Men's Roles in Women's Abortion Trajectories in Urban Zambia.

Context: Given that maternal morbidity and mortality from unsafe abortion persist, especially in Africa, there is a pressing need to understand the abortion decision-making process. However, little is known about men's influence on and involvement in women's abortion decision making and care seeking.

Methods: A qualitative study was conducted at the largest public provider of abortion-related care in Zambia. Thematic framework analysis was used to categorize and synthesize data from in-depth interviews conducted in 2013 with 71 women who received a safe abortion and 41 who received care following an incomplete (unsafe) abortion.

Results: Men influenced whether women sought a safe or unsafe abortion; their actions, lack of action and anticipated actions-negative and positive-reflected broader gender inequities. Abandonment by men, and the desire to avoid disclosing pregnancy to men because of fear of their reactions or interference, were important influences on some women's decision to seek abortion, on the secrecy and urgency with which abortion was pursued and on the level of risk assumed. However, other women discussed men's positive influences on their abortion care seeking. In this setting of low awareness of the legality and availability of abortion, some men used their greater social and economic resources to facilitate safe abortion by providing information and paying for care.

Conclusions: Increasing knowledge about the legality and availability of safe abortion is vital not only among sexually active women, but also among those they confide in, including men.