Peer-reviewed article
Decision-Making About Abortion in an Abortion-Restricted Setting: A Qualitative Study of Young Women in Namibia.
Mukerenge NF, Tjandja JM, Nakakuwa FN ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examines how young women aged 16-24 in Namibia make decisions about abortion in a context where abortion is legally restricted. Researchers interviewed 15 young women admitted to hospital with abortion-related complications. The women's decisions were shaped by fear of family rejection, lack of financial and social support, desire to continue education, and pressure to marry before having children. Young women understood abortion risks but felt they had few safe alternatives.
Key points
- Fear of rejection by parents and community was a major factor influencing abortion decisions
- Lack of social and financial support constrained young women's choices
- Most participants (10 of 15) were still in school, suggesting education was a priority
- Young women understood abortion risks despite pursuing unsafe options
- Restrictive legal and social context limited perceived alternatives for pregnancy management
Limitations
This is a small qualitative study of only 15 young women admitted to one hospital with abortion complications, so findings cannot be generalised to all young women in Namibia or those who did not seek hospital care. The study does not explain what specific unsafe abortion methods were used or provide quantitative data on prevalence of different decision factors.
Abstract
Background and aims Unsafe abortion is one of the leading causes of maternal death in low- and middle-income countries. In Namibia, restrictive abortion legislation limits young women's reproductive autonomy and contributes to unsafe abortion practices. Despite high teenage pregnancy rates and documented barriers to reproductive health services, little is known about factors influencing abortion decision-making among young women in this restrictive context. This study explored abortion decision-making among young women admitted with abortion-related complications at a referral hospital in Kavango East region, Namibia. Methods We employed a qualitative exploratory descriptive design. In-depth individual interviews were conducted with 15 young women (aged 16-24 years) admitted with abortion-related complications at a referral hospital in Kavango East region, Namibia, during 2022-2023. Participants were purposively sampled for diversity in age, educational status, and pregnancy history. Data were analyzed using thematic analysis following Braun and Clarke's (2006) six-phase approach. The study received ethical approval from the University of Namibia Research Ethics Committee. Results Participants' ages ranged from 16 to 24 years; 10/15 were currently attending school. and 8/15 had previous pregnancies. Abortion decision-making was highly influenced by personal and interpersonal factors operating within a restrictive legal and social context. Key themes included: (1) fear of rejection by parents and community; (2) lack of social and financial support; (3) desire to pursue education; and (4) expectations to bear children within marriage. Young women demonstrated an understanding of abortion risks yet felt they had limited alternatives. Participants expressed mixed views on abortion legalization, with concerns about reproductive autonomy, social discrimination, and future fertility. Conclusions Young women's abortion decisions are shaped by complex internal factors (personal aspirations, fears) and external factors (social stigma, lack of support, restrictive policies). Understanding these factors is critical for developing youth-centered reproductive health policies and services. Our findings support the need for policy reform to make safe abortion services available and accessible to young women in Namibia, potentially reducing unsafe abortion-related morbidity and mortality in this vulnerable population.