“I wasn’t ready”: abortion decision-making pathways in Ouagadougou, Burkina Faso

OBJECTIVES: This study explores abortion decision-making trajectories in Ouagadougou, Burkina Faso, examining the spaces for decision making that young people manage to create for themselves within restrictive policy, gender norms and other constraints. METHODS: The study presents data collected from observations in three referral health facilities in Ouagadougou and interviews (with 31 young women (aged 17–25) who had sought abortions and five men (aged 20–25) whose partners had done so). Using inductive content analysis, we capture the different streams, actors and rationales in the decision-making process, as well as the pattern of negotiation. RESULTS: Abortion decision-making trajectories are complex and affected by a range of factors including fertility desires, relationship stability and financial stability. The process can include intense periods of negotiation between intimate partners when their rationales are discordant. Constraints on women’s decision making include restrictive policy environment, coercion from partners (threats, emotional blackmail and even physical force) and pressure from people in and out of their social network. CONCLUSIONS: In a context where legal abortion is highly restricted and women’s decision-making power is constrained, the abortion decision making appears as collective, operates in an uncertain time frame, an unofficial social environment and has an unpredictable collaborative mechanism.