Religiosity and Abortion Perceptions in Three Zambian Provinces
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Date
2018-09-11
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Johns Hopkins University
Abstract
Background: Access to safe abortion is critical to the health of women. In Zambia, where abortion laws are among the least restrictive in sub-Saharan Africa, an estimated 30% of the annual 398 maternal deaths per 100,000 live births are due to unsafe abortion, which is higher than many neighboring countries. Zambia is also a notably Christian country, with 98% of the population ascribing to Protestant or Catholic denominations; further, Evangelicals comprise an estimated 25% of the overall population. These religious denominations tend to view abortion as a sin within their doctrine and Zambia is a country where negative attitudes toward abortion are common, often prompting women to access clandestine, and often unsafe, abortion services to avoid the perception of stigma that would potentially result from disclosure.
Objectives: The objectives of this study were to first construct measures of personal abortion attitudes, support for Zambian abortion laws, and individual religiosity. Next, individual and community factors that influence individuals’ abortion perceptions (abortion attitudes and support for Zambian abortion law) were investigated. Finally, the role that religion and stigma play in women’s understanding of abortion and how it informs their perceptions, decision-making, and social experiences with abortion were explored.
Methods: This study was based on secondary analysis of a cross-sectional household sample of women of reproductive age (15-44) living within three Zambian provinces and in-depth interviews at two time points with 51 women who had terminated a pregnancy. Exploratory and confirmatory factor analyses were conducted to validate the Duke University Religion Index (DUREL) as well as an abortion attitude scale. Multivariate logistic regression models were employed to measure the association between individual religiosity and perceptions of abortion as well as the influence of community religiosity and community abortion attitudes on individual abortion perceptions. Finally, a directed content analysis approach was applied to semi-structured in-depth interviews with woman conducted immediately after they had terminated a pregnancy and again 3-4 months later.
Results: The DUREL showed good internal consistency; however, the results of the EFA and CFA suggest that DUREL cannot be used as a scale to measure religiosity within this population, as the subscales of the DUREL are not explained by a common underlying construct, as evidenced by goodness of fit statistics. The findings support the validity of the three-item subscale measuring intrinsic religiosity. The validity assessment of the DUREL supports that the DUREL be analyzed as three independent subscales and not an aggregate measure of religiosity. Within this female Zambian population, the five survey questions pertaining to abortion attitudes do not function together as a valid scale.
The multivariate analyses do not find associations between religiosity and abortion perceptions at an individual level but find associations between religiosity at a community level and individual abortion perceptions.
The analysis of the in-depth interviews found that many of the women interviewed viewed abortion is a sin in their religion. Though most believed that praying for forgiveness would lead to absolution, many women still noted feelings of guilt and shame. Several respondents felt that abortion is perceived as non-normative and unacceptable within their religious communities, which can lead to difficulty reintegrating.
Conclusion: Although this is the first study of its kind, this research suggests that religiosity at a community level may play a role in perpetuating abortion stigma and influencing abortion perceptions for women. The qualitative research suggests that women perceive that they are being judged by their communities, notably their religious communities, even in situations where their abortion is unknown. This study provides initial evidence that community religiosity and attitudes may motivate abortion stigma. Further research is need to in sub-Saharan Africa to confirm these findings and better understand this important social dynamic.
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abortion, religiosity, religion, Zambia