Unsafe abortion constitutes a major public health problem in Burkina Faso and concerns mainly young women. The legal restriction and social stigma make abortions most often clandestine and risky for women who decide to terminate a pregnancy. However, the exposure to the risk of unsafe induced abortion is not the same for all the women who faced unwanted pregnancy and decide to have an abortion. Drawn from a qualitative study on the issue of abortion in Ouagadougou, Burkina Faso’s capital, the contrasting cases of two young women who had abortion allow us to show how the women’s personal resources (such as the school level, financial resources, the compliance to social norms, the social network, etc.) may determine the degree of vulnerability of women, the delay to have an abortion, the type of care they are likely to benefit from, and the cost they have to face. This study concludes that the poorest always pay more (cost and consequences), take longer to have an abortion, and have more exposure to the risk of unsafe abortion.
The issues of inequalities between human beings have always been a topic of interest. Inequalities are perceived as at the foundation of the stratification of societies [
Almost all over the world, there are demonstrable social gradients in health [
Induced abortion is a practice that has been used since generations as a method of fertility regulation [
Studies (especially quantitative) have shown that women in poor countries with low socioeconomic resources are more likely exposed to unsafe induced abortion compared to women with high socioeconomic resources in developing countries or women living in countries where there is a liberalized access to abortion [
Thonneau [
We propose, in this contribution, further reflection on the determinants of inequalities in access to clandestine induced abortion practices in a context of legal restrictions, stigmatization, and poverty such as in Burkina Faso. By using a thick ethnography of two contrasting trajectories of women who had abortion, we will show how economic resources and also determinants such as social networks, the compliance to social norms, or the fact of being educated or not can induce a differential exposure to a same risk of clandestine abortion. This thick description could contribute to make a visible picture of “the imponderable and the invisible” (an expression used by Fassin [
The aim of this paper is to demonstrate, throughout two cases studies (T and A cases), how social determinants such as personal resources (social and economic) may determine the type of clandestine abortion women are likely to access (safe or unsafe) and the time taken from knowing that a woman is pregnant to the situation of effective abortion within a country where the access to induced abortion is restricted.
The cases of T and A (both pseudonyms) are drawn from a qualitative study conducted in 2011-12 in Ouagadougou (Burkina Faso’s capital). This qualitative study is part of a larger project of research focused on the issue of access to postabortion care in Burkina Faso and funded by The Research Council of Norway. Its objective was to identify and analyze the plurality of actors, norms, and practices around abortions and postabortion care, and throughout it, the process of decision making to have an abortion.
The illegality of most abortions and its clandestine nature imply difficulties in identifying women who had an abortion. Therefore, we chose to go through the entry of an institutionalized health service, postabortion care, to establish contact with women. A long immersion in three health facilities allowed us to observe the interactions between health workers and women during postabortion care performing and to identify 45 women (from 17 to 36 years old) who have been treated for incomplete induced abortion or complications of induced abortion and to conduct interviews with them. This paper is based on in-depth interviews using semistructural interview guide and informal discussions with two contrasting cases out of this sample (contrast in terms of level of education, compliance to norms, economic status, and their itineraries to perform their abortions). The consent of the women (formal or oral consent) has been asked before undertaking the interviews. The interviews have been undertaken at the health facilities, at their homes, or at their place of work, and occasionally at the interviewer home.
A, the first young woman, is a 26-year-old unmarried woman. Her father is a manager of an NGO and her mother is a housewife, and she is their only. She is a law student and is hired as a cashier (part-time) in a transport company with 150.000 fr (305$US) (1$US = 491.669 FCFA) as monthly salary. She has also the financial support of her parents and her boyfriend who is a 28-year-old single man.
When she accidentally got pregnant (contraceptive method failure), she decided to have an abortion because she did not feel ready to be mother. Her boyfriend, despite his desire to have a child, accepted her decision. She was about three weeks pregnant when she did the pregnancy test:
She bought the Misoprostol 5000 fr (amount in dollars US) from a drugstore, took it at home, and then she went to the clinic ABBEF two days afterward for a consultation where she openly said she had taken Misoprostol to have abortion: “
T is a 25-year-old unmarried woman. She already has two children (both live with her mother in Bobo-Dioulasso, the second town of Burkina Faso). She left her parents’ home to find job in Ouagadougou 10 years ago (at 15 years). She comes from a polygamous family and has only primary school level. When I met her, she was a waitress in a “maqui” (a bar) in Ouagadougou with 25.000 fr (50$US) as monthly salary. Her father died ten years ago and she has to bring financial support to her mother and sisters who live in Bobo-Dioulasso. Her boyfriend is a married man who rents out the house where she lives. When she found herself with an unwanted pregnancy, she decided to have an abortion because her priority now is to get married.
She was admitted first in a primary health facility, and there the midwives decided immediately to take her to Yalgado referral hospital. When she arrived at Yalgado, she said:
Two months after her stay at Yalgado hospital, she realized that she was still pregnant:
She tried, then, to find another way to have abortion. One of her colleagues told her about a private clinic where she can have an abortion:
She describes this second attempt as very painful and complicated too.
The “historical” lower social position of women than men at an aggregate level has been documented. They are not only affected by their own social position but also by the position of male, family members, and friends [
The description of T and A search for abortionshows that their personal resources have led to differential itineraries in their search of abortion and differential exposure to the same risk factors which is the illegal induced abortion. Indeed, A’s resources helped her to get her abortion in one week and she paid just 17075 fr (35$US), while T, after discovering her pregnancy about at the same gestation as A’s pregnancy, had her abortion five months later after several attempts and paid about 186.000 frca (325$US).
When we refer to the description of the vulnerability made by Delor and Hubert [
In the case of abortion in Burkina Faso, the Penal Code punishes induced abortion in its Articles 383 to 386 and 388 to 390. The Article 383, for example, states “
The school level, financial situation, the compliance to norms, the social networks, and so forth have a significant influence on the timing to get induced and effective abortion. As we saw in the case of A, she decided to challenge the law prohibition and the social reprobation and their consequences—risk of prosecution and risk of stigmatization and rejection by family and friends—to have a safe abortion. Her situation can be justified by her financial autonomy (which, e.g., help her not being afraid of losing financial support in case of rejection), her school level (she is a law student who has knowledge of the abortion law and how it works and she can find the necessary arguments to convince a health worker to help her), her status in her relationship with her boyfriend (which helped her to decide and convince quickly her boyfriend to accept her decision).
In contrast, T was in a quite differential situation: she was financially dependent on her boyfriend, had a lower level of schooling, and was in a strong logic of concealment of her abortion because of the consequences this may have on her social network. Indeed, women in situations of dependence (residential, economic, and decisional), and also because of the economic and social precariousness in which the pregnancy puts them (a weakening of their social relationships) [
The authors declare that there is no conflict of interests regarding the publication of this paper.