Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jun 1;21(1):76.
doi: 10.1186/s12978-024-01814-0.

Motivations for using misoprostol for abortion outside the formal healthcare system in Colombia: a qualitative study of women seeking postabortion care in Bogotá and the Coffee Axis

Juliette Ortiz  1 , Nakeisha Blades  2 , Elena Prada  3
Affiliations

Motivations for using misoprostol for abortion outside the formal healthcare system in Colombia: a qualitative study of women seeking postabortion care in Bogotá and the Coffee Axis

Juliette Ortiz et al. Reprod Health. .

Abstract
in English, Spanish

Background: In 2006, a Constitutional Court ruling partially decriminalized abortion in Colombia, allowing the procedure in cases of rape, risk to the health or life of the woman, and fetal malformations incompatible with life. Despite this less prohibitive law, some women and pregnant people preferred self-managing their abortions outside the formal healthcare system, often without accurate information. In 2018, we undertook a study to understand what motivated women to self-manage using medications that they acquired informally. Colombia has since adopted a progressive law in 2022, permitting abortion on request through the 24th week of pregnancy. However, the implementation of this law is still underway. Examining the reasons why women chose to informally self-manage an abortion after 2006 may not only highlight how barriers to legal services persisted at that time, but also could inform strategies to increase knowledge of the current abortion law and improve access to services going forward.

Methods: In-depth interviews were conducted in 2018 with 47 women aged 18 and older who used misoprostol obtained outside of health facilities to induce an abortion, and who were receiving postabortion care in two private clinics. Interviews explored what women knew about the 2006 abortion law which was then in effect, and the reasons why they preferred informal channels for abortion care over formal healthcare services.

Results: Women's motivations to use misoprostol obtained outside the formal healthcare system were influenced by lack of trust in the healthcare system along with incomplete and inaccurate knowledge of the abortion law. Conversely, women considered misoprostol obtained outside the healthcare system to be effective, affordable, and easier to access.

Conclusions: Obtaining misoprostol outside the formal healthcare system offered a more accessible and appealing prospect for some women given fears of legal repercussion and stigma toward abortion. Though this preference will likely continue despite the more liberal abortion law, strategies should be implemented to broaden knowledge of the recent change in law and to combat misinformation and stigma. This would support knowledge of and access to legal abortion for those who wish to avail themselves of these services.

Contexto: En el 2006 la Corte Constitucional de Colombia despenalizó el aborto en casos de violación, riesgo para la salud o vida de la mujer y malformaciones fetales. A pesar de ello, algunas mujeres y personas con capacidad de gestar continuaron obteniendo abortos fuera del sistema de salud. En el año 2018, realizamos un estudio para comprender qué las motivaba a hacerlo. Desde entonces Colombia ha adoptado un marco legal más progresista, permitiendo en el año 2022 el aborto a solicitud hasta la semana 24 de embarazo. Sin embargo, la implementación de este marco legal aún está en curso. Examinar las razones por las que las mujeres recurrieron a auto inducirse un aborto de manera informal después del 2006 no solo informa sobre las barreras a los servicios legales en ese periodo, sino también ayuda a desarrollar estrategias para aumentar el conocimiento del marco legal actual y mejorar el acceso a los servicios MéTODOS: Durante el 2018 entrevistamos a 47 mujeres mayores de 18 años que compraron misoprostol fuera del sistema de salud para inducirse un aborto, y que recibieron atención postaborto. En las entrevistas exploramos lo que sabían sobre el marco legal de ese momento –el del 2006–, y las razones por las cuales recurrieron a fuentes informales para abortar.

Resultados: Las motivaciones de las mujeres para usar misoprostol obtenido de fuentes informales resultan de la desconfianza hacia el sistema de salud y un conocimiento incompleto del marco legal. En contraste, las mujeres consideran que el misoprostol obtenido por fuentes alternativas ofrece eficacia y asequibilidad, y es más fácil de obtener.

Conclusiones: Obtener misoprostol fuera del sistema de salud formal es una alternativa más llamativa para algunas mujeres dadas las preocupaciones sobre las repercusiones legales y el estigma asociado al aborto. Aunque esta preferencia persista a pesar del cambio del marco legal, se deben implementar estrategias para ampliar el conocimiento sobre la despenalización y combatir la desinformación y el estigma. Esto garantizaría que las mujeres estén informadas y puedan acceder a servicios legales de aborto de calidad si así lo desean.

Keywords: Legality perception; Misoprostol; Post-abortion care; Self-managed abortion.

Plain language summary

Despite the availability of legal services, pregnant individuals in Colombia have continued to seek abortion outside of the formal healthcare system. Understanding their knowledge of the abortion law and their perceptions of legal abortion services may provide insight into what motivates them to seek alternative routes of abortion.Women who obtained misoprostol outside of the formal healthcare system were interviewed in 2018, twelve years after abortion was partially decriminalized in Colombia (and prior to the full decriminalization of abortions up to 24 weeks in 2022). A combination of factors led women to seek misoprostol in this manner: incomplete knowledge of the abortion law, fear of legal consequences, fear of social stigma, and a desire for a faster and private process.Self-management with informally obtained medication can offer pregnant individuals the opportunity to have an abortion on their own terms, especially when abortion in the formal healthcare system appears to be unavailable, proves difficult to access, or is accompanied by social and legal risks. While increasing awareness that abortion is legal in Colombia might empower pregnant people to seek formal care, judgment from their community, healthcare providers, and law enforcement may still serve as powerful hindrances to obtaining these services unless there are efforts made to combat abortion stigma as well.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Similar articles

See all similar articles

Cited by

References

    1. Sentencia C-055/22. 2022. https://www.corteconstitucional.gov.co/Relatoria/2022/C-055-22.htm. Accessed 26 Sept 2023.
    1. Sentencia C-, 355/06. 2006. https://www.corteconstitucional.gov.co/relatoria/2006/c-355-06.htm. Accessed 26 Sept 2023.
    1. González Vélez AC, Jaramillo IC. Legal Knowledge as a Tool for Social Change. Health Hum Rights. 2017;19(1):109–118. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5473042. Accessed 28 Aug 2023. - PMC - PubMed
    1. Stifani BM, Gil Urbano L, Gonzalez Velez AC, Villarreal Velásquez C. Abortion as a human right: the struggle to implement the abortion law in Colombia. Int J Gynaecol Obstet off Organ Int Fed Gynaecol Obstet. 2018;143(Suppl 4):12–8. doi: 10.1002/ijgo.12672. - DOI - PubMed
    1. Sentencia C-096. /18.; 2018. https://www.corteconstitucional.gov.co/relatoria/2018/SU096-18.htm. Accessed 26 Sept 2023.

Substances