“Women’s Three Bodies”: An Anthropological Perspective on Barriers to Safe Abortion Services in Kibera Informal Settlements, Nairobi, Kenya

Background: Abortion remains a critical determinant of maternal morbidity and mortality in Kenya. Recent studies on induced abortion estimated an annual abortion incidence of 48 abortions per 1,000 women of reproductive age, which is higher than other East African countries. In 2010, the Kenyan Constitution widened the provisions under which women qualified for safe abortions. However, majority of women still seek abortion services from unqualified providers. Using an interpretive, meaning-centered approach, this study aims to explore the barriers to safe abortion services in Kibera informal settlements, Nairobi Kenya. Subjects and Method: This was a cross-sectional study encompassing both qualitative and quantitative research methods. We used different sampling techniques (convenient, purposive and snow ball methods) to recruit our study participants (n=55). Quantitative data was collected using a survey questionnaire and data was analyzed by SPSS version 21. Qualitatively, data was collected using Focus Group Discussions (FGDs), Key Informant interviews and case study narratives. This involved note taking and audio recordings, which were transcribed verbatim and thematically analyzed using QSR Nvivo 21 software. Results: This study revealed that women’s decisions to procure abortion are influenced by a myriad of complex factors: a multiplicity of meanings regarding abortion, as provided by the law or as dictated by cultures or religion. Women’s access to safe abortion services were also determined by their ability to afford the procedure and to identify and reach a health care provider who offered the services. Conclusions: Legal access to abortion does not simultaneously ensure access to safe abortion services. Policy makers and health promoters need to work towards changing the socio-economic and religious forces that hamper access to safe abortions. Safe and affordable abortion services to women in Kenya including post abortion care need also be ensured