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
incidence rate (from 32 to 48 per
1000 WRA) in the last 10 years in
Kenya (APHRC 2013)
• In 2012, 465,000 women treated
for complications from incomplete
or unsafe abortions
• 119,912 women treated for induced
abortion complications
WRA (in
000’s)
Induced
Abortion
Rate per
1,000 WRA
Induced
Abortion
Ratio per
100
Total 9600 48 30
Central & Nairobi 2186 32 20
Coast & N.Eastern 1298 51 32
Eastern 1382 20 13
Nyanza & Western 2329 63 39
Rift Valley 2404 64 40
Induced Abortion Rates and Ratios
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
Stereotype
Separate
Discriminate
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)
48%
44%
57%
49% 52%
56%
43%
51%
Male Female Male Female
Trans Nzoia Machakos
Single Married
Community Members’ Level of Education, by
County (N=718)
29%
33% 34%
36%
44%
39% 40% 39%
27% 28% 27%
24%
Male Female Male Female
Trans Nzoia Machakos
No Education/Primary Secondary Post secondary
Community Members’ Religious Affiliation, by
County
0%
10%
20%
30%
40%
50%
60%
70%
80%
MaleFemale
MaleFemale
MaleFemale
Trans nzoia
Machakos
Total
4% 3%
6%
3% 5%
3%
6% 3%
3% 2%
4% 2%
23% 19%
17% 17% 20%
18%
67% 75% 75% 78%
71% 77%
No Religion Muslim Catholic Protestant
Mean Scores for SABAS and its Subscales, by
County
Trans Nzoia
(N=358)
Machakos
(N=360) p-value
Full scale 55.4 53.1 0.110
Negative
stereotyping
29.7 28.5 0.009
Exclusion and
discrimination
18.5 17.6 0.000
Fear of
contagion
7.3 7 0.000
Mean Scores for SABAS and its Subscales, by
County and Population Density
Trans Nzoia
(N=358)
Machakos
(N=360)
Urban
Semi-
urban Rural Urban
Semi-
urban Rural
p-
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
discrimination
18.3 18.9 18.3 16.4 17.1 19.2 0.000
Fear of
contagion
6.6 7.8 7.3 6.7 6.7 7.4 0.000
Mean Scores for SABAS and Sub scales by
County and Level of Education
Full scale Negative
stereotyping
Exclusion and
discrimination
Fear of
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.
