Navigating an ambiguous abortion terrain in Addis Ababa, Ethiopia: autonomy and relational dynamics in pregnancy termination

Ethiopia liberalized its abortion law in 2004 and issued technical guidelines in 2006 to expand access to legal and safe abortion services. However, the implementation of this progressive policy is shaped by stigma, patriarchal norms, and influential actors. As a result, women seeking abortion are required either to negotiate these power dynamics or to go through unsafe procedures. Despite this policy overhaul, there is a paucity of data on how women navigate complex abortion landscape. Therefore, this paper explores how women in Addis Ababa exercise relational autonomy amidst the multiple factors that influence abortion decisions. This study involved a total of 16 participants purposively selected from two sexual and reproductive healthcare providers in Addis Ababa, Ethiopia. While 13 women (10 seeking abortion and three who had recently undergone the procedure) participated in in-depth interviews, three health professionals participated in key informant interviews. The interviews were audio-recorded, transcribed verbatim, and analysed thematically using Braun and Clarke’s six-phase framework. Susan Sherwin’s (1998) relational autonomy theory guided the analytical process and provided the conceptual lens. The study found that abortion decisions are shaped by multiple actors, including male partners, friends, and health professionals, who provide emotional, informational and financial support. However, the final decision rests with the woman, who strategically determines whom to involve and when based, among other things, on the potential implication of her decision. Thus, women exercise agency through the strategic negotiation and navigation of the influence exerted by individuals within their immediate social networks. Women’s agency in abortion decisions is shaped by social and relational constraints rather than being a purely individual decision. By selectively engaging support networks, women navigate socio-economic barriers to assert control over their choices. Multi-level strategies, including the strengthening of support systems and involving men as “partners in care” can foster such supportive environments and enhance women’s autonomy.