“As it is about that, they do as they please”: Women’s experience of the accessibility and acceptability of postabortion care in Kaya, Burkina Faso

Accessing acceptable postabortion care (PAfor remains a major challenge in sub-Saharan Africa, where abortion is legally restricted and highly stigmatized, particularly for young and socioeconomically disadvantaged women. Evidence on the specific obstacles faced by these groups in rural and semi-urban settings is limited. This study explored women's experiences with PAC quality in Kaya, a small town in Burkina Faso. We conducted in-depth interviews with women (n = 35) who had participated in a respondent-driven sampling survey on abortion safety in 2021 and had sought PAC for abortion-related complications in formal health facilities. Additional interviews were carried out with representatives of local grassroots associations involved in sexual and reproductive health in the town (n = 8). Thematic analysis was used to examine perceptions of abortion stigma within the community, followed by a typology analysis to identify inequalities in the accessibility (timely, geographically reasonable, and affordable provision of care) and acceptability (patient-centeredness, including cleanliness, privacy, respect and non-judgemental care) of PAC across different categories of women. Both women and association representatives strongly condemned abortion, and the legal exceptions were largely unknown. Abortion stigma was much stronger for young and unmarried women who often sought abortions due to partners denying responsibility and fear of social exclusion. Married women faced less stigma when abortions were linked to closely spaced pregnancies or economic hardship. Fear of prosecution and mistreatment delayed care-seeking, especially among unmarried adolescents and young women. They also reported more verbal abuse, longer waiting times, and a lack of privacy during care, reflecting and reinforcing the heightened stigma they faced. Women with greater socioeconomic resources more often used private facilities, where both accessibility and acceptability were perceived as better, particularly for unmarried women. This study highlights substantial inequalities in the accessibility and acceptability of PAC in Kaya, shaped by women's marital status, age, and socioeconomic position.