18.3
discrimination
18.9
18.3
16.4
17.1
19.2
0.000
6.6
7.8
7.3
6.7
6.7
7.4
0.000
Fear of
contagion
Mean Scores for SABAS and Sub scales by
County and Level of Education
Negative
stereotyping
Full scale
Exclusion and Fear of
discrimination
contagion
Education Trans N.Macha Trans N. Macha
Trans N. Macha Trans N.Macha
No educ/
primary
57.0
57.6
30.4
29.5
19.0
20.0
7.6
8.0
Secondary
school
56.2
52.5
29.7
28.4
19.0
17.2
7.5
7.0
Post
secondary
55.4
48.8
28.5
27.3
16.9
15.6
6.5
5.8
p-value
0.00012
0.0016
0.0013
0.00124
Regression Model
• Independent variables: County/region, age,
gender, education, marital status, and religion
• Dependent variable: SABAS score
• Significant relationship emerges between SABAS
and educational attainment (p-value<0.001)
• i.e. SABAS scores go down as education level goes up.
Conclusion and Recommendation
• In this study the County that had higher incidences of unsafe
abortions also had higher levels of stigma among general
community members.
• Communities in rural areas were more stigmatizing compared
to communities in semi- and urban areas.
• To reduce unsafe abortions, interventions need to address
stigmatizing attitudes in communities, targeting rural
communities and less-educated community members.