Ethical Concerns Facing Abortion Researchers in Restrictive Settings: The Need for Guidelines

Abstract

Several African countries criminalise induced abortion, and the issue is hotly contested. Nevertheless, induced abortion occurs as frequently in countries that ban abortion totally (with only minor exceptions) as in countries without restrictions.1 The difference between countries where abortion is legal and those where it is illegal is the proportion of abortions that are unsafe. For example, in Kenya, where the legal environment is restrictive, Mohamed et al. reported that 75% of all induced abortions are unsafe.2 The World Health Organization3 defines unsafe abortion as any procedure for pregnancy termination performed by either a person who lacks the requisite skills/training or in an environment without the minimum medical standards, or both. In this commentary, we share our experiences conducting research on abortion (spontaneous and induced and safe and unsafe) and post-abortion care, highlighting situations where participants have revealed information to us that has been ethically challenging. We have undertaken studies on diverse aspects of abortion in African countries including Burkina Faso, Kenya, Liberia, Nigeria, Sierra Leone, and Zambia. We feel it is critical to share the ethical dilemmas we have encountered in conducting abortion research to facilitate a broader public discourse on the issues and the possible development of regional and national guidance that offers specific support to researchers investigating criminalised and stigmatised behaviour.