Contextualising abortion opinions in Kenya: A vignette-based national survey

Abortion is a deeply controversial public health issue, evoking diverse opinions regardless of legal context. Yet policymaking often relies on generalised opinion surveys that lack contextual nuance. We examined public opinions of abortion in Kenya in relation to circumstances of rape, foetal anomaly, and maternal health risk. We used a nationally representative sample of 8,942 adults in Kenya, drawn from a database of 12 million phone users. Using a two-stage sampling approach with random-digit dialling, the sample was stratified by location, sex, and age to ensure proportional representation. A vignette-based questionnaire described three scenarios involving foetal anomaly, threats to the woman's life or health, and rape. It included 14 opinion statements per vignette, each with six response options indicating degrees of agreement or disagreement, and three questions to ascertain levels of support for abortion rights in these circumstances. Trained interviewers administered the questionnaire via telephone between October and November 2022. Multivariable-adjusted linear regression was used to assess factors influencing abortion opinions. Most respondents (> 61%) favoured abortion when pregnancies threaten women's life or health, while only 29% and 44%, respectively, supported it in cases of rape or foetal anomaly. There was significant support for abortion to be performed by the public health system, yet lower support for the idea of abortion as a woman's right. Liberal constructs had higher mean scores than conservative ones, with women's reproductive autonomy scoring highest (3.44 ± 1.07), indicating widespread agreement that abortion decisions should rest solely with the pregnant woman. Among conservative constructs, the sanctity of life had the highest mean score (2.40 ± 0.89), reflecting a strong belief in the value of life among abortion opponents. Abortion opinions varied depending on circumstance, with notable support for legal abortion across contexts. It is recommended that public policy reflect these nuanced views and address key barriers to support, particularly in framing abortion as a matter of public health, gender equality, and human rights.