Men’s roles in abortion trajectories in urban Zambia

Context: The actions and inactions of men can shape women’s sexual and reproductive health in positive and negative ways. However men’s influence on and involvement in women’s pathways to either safe or unsafe abortion are little understood. As maternal morbidity and mortality from unsafe abortion persists, especially in Africa, there is a pressing need to understand the various factors that shape abortion trajectories. In this paper, we consider the influence of men in those trajectories. Methods: We interviewed women (N=112) who attended hospital for safe abortion (n=71) or care following an incomplete (unsafe) abortion (n=41) at the largest provider of abortion-related care in Zambia between January-December 2013. We analysed their narratives using the Framework method. Results: Men influenced whether or not women sought safe or unsafe abortion and the complexity of trajectories to abortion-related care. Their actions, inactions, or anticipated actions – negative and positive – reflected broader gender inequities. Men’s abandonment or denial of paternity, and women’s desire to avoid disclosing pregnancy to men through fear, were significant influences on some women’s decision to seek abortion and on the secrecy, urgency and risk with which abortion was pursued. However other women discussed men’s positive influences in their abortion trajectories. In this setting of low awareness of the legality and availability of abortion, men used their greater social and economic resources to facilitate safe abortion by providing information and paying for care. Conclusions: Interventions to address unsafe abortion should target a much wider population than sexually-active women.