Health care providers’ attitudes towards termination of pregnancy: A qualitative study in Western Nigeria

Abstract

Background:\rDespite restrictive abortion law in Nigeria, women still seek abortion\rservices. Restrictive policies on abortion make it difficult for safe and legal\rabortion to be obtained. Hence, abortion is provided on clandestine basis in\rsome private health facilities, and where the cost of such service is\rprohibitory, women resort to unsafe methods, including visiting quacks and self\rmedication, resulting in severe complications including death. In Nigeria, little\ris known about the personal and professional attitudes of individuals who are\rcurrently providing abortion services. Exploring the factors which determine\rhealth care providers’ involvement in or disengagement from abortion services\rmay facilitate improvement in the planning and provision of future services.\rMethods: Data were collected using qualitative research methods. Thirty-six\rin-depth interviews and one focus group discussion were conducted between\rJanuary 2010 and July 2010 with health care providers who were involved in a\rrange of abortion services provision in theWestern\r Nigeria. Data were analysed using a thematic analysis approach.\rResults: Complex patterns of service delivery were prevalent throughout many\rof the health care facilities. Fragmented levels of service provision operated\rin order to accommodate health care providers’ willingness to be involved in\rdifferent aspects of abortion provision. Closely linked with this was the\rurgent need expressed by many providers for liberalization of abortion laws inNigeriain\rorder to create a supportive environment for both clients and providers. Almost\rall providers were concerned about the\rnumerous difficulties women faced in seeking an abortion and their\rgeneral quality of care. An overriding concern was poor pre and\rpost abortion counselling including contraceptive counselling and provision. Conclusion:\rThis is the first known qualitative study undertaken in Nigeria exploring\rproviders’ attitudes towards abortion and it adds to the body of information addressing\rthe barriers to safe abortion services. In order to provide an enabling\renvironment and sustain a pool of abortion service providers, a drastic change\rin Nigerian abortion laws is mandatory, after which policies that both\rattract prospective abortion service providers and retain existing ones can\rbe developed.