Although illegal abortion is believed to be widely practiced in Haiti, little data exists on such practices. This study aimed to learn about illegal abortion access, methods, knowledge sharing and perceived barriers to abortion related care. Additionally, we aimed to identify the proportion of visits to a public hospital’s maternity ward that were attributable to unsafe abortion in Cap Haitien, Haiti.
We conducted 8 focus group discussions with a total of 62 women living in different communities of Cap Haitian and 13 interviews with women’s health providers; including physicians, nurses and community health workers. We used the information from those qualitative portions of the study to guide the development of a survey. We then surveyed pregnant women (who were 20 weeks of gestation or less) presenting to the maternity ward of a large public hospital over a 6-month time period (n=263).
Among focus groups, there was widespread knowledge of misoprostol and herbs for self-induced abortion. Women described the frequent use of multiple agents, like antibiotics, antimalarial drugs, various herbs, beer and seawater in combination with misoprostol. Women learned about abortion from other women, “a secret friend”, traditional doctors, and traditional birth attendants. Women reported informal pharmacies commonly sold misoprostol only to men. If suspected of having an abortion, women often suffered stigma-related consequences within the public sector, churches and health care systems. Participants gave examples including being removed from church choir, taunted by peers and school children and temporarily ostracized from communities. Women perceived that stigma-related mistreatment in health care settings frequently occurs and participants linked this as contributing to women avoiding or delaying safe post-abortion care. Providers perceived that women seeking post-abortion care often didn’t disclose the details of their self-induction regimen and saw this as hindering care.
Of women surveyed, 62.7% reported the current pregnancy was unintended (n=165) and 30% (n=78) reported attempting induced abortion in this pregnancy. The majority of women used misoprostol (85.1%, n=63) as a part of the abortion regimen. Among women who reported self-induction, 61.0% (n=47) had experienced their presenting symptoms for over a week before seeking post-abortion care. When asked who advised them on what medications/herbs to use, 65.5% (n=38) reported it was their male partner and 24% reported it was a friend or family member (n=14). Very few women procured information from medical professionals (n=2, 3.4%).
In summary, these findings demonstrate that awareness of methods to induce abortion is high among women in urban Haiti and self-induction of abortion appears to be widely practiced; yet knowledge of the safest self-induction options remains incomplete. Although misoprostol is frequently used for self-induced abortion women likely rely on men for access to misoprostol through the informal marketplace. Future public health programs targeted at abortion safety would likely benefit from educating both men and women. Safe abortion education strategies and improved post-abortion care services could greatly improve reproductive health care in the region.