A qualitative study of abortion decision-making trajectories among pregnant women at their first antenatal care visit in Kampala, Uganda.

Background: In Uganda, only about half of women who want to avoid pregnancy are using modern contraceptives, leading to high numbers of unintended pregnancies and elevated maternal and neonatal morbidity and mortality. In this study, we aimed to learn more about women's abortion decision-making before continuing to carry a pregnancy.

Methods: We utilised a qualitative study design and interviewed 31 purposively selected single and partnered pregnant women aged ≥18 years at their first antenatal care visit at Kawempe National Referral Hospital in Kampala, Uganda. We conducted the interviews in Luganda or English, transcribed them, and then translated them into English, as needed, for analysis. We analysed the data using thematic analysis. Deductive codes were based on social networks, social support, and health behaviour theories, and inductive codes were derived from interview transcripts.

Results: Almost half of the study participants (n = 13) considered an induced abortion before deciding to continue carrying their pregnancy. The most commonly stated reasons they considered abortion included anticipated interruptions to work and education, exhaustion related to child-rearing, and lack of social support. Other participants (n = 9) reported not considering abortion due to anticipated social support for their pregnancy, concerns about abortion-related morbidity and mortality, late confirmation of pregnancy, and religious beliefs. No participants discussed Uganda's restrictive abortion policies as a reason not to consider abortion.

Conclusions: Our results point to opportunities for continued reproductive health education and improved access to reproductive health services to allow pregnant women to meet their reproductive needs, seek out family planning, antenatal care, and safe abortion services when desired, and create support networks for pregnant women.