INFLUENCE OF ABORTION ON PSYCHOLOGICAL WELL-BEING AMONG

STUDENTS IN KENYATTA UNIVERSITY.

WANYONYI AMANDA MARTHA C77S/19591/2016

SININA MOHAMMED LUTFA C77/0636/2016

NYABUTI PHELLIM MORAA C117/0663/2016

MONICAH WANJIRU WANJIKU C77/0612/2016

A RESEARCH PROJECT SUBMITTED TO THE SCHOOL OF HUMANITIES AND

SOCIAL SCIENCES IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR
THE AWARD OF THE DEGREE OF BACHELOR OF ARTS (COUNSELING
PSYCHOLOGY) OF KENYATTA UNIVERSITY.

JULY, 2021

i
 DECLARATION
This project is our original work and has not been presented for a degree in any other
university or for any other award.

Signature……………………………………………. Date

Wanyonyi Amanda Martha C77S/19591/2016

Signature……………………………………………. Date

Sinina Mohammed Lutfa C77/0636/2016

Signature…………………………………………… Date

Nyabuti Phellim Moraa C117/0663/2016

Signature…………………………………………… Date

Monicah Wanjiru Wanjiku C77/0612/2016

This project has been submitted for review with my approval as university supervisor

Signature……………………………………………. Date

Esther Muthoga

Department of Psychology

Kenyatta University

ii
 DEDICATION
This work is dedicated to our family members for all their dedication, unending love and efforts
towards seeing our university completion.

iii
 ACKNOWLEDGMENT
We acknowledge the contribution of our supervisor Esther Muthoga whose guidance and tireless
effort to see this project through led to its completion. We are very grateful for all the immense
support you put in seeing the completion of this project.

iv
 TABLE OF CONTENTS
DECLARATION.......................................................................................................................................ii
DEDICATION..........................................................................................................................................iii
ACKNOWLEDGMENT..........................................................................................................................iv
TABLE OF CONTENTS.............................................................................................................................v
ABBREVIATIONS AND ACRONYMS...............................................................................................viii
DEFINITION OF TERMS........................................................................................................................x
ABSTRACT..............................................................................................................................................xi
CHAPTER ONE........................................................................................................................................1
INTRODUCTION.....................................................................................................................................1
1.3 Purpose of the study..........................................................................................................................7
CHAPTER TWO.......................................................................................................................................9
LITERATURE REVIEW.........................................................................................................................9
2.1 Introduction.......................................................................................................................................9
2.2 Theoretical framework.......................................................................................................................9
2.2.1 Social Identity Theory................................................................................................................9
2.2.2 Cognitive Dissonance Theory...................................................................................................11
2.3 Review of related studies.................................................................................................................12
2.3.1 Prevalence of abortion among students in Kenyatta university.................................................12
2.3.2 Psychological well-being among students in Kenyatta university.............................................14
2.3.3 Psychological interventions that can be used to address influence of abortion among students in
Kenyatta University...........................................................................................................................16
2.4 Summary of Literature Review........................................................................................................18
2.5 Conceptual Framework....................................................................................................................18
CHAPTER THREE.................................................................................................................................20
METHODOLOGY................................................................................................................................20
3.2 Research Design..............................................................................................................................20
3.3 Study variables................................................................................................................................20
3.7.1 Abortion Questionnaire.............................................................................................................22
CHAPTER FOUR...................................................................................................................................24
DATA ANALYSIS AND PRESENTATION OF FINDINGS..............................................................24
4.1 Introduction.....................................................................................................................................24
4.2 Demographic Data...........................................................................................................................24
4.2.1 Distribution of responses by Age and Gender...........................................................................24

v
 4.2.2 Residential Status of the Respondents......................................................................................25
4.2.3 Year of Study of the respondents..............................................................................................26
4.3 Prevalence of Abortion....................................................................................................................27
4.3.1 Reasons for abortion.................................................................................................................27
4.3.2 Abortion experience..................................................................................................................28
CHAPTER 5............................................................................................................................................36
DISCUSSIONS, CONCLUSIONS AND RECOMMENDATION........................................................36
5.1 Introduction.....................................................................................................................................36
5.2 Discussions of the Study Findings...................................................................................................36
5.2.1 Demographic Information of the Study Sample........................................................................36
5.3 Prevalence of Abortion....................................................................................................................37
5.3.1 Reasons for Abortion................................................................................................................37
5.3.2 Abortion Experience.................................................................................................................38
5.3.3 Abortion Procedure...................................................................................................................39
5.3.4 Social Support...........................................................................................................................39
5.3.6 Relationship Problems..............................................................................................................40
5.4 Psychological Well-being................................................................................................................40
5.4.1 Anxiety experienced Before, During and After Abortion.........................................................40
5.4.2 Depression................................................................................................................................40
5.4.3 Guilt and Anger........................................................................................................................41
5.5 Psychological Interventions.............................................................................................................41
5.5.1 Suggested Psychological Interventions.....................................................................................42
5.6 Conclusions of the Study.................................................................................................................42
5.7 Recommendations...........................................................................................................................43
5.8 Suggestions for Future Research.....................................................................................................43
REFERENCES........................................................................................................................................45
APPENDICES.........................................................................................................................................53
APPENDIX 1: STATEMENT OF INTRODUCTION:........................................................................53
APPENDIX 11: CONSENT FORM.......................................................................................................53
APPENDIX 111: QUESTIONNAIRE....................................................................................................54
APPENDIX 1V: THE STUDY WORK PLAN......................................................................................59

vi
 LIST OF TABLES

Table 4.1: Distribution of Respondents by Age and Gender.........................................................25

Table 4.2 Distribution of respondents by their year of study........................................................ 27
Table 4.3 Reasons for abortion......................................................................................................28
Table 4.4 Abortion experience...................................................................................................... 28
Table 4.5 Abortion Procedure........................................................................................................29
Table 4.6 Social Support................................................................................................................30
Table 4.7: Social Stigma................................................................................................................30
Table 4.8: Relationship Problems..................................................................................................31
Table 4.9 Abortion Anxiety levels.................................................................................................32
Table 4.10 Depression levels.........................................................................................................32
Table 4.11 Guilt and anger levels..................................................................................................33
Table 4.12 Psychological Interventions.........................................................................................33
Table 4.13 Suggested Interventions...............................................................................................34

vii
 LIST OF FIGURES
Figure 2.1 The influence of abortion on psychological well-being of students in Kenyatta University.
Figure 4.1 Residential Status of the respondents

viii
 ABBREVIATIONS AND ACRONYMS
WHO: World Health Organization

SPSS: Statistical Package for Social Sciences

CGEE: Center for Gender Equity and Equality

KUSA: Kenyatta University Students’ Association

TFMHA: Task Force on Mental Health and Abortion

PTSD: Post-Traumatic Stress Disorder

FIGO: International Federation of Gynecology and Obstetrics

ix
 DEFINITION OF TERMS
Counseling: A professional relationship that empowers diverse individuals, families and groups
to accomplish mental health, wellness, education and career goals.

Psychological well-being: Inter and intra-individual levels of positive functioning that can
include one’s relatedness with other people and personal growth.

Psychological Interventions: Are techniques that target cognitive, emotional, interpersonal and
social factors with the aim of improving mental functioning and well-being.

Vacuum Abortion Procedure: Is the procedure performed to remove incomplete miscarriage or

retained pregnancy through the cervix using a vacuum tube.

Social Stigma: Is the discrimination against a person or groups of people based on perceivable
social characteristics that serve to distinguish them from other people in a given community.

Cognitive Dissonance: Refers to a situation involving conflicting thought processes, beliefs,

attitudes or behaviors.

Abortion: Is termination of pregnancy by removal or expulsion of an embryo or fetus. It is the

process of ending a pregnancy.

x
 ABSTRACT
Despite various studies carried out on abortion, few studies have been done to solely focus on
effects of Abortion on Psychological Well-being of Students. To address this gap, the study
determined the Influence of Abortion on Psychological Well-being of Students in Kenyatta
University. The study was guided by Tajfel’s and Turner’s Social Identity Theory (1979) and
Festinger’s Cognitive Dissonance Theory (1957) that identify the roles social stigma, social
support and relationships play in psychological well-being of students before, during and after
abortion. The study incorporated cross-sectional research design that entailed a sample size of
163 respondents from an accessible target population of 65,000 students, aged between 19-28
years in Kenyatta University. The researchers developed a questionnaire which was used to
collect data from the respondents. Data was analyzed using descriptive techniques like
frequencies, percentages, standard deviation and mean, with the help of Statistical Package for
Social Sciences (SPSS) Version 23 and were presented in tables. The findings revealed that
students indicated to have been, in one way or another, affected psychologically by abortion.
Guidance and Counseling, Life-Coaching, Training on Self-Awareness, Assertiveness Skills
Training and Sexual and Reproductive Health Training were suggested by respondents as some
of the psychological interventions that may enhance psychological well-being before, during and
after having an abortion. Based on the study findings, researchers recommend that; there is need
for sexual and reproductive health training, both in organized students’ workshops and
classrooms. Researchers’ also recommend that more sensitization and counseling services be
carried out especially those offered by peer counselors and the University’s Wellness Centre.
Lastly, it was recommended that the University’s Wellness Centre in collaboration with the
Centre for Gender, Equity and Equality (CGEE) and Kenyatta University Students’ Association
(KUSA) work together in distributing condoms in students’ washrooms and hostels to reduce
unintended pregnancies.

xi
 CHAPTER ONE

INTRODUCTION
1.1 Background of the study

According to the National center for Health and statistics, the centers for Disease Control and
Prevention and World Health Organization, abortion is defined as pregnancy prior to 20 weeks’
gestation or a fetus born weighing less than 500 g (Cunningham, 2010). The concept of abortion
has not been a new occurring but one that most people would rather not talk about. Many people,
especially in developing countries consider abortion as an “abomination” or something that
should not be said out loud. Nonetheless, people’s views on abortion reflect their beliefs on
fundamentally important issues such as when life begins, when the rights of the fetus become
equal to the rights of the mother and whether or not we have complete sovereignty over our own
bodies (Gleeson, Forde, Bates, Powell, Jones and Draper, 2008). There have been several
debates on whether or not abortion should be legalized though in countries such as the United
States of America it is legal to carry out an abortion.

Globally, In the United States, various anti-abortion laws have been in force in each state since
(1900). Before the Supreme Court of the United STATES decisions of Roe V Wade and Doe V
Bolton decriminalized abortion nationwide in 1973, abortion was already legal in several states,
but the decision imposed a uniform framework for state legislation on the subject. It established a
minimal period during which abortion is legal. That basic framework, modified in Planned
Parenthood V. Casey (1992), remains nominally in place, although the effective availability of
abortion varies significantly from state to state. The abortion debate most commonly relates to
the “induced abortion” of an embryo or fetus at some point in a pregnancy, which is also how the
term is used in legal sense. When the United States first became independent, most states applied
English common law to abortion. This meant it was not permitted after quickening or the start of
fetal movements, usually felt 15-20 weeks after conception. In a few states first trimester
abortion was legal under all circumstances, in some abortion was permitted under only certain
conditions (i.e., in cases of rape, incest and or danger to a woman’s health) and in the majority of
states abortion was illegal (Gold, 2003).

1
Despite campaigns to end the practice of abortion, abortifacient advertising was highly effective,
though less so across Europe. Contemporary estimates of mid-19th century abortion rates suggest
between 20 and 25% of all pregnancies in the United States during that era ended up in abortion.
This era saw a marked shift in those who were obtaining abortions. Before the start of the 19th
century, most abortions were sought by unmarried women who had become pregnant out of
wedlock. Out of 54 abortion cases published in American medical journals between 1839 and
1880, over half were sought by married women, and well over 60% of the married women
already had at least one child. In The Revolution, operated by Elizabeth Cady Stanton and Susan
B. Anthony, an anonymous contributor signing “A” wrote in 1869 about the subject, arguing that
instead of merely attempting to pass a law against abortion, the root cause must also be
addressed. Since September 2000, the percentage of abortions that were medically induced in the
US has increased. By 2011, 23% of all non-hospital abortions were medication abortions (Jones
& Jerman, 2014).

Nevertheless, abortion has many psychological consequences, both to the individual procuring it
and the parties involved (The American Psychological Association’s Report, 2008). Task Force
on Mental Health and Abortion (TFMHA) concluded that “it is clear that some women do
experience sadness, grief and feelings of loss following termination of pregnancy, and some
experience clinically significant disorders, including depression and anxiety.” (Major,2008)
reported that two years after their abortions, 1.5% of the remnant participating in her case series
(38% of the 1177 eligible women, after dropouts had all the symptoms for abortion-specific post-
traumatic stress disorder. (PTSD). The parties involved include a person’s partner and or other
social relations. It is a difficult task nonetheless to define a woman’s psychological effects of
abortion. Identifying the psychological consequences of abortion is complicated for our society,
because the mere fact of talking about them arises stigma. The French Institute for Demographic
Studies (INED, 2002) says that 40% of French women have an abortion during their life. Despite
the fact that many women are affected by this act, very few of them admit to this painful
experience or are able to talk about it openly. It is difficult to touch upon this suffering- the guilt,
the absence of the child and the need to mourn the aborted child. The incidence of unintended
pregnancy decreased from 2008 to 2011, with disparities in rates between groups narrowing
(Finer & Zoina, 2016).

2
The post-abortion syndrome is sometimes used to describe the mental turmoil experienced after
abortion. They are mostly associated with anxiety, depression, and some post-traumatic stress
disorder. The buried psychological pain requires strong triggering events to manifest itself and
for the person to see the link between her suffering and the abortion procured.

There are numerous studies conducted in Africa on abortion and they cover numerous subjects
like why people procure abortions, methods used in procuring abortions and legal issues and
ethics on abortion practices. For instance, abortion is yet to be accepted especially in Africa
where cultures, morals and values are deeply embedded in the preservation and respecting of
human lives. This has led to abortion being highly condemned and as such treated as a
punishable offense in most if not all of African countries. In South Africa during the Apartheid
Era, a lot of policies were pushed forward encouraging the white women to procreate more while
the women of color were subjected to family planning methods. This came after fear took on
racist overtones manifesting the propaganda that suggested that the black population was
growing too quickly while the white population was stagnating, and the people of color were
becoming a burden to the country’s resources (Klausen,2010). Because of this, family planning
became associated with the racist policies of the apartheid government. Since pregnancies could
not be terminated especially by the white women, they took it upon themselves to have it done
by their private practitioners. This was protected under the law that the pregnancy endangered
the woman’s life thereby justifying the abortion. The dominant narratives of the time combined
moral censure with medical necessity. It asked that the law should register respect for the unborn
child, recognize South Africa’s Christian views and strict moral norms and ensure drastic action
against women who sought abortion outside of the law (Hansard,1973).

Abortion in Kenya is regulated by Article 26 (IV) of the constitution of Kenya, which states
abortion is not permitted unless in the opinion of a trained health professional, there is need for
emergency treatment, or the life or health of the mother is in danger, or if permitted by any other
written law. Abortion as been reflected in what has been termed as ‘female crimes’ carried out
by young women aged between 16 to 25 years (Njonjo, 2010).

A survey of 2012 by the Kenyan Ministry of Health, African Population & Health Research
Center and IPSAS found that there were 464,000 abortions induced that year, which translates to

3
an abortion rate of 48 per 1000 women aged 15 to 49; and an abortion ratio of 30 per 100 live
births. (Mutua, Kimani, Ziraba, Bankole, Singh, Egesa, August 2015).

Marie Stopes International estimates that 2600 women die from unsafe abortions annually,
average of 7 deaths a day. About 120,000 women receive care for complications of induced
abortion in health facilities. About 49% of all pregnancies in Kenya were unintended and 41% of
unintended pregnancies ended in an abortion. Unsafe abortions are a leading cause of maternity
morbidity in Kenya. The 2010 Kenyan Constitutional Referendum than introduced article 26
broadened access to abortion by allowing it for maternal health reasons. The National Council of
Churches in Kenya, which featured it would lead to the legislation of abortion, opposed the
amendment (Greene, August 2010).

Nonetheless, there are several issues that follow during and after one procures an abortion. For
instance, women may fear to express their pain because in Kenya abortion is considered illegal in
most cases. The woman may later develop psychological symptoms such as depression, which
could be mild, suicidal tendencies, withdrawal from relationships, loss of self-esteem and
increased self-doubt, acute feelings of guilt, shame and feeling of not being a good mother.

Marie Stopes International spearhead their defense of women’s right to abortion and pride
themselves in providing safe abortion services wherever the law permits. They believe every
woman has a right to determine her own future, whether that means using contraceptives to
prevent unintended pregnancy or choosing to end a pregnancy through unsafe abortion. Access
to safe abortion does not only enable a woman to determine her own future but also means she
can contribute to creating a better, more sustainable future for everyone. MSI seeks to help
women choose a contraceptive method that suits their individual lifestyles and medical needs.
(Marie Stopes, 2018).

The International Federation of Gynecology and Obstetrics (FIGO,2019) in Kenya has initiated a
project to advocate for reducing unsafe abortion in Kenya. The multi-prolonged effort will bring
together organizations with the shared goal of ensuring access to safe abortion is provided within
the law. For example, working with healthcare professionals to reduce stigma and increase
knowledge of the legal context. The project come at an opportune time when Kenyan
communities need all the help they can get to save women from death and maiming from unsafe
abortion.

4
There have been numerous cases of abortion especially among university students. In a study
carried out to investigate attitude towards abortion among Kenyan University students, and the
main reasons that motivate female students to procure abortions, a descriptive survey design was
adopted. The study sample comprised 205 students from Nairobi and Kenyatta universities. It
was discovered that variables of religion, parental income and faculty significantly influenced
the students’ attitudes towards abortion in relation to some of its three facets namely fetal person
hood, morality and legalization (Nthangi, 2005). The students also gave their opinions regarding
factors that motivate female university students to procure abortion. Three highly ranked factors
were fear of humiliation, fear of discontinuing studies and financial constraints.

Despite the above mentioned psychological effects according to (Steele & Sutton, 1973) women
who have procured abortion face, some also report feelings of denial, which they use as a
defense mechanism to allow them escape the various emotional turmoil they may be feeling at
the time. Some of the students report feelings of anger, especially towards the partner who was
not there, didn’t want the child or provided very little support during the pregnancy period. They
have also directed anger towards family members and others in their social circle. The guilt they
experience is majorly because of their individual values especially religion which stipulates one
against killing.

1.2 Statement of the problem

Statistics indicate number of abortion procured is higher now than in the recent past. Identifying
the psychological consequences of abortion is complicated for our society because talking about
them is an unwelcome debate. A study carried out in Germany indicates the numbers of abortion
to have risen from 16,024 between 2004 and18,870 in 2009, an increase of 18%. According to
European Institute of Bioethics, there are psychological disturbances that can affect women who
abort. For instance, they experience feelings of denial, anger, doubt, depression, anxiety among
other psychosomatic symptoms. There have been existing treatments and support for the
afflicted, particularly in Belgium and France. The American Psychological Association’s report
Task Force on Mental Health and Abortion (TFMHA) concluded that “it is clear that some
women do experience sadness, grief and feelings of loss following termination of a pregnancy,
and some experience clinically significant disorders, including depression and anxiety” (Major,
2008). Brenda Major’s own research had reported that 2 years after their abortions, 1.5% of the

5
remnant participating in her case series (38% of the 1177 eligible women, after dropouts) had all
the symptoms for abortion specific post-traumatic stress disorders (PTSD). In addition, she found
that compared to their one-month post-abortion assessments, at 2 years the participating remnant
had significantly rising rates of depression and negative reactions and lowering rates of positive
reactions, relief and decision satisfaction.

An abortion does not occur in isolation from interrelated personal, familial, and social conditions
that influence the experience of becoming pregnant, the reaction to discovery of the pregnancy,
and the abortion decision (Reardon, 2018). These factors will also affect women’s post-abortion
adjustments, including adjusting to the memory of the abortion itself, potential changes in
relationships associated with the abortion, and whether this experience can be shared or must be
kept secret. These are all parts of the abortion experience. Therefore, the mental health effects of
abortion cannot be properly limited to the day on which the surgical or medical abortion takes
place. The entirety of the abortion experience, including the weeks before and after it, must be
considered.

In a cross-sectional exploratory study conducted in Kisumu and Nairobi counties on abortion in

Kenya between May and October 2017, communities representing rural, semi-urban, urban
informal and urban formal settings were included. Data analysis was performed using the
thematic framework approach, as described by Ritchie and Spencer. Participants recognized and
accepted abortion as a common occurrence in the community. However, the dominant view
expressed by both female and male participants is that abortion is objectionable and a deviation
from the social norms and perspectives embedded in religious and cultural beliefs. Considering
the negative community opinions related to pregnancy termination, and the fear of shame and
stigma resulting from it, abortion is often conducted in secrecy (Mutua, 2019).

The study findings aimed to contribute towards new and scholarly literature to the already
existing knowledge on the influence of abortion on psychological well-being among students in
Kenyatta University, and may provide a foundation for farther research in this area and
respective interventions.

6
1.3 Purpose of the study
The purpose of this study was to establish the influence of abortion on psychological well-being
among students in Kenyatta University.

1.4 Objectives of the study

The following objectives guided the study:

1. To determine the prevalence of abortion among students in Kenyatta university.

2. To examine the psychological well-being among students in Kenyatta university.
3. To explore psychological interventions that can be used to address the influence of
abortion among students in Kenyatta university.

1.5 Research questions of the study/hypothesis

1. What is the prevalence of abortion among Kenyatta university students?
2. What are the levels or state of psychological well-being among Kenyatta university
students?
3. What are psychological interventions that can be used to address the influence of abortion
on psychological well-being among Kenyatta university students?

1.6 Significance of the study

This study was significant both to students, school authority and family. Students were provided
with information necessary on mental health care useful in pre-abortion and post-abortion
conditions. School authority gets to have a general knowledge of abortion statistics and measures
they can put in place to help reduce numbers of pregnancies and abortion. The families are to
benefit in understanding the importance of social support during pre-abortion and post-abortion
periods.

1.7 Scope of the study

This research work was carried out among students in Kenyatta University main campus in
Kahawa Sukari area. Both male and female students participated in this research. The thematic
scope of the study was focused on the feedback on influence of abortion on psychological well-
being among students in Kenyatta university.

7
1.8 Limitations of the study

The information from respondents was based on self-subjective reports therefore may have been
biased based on the needs of the people involved. The researchers explained to the participants
the need to provide honest answers to avoid social desirability of the responses.

1.9 Assumptions of the study

The study assumed that;

Students in Kenyatta University procure abortions, and it affects them.

When students procure abortions, there are psychological consequences associated with it.

There would be willing and honest participation in the study.

8
 CHAPTER TWO

LITERATURE REVIEW

2.1 Introduction
This chapter entails a review of the following areas; theoretical framework, review of related
studies and the conceptual framework.

2.2 Theoretical framework

In this section, Tajfel’s and Turner’s Social Identity Theory (1979) and Festinger’s Cognitive
Dissonance Theory (1957) are discussed to provide a theoretical background for establishing the
influence of abortion on psychological well-being among students in Kenyatta University.

2.2.1 Social Identity Theory

Social identification is important because it influences how people see themselves and about how
they interact with others. Social identity theory (Tajfel & Turner, 1979) introduced the concept
of social identity as a way in which to explain inter group behavior. Generally, individuals wish
to maintain a positive social identity by maintaining their group’s favorable social standing over
that of relevant out-groups (Vinney, 2019).

The Social Identity Theory focuses on the individual’s account of processes involved in abortion,
undergoing the procedure and coming to terms with any social disapproval that may follow. It
focuses on the stigma women face after procuring an abortion or even at the thought of wanting
to carry on the procedure. Women who seek abortions challenge localized cultural norms about
the “essential nature” of women. We posit that stigma may also apply to medical professionals
who provide abortions, friends and families who support abortion patients, and perhaps even to
pro-choice advocates (Kumar, Hessini & Mitchell, 2009). Stigmatization is a deeply contextual,
dynamic social process. It is related to the disgrace of an individual through a particular attribute
he or she holds in violation of social expectations. Abortion stigma is seen as a negative attribute
ascribed to women who seek to terminate a pregnancy that marks them, internally or externally,
as inferior to ideals of womanhood (Kumar, 2009).

The three key tenets of this theory are social categorization, social identification and social
comparison. In social categorization, individuals are organized into groups in order to understand
their social world. People are defined based on their social categories more often than their
individual characteristics. This may foster social stigma especially for individuals who may

9
decide to procure abortions. Individuals may be alienated based on the virtue that they have
procured abortions. They may be deemed immoral or with no personal values. Social
identification on the other is where individuals strive to identify as a group. This leads
individuals to behave in a way that they believe members of that group should behave. This
greatly impacts on the individuals’ esteem. Social comparison is where people compare their
group with other groups. In order to maintain self-esteem, one must perceive his or her group as
having a higher social standing than an out-group (McLeod, 2008). In-group favoritism and out-
group discrimination can result in negative outcomes, from prejudice, stereotypes, social
stigmatization, which in turn can affect women who decide to procure abortions.

Another key tenet of the theory is the Interpersonal-Inter Group Continuum. This explains the
occurrence of negative psychological consequences because of social behavior which will want a
person to change his or her behavior while in a group (Turner, 1999). These negative
consequences are associated with depression, anger, fear, guilt and frustration. Therefore,
Kenyatta University students who procure abortions are more likely to develop negative
psychological consequences because of both their personal characteristics and societal
expectations.

The above model is appropriate for the study as it explains how university students develop
negative psychological problems (whether salient or transitory) before, during and after
procuring an abortion. It means that those university students in Kenyatta University who
procure abortions may end up experiencing psychological discomfort.

The three tenets can jointly or independently be applied in this study in several ways. First and
foremost, in social categorization, the study aims to recognize and understand how different
groups and individuals’ social worlds may propagate stigma and social isolation especially
groups of students who may have procured abortions. It broadly sheds light of the challenges
students procuring abortions and those who already have may be going through. Both social
identification and social comparison contribute to alienation of students who have undergone an
abortion procedure. They are more often than not deemed immoral and as lacking personal
values or standards. It amplifies the social stigma experienced and other psychological problems
such as anxiety, depression, feelings of guilt and anger affecting their psychological well-being.
They may feel like outcasts and end up alienating themselves from others who may have not

10
been in the same situations. They also may feel not understood and this may be a major cause of
self-isolation rather than stigma from the society as a whole.

2.2.2 Cognitive Dissonance Theory

The Cognitive Dissonance theory (Festinger, 1957) suggests that we have an inner drive to hold
all our attitudes and behavior in harmony and avoid disharmony (or dissonance). Cognitive
dissonance refers to a situation involving conflicting attitudes, beliefs or behaviors. This
produces a feeling of mental discomfort leading to an alteration in one of the attitudes, beliefs or
behaviors to reduce the discomfort and restore balance (McLeod, 2018). It postulates that once
an individual has experienced the negative thinking associated with anxiety and depression, there
is an increased risk that he or she will develop maladaptive cognitive schema, which, with
repetition, can become entrenched (Beck, 1995). During an episode of anxiety, worried mood
and feelings of inadequacy in the face of impending doom, there’s excessive feelings of failure,
guilt, remorse or self-blame.

Depression and other emotional side effects are not uncommon after an abortion or pregnancy
termination, whether it was planned or not. The decision to terminate a pregnancy is rarely an
easy one, and it’s not always the individual’s preferred choice. Whether they choose a
termination or not, they can have mixed feelings after the procedure (McGill, 2018).

The study on Influence of Abortion on Psychological Well-being among Students in Kenyatta

University has some similarities with the study of The Impact of Pro-Life Education on Abortion
Attitude Among College Students in Nepal because both studies look at the impact brought about
by abortion.

A key tenet of the Cognitive Dissonance Theory is the tendency for individuals to seek
consistency between their beliefs, opinions and other cognition. According to this theory,
learners feel more dissonance when their actions go against their beliefs (Pappas, 2016). For
instance, it is very difficult for Christian students who have been brought up in a society that
condemns abortion and who strongly believe that abortion is a sin and is against their personal
values; but who also know that they are still young and do not have the necessary resources to
bring up a child and therefore want to procure an abortion. This is a very hard choice for them
and may lead to emotional and psychological disturbances.

11
The Cognitive Dissonance Theory is relevant in this study as it tries to explain how negative
automated thoughts and dysfunctional beliefs brought about by Post-Abortion Syndrome
negatively affect an individual after procuring an abortion. It highlights some of the major
psychological issues university students who have procured abortions may be going through.

2.3 Review of related studies

In this section, a review of influence of abortion on psychological well-being among students in
Kenyatta university is discussed as guided by the objectives of the study.

2.3.1 Prevalence of abortion among students in Kenyatta university.

Worldwide, abortion is one of the commonest gynecological procedures (Sedgh, 2012). The
common occurrence of abortion around the globe, however, has considerable diversity in the
social, political, and ethical meanings of terminating a pregnancy, as well as the practice
surrounding abortion. All of these vary from locale to locale, from one historical time to another,
and among social groups within particular times and places. The legal context for abortion-
whether or not the state allows abortions and how it regulates them sets the framework for
provides of abortion services and for women who seek these services. At the start of the 20th
century, abortion was illegal in almost every country of the world. Indeed, it appears that China
is the only country that has not placed criminal restrictions on abortion (Berer, 2016). During the
2nd half of the 20th century, a number of countries enacted laws that allowed abortion on specified
grounds. Currently, the circumstances under which abortion may be legally performed vary
widely from country to country. The Center for Reproductive Rights has grouped countries into
four categories from “most restrictive”, where abortion is prohibited altogether or permitted only
to save a woman’s life, to “least restrictive” where there are no restrictions as to the reason for
terminating a pregnancy. Furthermore, it was estimated that of the 21.6 million unsafe abortions
that took place globally in 2008, 21.2 million took place in “developing” regions; these regions
typically had more restrictive abortion legislation (WHO, 2011).

Decision making by medical practitioners can be relatively important in some situations, but in
other situations, state regulation of abortion undermines women’s autonomy and agency. In some
times and places, women have been compelled to abort their pregnancies (Eklund & Purewal,
2017). Between 1979 and the late 1990s, China imposed on its citizens a variety of measures to

12
control population growth. These included compulsory screening of women for unauthorized and
forced abortion.

Cultural factors other than religious beliefs also influence abortion policies, practices, and
individual decisions. Pressures to bear sons rather than daughters have led to sex-selective
abortions in India and China (Eklund & Purewal, 2017). Cultural norms and values regarding
abortion also differ widely across the world. Certain religions raise moral objection to
terminating a pregnancy by induced abortion. Devout women who face an unwanted or
untenable pregnancy may experience considerable difficulty in weighing their courses of action.
Women, especially in Africa, may also face strenuous religious or moral objections from their
spouses and family members. Beyond personal moral dilemmas, opposition to abortion by
institutionalized religions sometimes constitutes a significant barrier to women’s access to
abortion (Miller, 2014). Catholic church has not only condemned the practice of abortion and
artificial contraception by Catholics, but has also carried out vigorous campaigns to influence
local and national electoral politics in the hopes of restricting access to abortion to all women.

In much Africa, 20-24-year-old women tend to have the highest abortion rate of any age group,
and the bulk of abortions are accounted for by women in their twenties. Adolescent abortion
rates in countries in developed regions are fairly low (e.g. 3-16 per 1000 women aged 15-19)
compared to abortions that occur in restrictive categories of countries (which is 34-37 per 1000
women) respectively (Jewkes & Rees, 2005).

In South Africa, for example, abortion was largely illegal from 1975 until The Choice on
Termination of Pregnancy was passed after Apartheid ended in 1996, granting legal access to
abortion upon request until 12 weeks of pregnancy (Singh, 2012; Truman, 2013). This caused a
dramatic 91% decline in abortion related mortality from 1994 to 2000.

In 2012, an estimated 464,000 induced abortions occurred in Kenya. This translates into an
abortion rate of 48 per 1000 women aged 15-49 years, most of which are in their early 20s, and
an abortion ratio of 30 per 100 lives. About 120,000 women received care for complications of
induced abortion in health facilities. About half 49% of all pregnancies in Kenya were
unintended and 41% of unintended pregnancies ended in an abortion (Mohamed, Mutua, Ziraba,
2015).

13
Most of the women who sought abortion in Kenya in 2012 were younger than 25 years old.
Many unsafe abortion patients in Kenya suffer fatalities and severe complications (such as
sepsis, shock or organ failure), experience multiple unintended pregnancies and repeat abortions
(African Population and Health Research Center, 2013). The treatment of abortion complications
utilizes a large amount of scarce health systems resources. At the Kenyatta National Hospital,
Kenya’s premier health facility, incomplete abortion accounted for more than half of all the
gynecological admissions in 2002. Most of these admissions were emergencies, requiring long
periods of hospitalization, repeated visits to hospitals, intensive care, and attendance by highly
skilled health providers (Gebreselassie, 2005).

2.3.2 Psychological well-being among students in Kenyatta university.

While abortion stigma continues to receive critical attention globally in studies of abortion safety
and care seeking practices (Herrera & Zivy, 2002), little of the existing research has directly
addresses lay perceptions of abortion safety in the context of abortion stigma. The focus on
published research has been on models for measuring abortion stigma (Huntington, 1996) the
sites and spaces- medical discourses, government and political structures, institutions,
communities and personal interactions- where abortion stigma is constructed (De Roubaix,
2007).

Abortion, whether medically induced or not, has distinctive physical, social and psychological
effects. A study was carried out in Dublin by Clare and Tyrell on psychiatric aspects of abortion
(Clare & Tyrell, 1994), to examine the evidence concerning the psychological consequences of
abortion, the risk of suicide in pregnancy and the psychological consequences for the mother and
the child in cases of refused abortion. Women who have strong religious or cultural attitudes
negative to abortion do experience high levels of psychological stress following abortion (Clare
& Tyrell, 1994) furthermore concluded from their review of the literature that “the risk of suicide
is low in pregnancy and suicide is a rare outcome of refused abortion”. In particular, Clare and
Tyrell studied 294 Swedish women who had been refused abortion 10 years previously. They
found a high level of poor adjustment and psychological problems in these women. These
findings have been father supported more recently (Dytrych & Matejeck, 2003).

Another review was carried out in the USA to identify studies which examined “the
psychological consequences of termination of pregnancy”. The review included 72 articles. In

14
addition, the authors identified 27 reviews of the literature. These 99 publications are presented
by the authors in summary form with key information concerning the study parameters and the
key findings (Bonevski & Adams, 2001). On the basis of their review, these authors observed a
number of consistent trends: There was “overwhelming indication that legal and voluntary
termination of pregnancy rarely causes immediate or lasting negative psychological
consequences in healthy women”.

The factors that do seem to predict negative psychological outcome include: “certain personality
traits including impulsivity, attachment, low-self-esteem and dependency, late gestation abortion,
prior psychiatric illness, and conflict with religious or cultural beliefs”. The research in overall
suggests that “greater partner or parental support improves the psychological outcome for the
woman and that having an abortion results in few negative outcomes in the relationship”. Review
of literature specifically concerning the effects on adolescents concludes that “the effects on
younger women are mild and transitory and that other confounding factors may influence
negative outcome”. In addition, they had several specific observations to make concerning
various aspects such as negative psychological outcomes and personal relationships (Bonevski &
Adams, 2001). Their literature that abortion rarely causes immediate or lasting negative
psychological consequences. When negative psychological consequences occur, the effects are
usually mild and transient. The authors point out that there are some groups of women who are at
a greater risk of some trauma from abortion. The predictor of negative outcomes most often cited
included personality traits. The majority of studies reported that negative psychological
diminished following the abortion.

One perspective argues that abortion is a uniquely traumatic experience because it involves a
human death experience, specifically, the intentional destruction of one’s unborn child and the
witnessing of a violent death, as well as a violation of parental instinct and responsibility, the
severing of maternal attachments to the unborn child, and an unacknowledged grief (Coleman,
Reardon, Strahan & Cougle, 2005). Rue and Speckhard (Speckhard & Rue, 1992) posited that
the traumatic experience of abortion can lead to serious mental health problems, for which they
coined the term post-abortion syndrome (PAS). They conceptualized PAS as a specific form of
post-traumatic stress disorder (PTSD).

15
Some studies examined the effects of relationships on abortion outcomes. (Summer & Major,
1994) found that if the partner accompanied the women to the procedure that this resulted in
better coping. (Grossman, 1974) found that partner and parent support predicted a more positive
outcome. In a cross-sectional study aimed to assess the relationship between perceived social
support among young women in Lima, Peru, women aged 15 to 25 years old were used as
participants. A total of 298 women were enrolled, mean age 22 years.

In Zimbabwe and Ghana, there was evidence of an association between low perceived social
support and induced abortion among women aged 18-25 years. Incidence of induced abortion
was similar or even greater than rates of countries where abortion is legal (Ganatra, 2014). Since
the abortion itself is perceived as a stressful life event, it is therefore important to explore the role
of support, decision-making and psychological responses thereafter. Speckhard & Rue, (1992),
assert that abortion may relieve stress for some women by ending an unwanted pregnancy, but
the event itself may simultaneously be experienced as a stressors causing anxiety, frustration,
doubt, grief, despair, guilt and anger.

In the Kenyan context, traditional socio-cultural norms and religious beliefs continue to
stigmatize and condemn abortion (Smith, Mohammed & Njunguru, 2018). In a study conducted
with Kenyan women aged between 18-24 years who recently received abortion and PAC
services at four Marie Stopes Kenya clinic sites in Nairobi, the most significant psycho-social
barrier respondents faced was perceived stigma. Female study participants responded that
because of severely felt stigma “women seeking to terminate an unintended pregnancy enjoyed
no respect, sympathy or support”. Furthermore, they internalized this belief and repeatedly stated
that abortion was “the worst thing you could do as a woman, if it is found out you’ll lose every
aspect you have, and people will immediately shun you” (Njunguru, 2018).

2.3.3 Psychological interventions that can be used to address influence of abortion among
students in Kenyatta University.
Although in many countries abortion is legal only on medical grounds, it is essential to evaluate
the woman’s motivation and background. Unlike many decisions the woman would have to take
in her life, the decision to terminate a pregnancy is irreversible. In addition, the possibility of
discussing the advantages and disadvantages of abortion with friends and family may be very

16
restricted. It seems therefore that pre-abortion counseling may be not only a helpful but
necessary service (Lambert, 2001).

Discussions on Counseling and support services found in literature emphasize the positive
impact it may have to coping of a woman after procuring an abortion. Research in overall
suggests that “greater partner or parental support improves the psychological outcome for the
woman and that having an abortion results in few negative consequences (Koumantakis, 2004).
Related to counseling is the question of social and economic support. These may be determining
factors in the decision to continue or terminate a pregnancy. Evaluation of existing services in all
these fields on a cross-national basis, would assist in the planning of appropriate preventive,
treatment and rehabilitation services.

Addressing stigma can be important for coping with sensitive and silenced health experiences
and contributes to psychosocial adjustments. Emotional care that incorporates interventions to
reduce stigma is likely to improve their ability for coping (Brown & Macintyre, 2003). From
literature review of a study conducted in the US on post-abortion stigma, a set of interpersonal
and intrapersonal interventions were presented. These interventions are mostly aimed at
improving the experience of the stigmatized or addressing the negative attitudes and behaviors of
the non-stigmatized. These interventions fall into four themes: counseling approaches,
information-based education, skills-building education and contact with affected group.
Counseling programs can provide healthcare information, emotional support, and empowerment
to people who experience stigma (Brown, 2003).

In a study carried out in Canada and the United States, data was collected from January 2007 to
January 2010, and included demographic and reproductive data as well as preferences for
interventions to reduce psychological distress after abortion. The study was conducted at the
McGill University students’ health services in Montreal. The study was part of a larger program
of research to develop an effective behavioral intervention for young women who seek treatment
for psychological distress after abortion. Principal Component Analysis was used to analyze
types of services that students desired, including assistance for unanticipated guilt, spiritual
distress, coping and education to understand their abortion experience (Curley & Johnston,
2014). These findings provide evidence to develop targeted post-abortion psychological services
for this population, which are generally not available in the clinical setting.

17
In a clinical case study in Africa, a Zimbabwean woman with Post-Abortion Syndrome (PAS), a
form of PTSD precipitated by carrying out an abortion was treated with cognitive behavioral
therapy. The case narrative documents the assessment based on current evidence-based models.
Factors that made her vulnerable to developing PTSD included active suppression of the memory
of the event and lack of social support (Edwards, 2014). An understanding of this factors was
used to guide an effective intervention.

Person-centered care is growing and plays a particularly crucial role in the quality of
reproductive health services (Sudhinaraset, 2017) and could potentially improve the quality of
abortion care. In a study conducted in 2012, it is estimated that 464,000 women in Kenya had
abortions in facilities (Mohammed, 2015). Other research finds that women who delayed care
due to perceived unsafe abortions and inadequate post-abortion care had disproportionately more
severe post-abortion complications such as death, organ or system failure and guilt (Ziraba,
2015).

2.4 Summary of Literature Review

From the literature review, abortion affects women differently varying from locale to
locale, time, political factors and jurisdiction, cultural and social norms and religion. Other
factors such as morality plays a major role in increase of stress for women who abort
especially those whose morality is deeply rooted in religion (Miller, 2014). Some studies
reviewed above seem to suggest that most of the psychological problems faced after
procuring an abortion fade with time and women who have support both from the partner
and parents tend to cope more during and after abortions.2.5 Conceptual Framework
As indicated in figure 2.1 the conceptual framework shows abortion as an independent variable
while psychological well-being among students as a dependent variable. The intervening
variables include age, socioeconomic status of students, marital status, sex and year of study.

18
 Independent variables
Dependent variables
REASONS FOR ABORTION
PSYCHOLOGICAL WELL-BEING AMONG
 Lack of social support STUDENTS
 Social stigma
 Depression
 Relationship problems
 Anxiety
 Guilt
 Anger

Intervening variables

 Age
 Socioeconomic status
 Marital status
 Sex
 Year of study

Figure 2.1 The influence of abortion on psychological well-being of students in Kenyatta

University.
Source: Author

CHAPTER THREE

METHODOLOGY
3.1 Introduction

19
This chapter entails the methodological steps to be undertaken to establish the influence of
abortion on psychological well-being among students in Kenyatta University. It denotes the
research design, study variables, research locale, study population, sample size and sampling
techniques, research instrument, validity & reliability, pilot study, data collection procedures,
data analysis & presentation, and, data management and ethical considerations.

3.2 Research Design

This research study adopted cross-sectional research design which involves looking at data at a
population at one specific point in time (Cherry & Gans, 2019). This design is appropriate as it
allows the researcher to look at numerous characteristics at once and collect data on the different
variables. Data was collected on the influence of abortion and psychological well-being among
students in Kenyatta University to test the nature of and data collected of the two variables.

3.3 Study variables

The main variables in the study were abortion and psychological well-being. Abortion was the
independent variable while psychological well-being the dependent variable. Psychological well-
being was measured by the information gathered through questionnaires administered to the
students and it encompassed different phenomenon such as depression, guilt, worrying about not
being able to conceive again, nightmare and regret. Abortion was measured in terms lack of
social support, social stigma and relationship problems. Other variables in the study are
extraneous and include: age, socioeconomic status, social support, year of study and personal
choices.

3.4 Site of the study

The study was carried out in Kenyatta University main campus, located in Kahawa Sukari near
Kahawa Barracks on Thika Superhighway in Nairobi, Kenya.

3.4 Target population

The target population was 65,000 undergraduate students from the various schools and
departments in Kenyatta university.

20
3.5 Sample size and sampling techniques

The study adopted convenience sampling to select the sampling study. In convenience data is
collected from population members who are readily available to participate in a study (Saunders,
Lewis & Thornhill, 2012). The researchers distributed questionnaires to the targeted groups on
Whats App. This sampling procedure was appropriate for the study because the researchers
needed a sample population that was readily available. A sample size of 163 undergraduate
students was selected using the Yamane (1973) formula to determine the sample size to be used.

The formula is as follows:

N= Total population of students in the sampled university, 65,000.

e= margin of error, 0.05

n- sample size

The calculation of the sample is as follows:

n=

n= 163.5

n= 163 students

A proportionate sample of 163 university students from Kenyatta university was used as the
sample population, a proportionate of 90 female and 73 male students based on Kenya National
Bureau of Statistics (KNBS,2014) figures of 44.78% male while 55.21% female students.

3.6 Research instrument

The researchers used the Likert-Scale rating system used in questionnaires which is a five (or
seven) point scale which is used to allow the individual to express how much they agree or
disagree with a particular statement (McLeod, 2019). The instrument encompassed two

21
 sections comprising of abortion questionnaire and Hospital Anxiety and Depression Scale
(Zigmond & Snaith, 1983). Both the HADS instrument and the abortion questionnaire had
close-ended questions to get higher response rates from participants that can be analyzed
statistically. This is particularly important when carrying out quantitative survey analysis.

3.7.1 Abortion Questionnaire

The questionnaire gathered demographic information of the participants and effects of abortion.
The researchers used Likert-Scale questionnaire with close-ended questions because close-ended
questions are made up of pre-populated answer choices for the respondents to choose from. The
researchers used check boxes to collect respondents’ demographic data.

3.7.2 Hospital Anxiety and Depression Scale

The current study adapted The Hospital Anxiety and Depression Scale (HADS), (Zigmond &
Snaith, 1983). It assesses both anxiety and depression, which commonly co-exist. The
questionnaire comprised seven questions for anxiety and seven questions for depression, and
takes 2-5 minutes to complete. The researchers used multiple choice options in the Hospital
Anxiety and Depression Scale (HADS).

3.7 Validity and reliability

Validity is the degree to which a test measures what it wants to measure (Sekaran, 2011). In
adapting the abortion questionnaire and the HADS, the researchers worked with the supervisor to
enhance validity and reliability of the instruments by generating sufficient number of items that
will cover abortion-related behavior. This was done by making it short and precise to avoid
respondents’ fatigue. Cronbach’s Alpha Test of internal consistency will be 0.78 specificity for
anxiety score of 8 or more and 0.9 sensitivity; and for depression a specificity of 0.79 and
sensitivity of 0.83.

3.8 Pilot study

To establish the appropriateness of the instruments, a pilot study was conducted among a sample
of 10 students from the university. They were excluded from the final sample. The pilot study
pre-tested the research instrument to determine its reliability and validity.

22
3.9 Data collection procedures

Data was collected online through online questionnaires over a period of two weeks. The
questionnaires were sent in WhatsApp students’ groups from different departments across the
different schools. The questionnaires were sent as google documents. The responses took
approximately 10-20 minutes to complete.

3.10 Data analysis and presentation

Descriptive and inferential statistics was used to analyze the data that was collected. Descriptive
statistics such as measures of central tendencies and percentages were used to describe the data.
Pearson Product Moment Correlation, r, was used to establish the influence of abortion on
psychological well-being among students in Kenyatta University. Data analysis was aided by the
use of Statistical Package for Social Sciences version 25 (SPSS).

3.11 Ethical considerations

Before conducting the study, permission was sought from the Project Supervisor. Ethical
clearance was obtained from Kenyatta University Ethics and Review Committee. In adherence
with the established ethical requirements of social science research, the researchers protected the
personal information of the respondents by upholding confidentiality and anonymity during and
after the study for purposes of research only.

Community considerations was obtained by seeking permission from the university authorities to
conduct the study. The findings and recommendations of the study will be availed to the
university.

CHAPTER FOUR

DATA ANALYSIS AND PRESENTATION OF FINDINGS

4.1 Introduction
This chapter entails the findings of the study on influence of abortion on psychological well-
being of students in Kenyatta University. It is divided into two sections. The first section
comprises findings on the demographic characteristics of the sample. The second section

23
comprises five sub-sections/parts. It contains descriptions of the findings on the independent
variable (reasons for abortion) while the other parts describe the dependent variables (anxiety &
depression, guilt and anger). The final part describes findings on the psychological interventions
to address influence of abortion on psychological well-being of students in Kenyatta University.

4.2 Demographic Data

The study targeted 163 Kenyatta University students. However, during data collection
researchers collected a total of 187 questionnaires. Of the collected data 24 questionnaires were
disqualified because they were incomplete. The final data used for analysis was obtained from
the 163 sample population. The demographic characteristics were analyzed in terms of age,
department, year of study, gender, residential area and marital status.

4.2.1 Distribution of responses by Age and Gender

The total study sample was one hundred and sixty-three (163) of whom 90 were female (55.21%)
and 73 were male students (44.78%). Table 4.1 shows the frequency and percentages of the ages
and gender of the sample. The ages of the sample range from 19 to 28 years with the mode of the
respondents age being age 22 (34.97%). The respondents aged 19 years were (4.29%), 20 years
were 5.52%, 21 years were 12.88%, 23 years were 6.13%, 24 were 13.49%, 25 years’ sample
were 12.26%, 26 years old sample were 6.13%, 27 years’ sample were 2.45% while 28 years old
sample were 1.84%.

Table 4.1: Distribution of Respondents by Age and Gender

Age Sample size by sex Total Sample Percentage

Female Male

19 6 1 7 4.29
20 6 3 9 5.52
s21 12 9 21 12.88
22 29 28 57 34.97
23 8 2 10 6.13
24 16 6 22 13.49

24
25 4 16 20 12.26
26 5 5 10 6.13
27 2 2 4 2.49
28 2 1 3 1.84

TOTAL 90 73 163 100

The ages of both male and female respondents were compared and the mean age of female
sample was 22.58 while that of male respondents was 23.1.

4.2.2 Residential Status of the Respondents

The respondents indicated in the questionnaire whether they live within the university premises
or outside the university. The respondents who lived inside the university were the majority
forming 62.8% while those residing outside campus were 37.2%.

within outside

Figure 4.1 Residential Status of the respondents

Outside Campus- 37.2%

25
Within Campus- 62.8%

4.2.3 Year of Study of the respondents

This section entailed year of study of the respondents. The table below shows the distribution of
the respondents by their year of study.

Table 4.2 Distribution of respondents by their year of study

Academic Year Frequency (f) Percentage

Fourth year 48 29.45

Third year 59 36.20
Second year 40 24.54
First year 16 9.82

TOTAL 163 100

From the above table, most respondents were in their 3rd year of study (36.20%), followed by
those in 4th year (29%), in second year (24.54%) and finally 1st year (9.82%). The study was
carried out between October 15th to November 19th, 2020 when students resumed school.

4.3 Prevalence of Abortion

This section contains findings of the study on the prevalence of abortion among students in
Kenyatta University, Reasons for Abortion, Abortion Experience, Abortion Procedure, Social
Support, Social Stigma and Relationship Problems.

4.3.1 Reasons for abortion

The respondents were asked if they had procured an abortion. 77 female respondents had
procured. That sums up to a total of 47.42% of the total population had procured abortions. The
respondents were asked to indicate the various reasons for abortion. A majority cited personal
choices as their reason for abortion which summed up to a total of 44.17%. The second most
popular reason for abortion was lack of social support which was 18.50%. The third reason,
economic reasons was 19.02%, followed by social stigma which was 17.18%. The last reason,

26
relationship problems had a percentage of 6.13 of the total population. The results are elaborated
in table 4.3 below.

Table 4.3 Reasons for abortion

Reason frequency percentage

Personal choice 72 44.17

Lack of social support 22 13.50
Economic reasons 31 19.02
Social stigma 28 17.18
Relationship problems 10 6.13

Total 163 100

4.3.2 Abortion experience

The respondents were asked about the abortion experience. A majority, 64 students reported the
experience to have been traumatic (39.26%), followed by 52 students who reported slightly
traumatic (31.90%). 28 students (17.18%), reported not traumatic. (11.66%), which comprised of
19 students reported the abortion experience to have been very traumatic. The results are
elaborated in the table below.

Table 4.4 Abortion experience

Abortion experience frequency (f) percentage

Not traumatic 28 17.18

Slightly traumatic 52 31.90
Traumatic 64 39.26
Very traumatic 19 11.66

27
TOTAL 163 100

4.3.3 Abortion procedure

The respondents were asked about the procedures used for abortion. The majority, 72 students
(44.17%) reported to have used surgical vacuum. The second majority, which comprised of 54
students (33.13%) reported they did not know the procedure used during abortion. 18
respondents reported they had been medically induced (11.04%). 19 respondents reported to
have used other abortion methods (11.66%). The results are illustrated in the table below.

Table 4.5 Abortion Procedure

Abortion Procedure frequency (f) Percentage
Medically Induced 18 11.04
Surgical vacuum 72 44.17
Other 19 11.66
Do not know 54 33.13

TOTAL 163 100

4.3.4 Social Support

The respondents were asked if they received social support before, during and after abortion. 110
respondents (67.48%) responded they did not receive social support. 53 respondents (32.52%)
responded they received social support. The respondents were then asked if they agreed social
support was important during this period. 122 respondents (74.85%) responded YES, while 41
respondents (25.15%) responded NO. The results are illustrated in the table below.
Table 4.6 Social Support
Received social support No. of students Percentage
Yes 53 32.52

No 110 67.48
TOTAL 163 100

28
View on social support No. of students Percentage
Important 122 74.85

Not Important 41 25.15

TOTAL 163 100

4.3.5 Social Stigma

The respondents were asked if they experienced social stigma before, during and after abortion.
107 respondents (65.64%) reported to have experienced social stigma. 56 respondents (34.56%)
reported to not have experienced social stigma. The highest number of respondents who reported
to have experienced stigma were 69 female participants (76.67%) out of a total of 90 female
respondents. The results are indicated in the table below:

Table 4.7: Social Stigma

Social Stigma No. of students Percentage
Yes 107 65.64

No 56 34.56
TOTAL 163 100

4.3.6 Relationship Problems

The respondents were asked if they had experienced relationship problems before, during and
after abortion. The responses were as follows: 89 respondents (54.60%) responded yes, while 74
respondents (45.40%) responded no. The results are indicated in the table below:

Table 4.8: Relationship Problems

Relationship Problems No. of students Percentage
Yes 89 54.60

29
No 74 45.40
TOTAL 163 100

4.4 Psychological Well-being

This section contains findings of the study on anxiety, depression, guilt and anger experienced
before, during and after abortion. The research focused on the dependent variables of the study.
The section also contains gender differences on both study variables. Below is a summary of the
data collected, findings and conclusions.
4.4.1 Anxiety Experienced before, during and after Abortion
The study aimed to find out the levels of anxiety students experienced after procuring abortion. It
can be seen that students would experience higher levels of anxiety mostly before the procedure
was carried which gradually reduced after the procedure. For proper analysis, the sample results
were divided into two groups each for each gender. Group A comprised of female students.
Groups B comprised of male participants. In groups B, the mean HADS Anxiety levels was 7.2
denoting normal anxiety levels, while Group A mean HADS anxiety levels was 9.3 denoting
borderline abnormal anxiety levels.

Table 4.9 Abortion Anxiety levels

Gender Anxiety levels
Normal Borderline Abnormal

Female 34 20.9 % 49 30.1 % 7 4.3%

Male 59 36.2 % 11 6.7 % 3 1.8%

Total 93 57.1% 60 36.8% 10 6.1%

4.4.2 Depression

30
The study aimed to find out levels of depression experienced because of abortion among the
sample. The sample results were divided into two groups, Group A for female participants, while
Group B for male participants for data analysis. The findings are shown in the table below.

Table 4.10 Depression levels

Gender Depression levels
Mild Moderate Severe
Female 44 27% 34 20.8% 12 7.4%

Male 58 35.6% 15 9.2% 0 0%

Total 102 62.6% 49 30% 12 7.4%

4.4.3 Guilt and Anger

The study aimed to find out the levels of guilt and anger brought about by abortion as
experienced by the respondents. The levels varied between 1 to 5, with 5 being abnormal/intense
and 1 being the least. For easy result analysis, the researchers divided the results into two groups,
A and B to represent both genders. In group A which comprised of female participants, the
highest number 51 respondents (56.67%) reported to have borderline anger and guilt after
abortion, followed by 27 respondents (30%) who experienced intense anger and guilt levels. 12
respondents (12%) reported normal anger and guilt levels. In Group B, 9 respondents (12.33%)
experienced intense levels of anger and guilt, followed by 41 respondents (56.16%) who reported
borderline anger and guilt levels and 23 respondents (31.51%) experiencing normal guilt levels.

Table 4.11 Guilt and anger levels

Gender Anger and guilt levels
mild moderate severe
Female 27 16.6% 51 31.3% 12 7.4%

Male 9 5.5% 41 25.2% 23 14.0%

31
TOTAL 36 22.1% 92 56.5% 35 21.4%

4.5 Psychological Interventions

The study also sought to find out psychological interventions that could be used to address
influence of abortion on psychological well-being among students in Kenyatta university. The
responses are illustrated in the table below.

Table 4.12 Psychological Interventions

Statement Females Males
(N=163) Mean SD Mean SD
Social support services are 3.75 1.277 3.81 1.271
Somewhat relevant before,
During and after abortion.
Counseling helps with coping 4.02 1.055 4.06 0.961
Of a woman after abortion.
Lack of partner and parental 4.00 1.079 3.92 1.141
Support is detrimental to
recovery.
Addressing social stigma is 3.79 1.286 3.81 1.234
Important for coping after
Abortion.
Addressing abortion stigma is 4.03 1.134 4.14 1.072
Is relevant for post-abortal
Recovery.

4.6 Suggested Psychological Interventions likely to reduce Influence of Abortion on

Psychological Well-being of Students in Kenyatta University
The questionnaire had open-ended questions to find out some of the interventions from the
respondents that could be put in place to reduce abortion effects on the psychological well-being
of students. Following content analysis conducted on responses obtained from the sample, the

32
findings indicated suggestions of the following interventions: 69 respondents (42.33%) of the
total sample population suggested Sexual and Health Education as a psychological intervention.
23 respondents (14.11%) suggested Assertiveness Skills Training as one of the interventions. 21
respondents (12.88%) suggested Training on Self-awareness. 33 respondents (20.25%) suggested
Life- coaching while 27 respondents (16.56%) suggested Guidance and Counseling as one of the
psychological interventions to reduce influence of abortion on psychological well-being of
students in Kenyatta University.
The responses above are illustrated in the table below:
Table 4.13 Suggested Interventions
Intervention Females Males

Sexual and Reproductive Health Education 42 27

Assertiveness Skills Training 19 4
Training on Self-awareness 9 12
Life-coaching 12 11
Guidance and Counseling 8 19
TOTAL 90 73

4.7 Summary of Findings

The findings of the study have been summarized as follows:
From the responses, a majority of the respondents lived within the school premises. This
comprised of 62.8% of the total study sample.
A majority of the respondents, 64 students, indicated the abortion experience to have been
traumatic. The rest, the second majority which comprised of 52 respondents indicated the
abortion experience to have been slightly traumatic, followed by 28 students who reported the
incident to not having been traumatic. The last group that comprised of 19 respondents reported
the experience to have been very traumatic.
Respondents indicated anxiety levels ranging from normal, borderline to abnormal, with the
results indicating that most male respondents’ anxiety levels ranged from normal to borderline
with only a few respondents 1.8% of 73 male respondents reporting to have experienced

33
abnormal anxiety levels. On the other hand, most female respondents reported to have
experienced borderline anxiety levels which encompassed 30.1% of 90 female respondents.

Respondents indicated mild and moderate depression levels, with only a small percentage 7.4%
of 90 female respondents indicating to have experienced severe depression levels.

Respondents indicated high agreement levels with the five statements that measured
psychological interventions as shown by an average mean of 3.93. In scoring the five statements
that measured psychological interventions, male respondents indicated slightly higher agreement
levels of an average mean of 3.94 than female respondents who had an average mean of 3.92.

Respondents suggested various psychological interventions likely to reduce the influence of

abortion on psychological well-being among students in Kenyatta University. These included:
Sexual and Reproductive Health Education, Assertiveness skills training, Training on self-
awareness, Life-coaching and Guidance & Counseling.

34
 CHAPTER 5

DISCUSSIONS, CONCLUSIONS AND RECOMMENDATION

5.1 Introduction
This chapter entails discussions of the findings, conclusions and recommendations drawn from
the study on Influence of Abortion on Psychological Well-being of Students in Kenyatta
University. The chapter entails discussions of the findings as per the study objectives, followed
by conclusions drawn from the discussions, and finally the recommendations based on the study
findings.

5.2 Discussions of the Study Findings

in this section, the researchers discuss study findings along with their implications. The first sub-
section highlights the findings of the analysis of demographic information.

5.2.1 Demographic Information of the Study Sample

The following observations were made based on the demographic information of the
respondents. With regard to age, our sample population ranged between 19 to 28 years, with the
majority (34.97%) 22 years. Respondents aged 21 to 25 years made up 79.8& of the total sample.
This indicated that majority of students in the university lie in that age bracket. The mean age of
the female respondents (22.6 years) was established to be slightly lower than the mean age of
male respondents (23.1 years). The overall mean age of the respondents in the study was 22.81
years.

35
With regard to residential status of the sample population, most students were found to live
inside university premises (62.8%), while (37.2%) reside outside campus premises. This may be
because Kenyatta University provide cheaper accommodation services compared to outside
rental services. Although since the university does not have enough accommodation hostels for
all students, it’s inevitable that some choose to reside in outside premises.

With regard to the year of study of the respondents, the majority were 3rd year students that
comprised of 59 students (36.20%). This may be because 3rd year and 4th year students are more
familiarized with reproductive health services and may know more about abortion services or
connection links to abortion services. On the other hand, 1st and 2nd year students, most of which
are pretty determined to achieve well academically, are or may still be naïve and may not so
much be familiarized with such services.

With regard to reasons for abortion, a majority, 88 female respondents had procured. That sums
up to 53.99% of the total sample population had procured abortions. A majority cited personal
choices as their reason for abortion (44.2%), followed by lack of social support which comprised
of (18.5&). The other reasons like economic reasons, social stigma, inconveniences with life
plans and relationship problems were 19.02%, 17.18%, 1.84% and 4.29% respectively.

This could be because many organizations have been advocating for abortion services as a
human right and because of these students have learnt that they have a choice when it comes to
their reproductive health. Most may opt to abort because they know they know they can get away
with it. Also, social support plays an important part when it comes to whether or not one may
keep or terminate a pregnancy. In situations where a school girl gets pregnant, they are not
economically stable and they do not have anyone to support them, they may see abortion as the
best way out of a nearly impossible situation.

5.3 Prevalence of Abortion

In this section, we are going to discuss number of abortion cases, reasons for abortion, abortion
experience, abortion procedure, social support, social stigma and relationship problems.

5.3.1 Reasons for Abortion

Analysis of data indicated that a majority of the sample population (44.17%) cited personal
choices to have been their reason for abortion. The second most popular reason was lack of

36
social support which constituted 18.50%. The third reason, which constituted 19.02% cited
economic reasons followed by social stigma which constituted 17.18% of the total population.
The last reason to be cited was relationship problems which constituted 6.13% of the total
population. From the above observations, we can deduce, based on personal choices as a reason
for abortion, that students have now embraced that they have a choice to either keep or terminate
a pregnancy based on whatever situation they are in. with regard to lack of social support, most
students may not be in a position to carry a pregnancy to term and take care of the baby
afterwards in situations where they have no or very little support from family members. With
regard to economic reasons, carrying a pregnancy to term can be very expensive in terms of
accessing quality medical support and other resources leasing to the decision to terminate a
pregnancy. With regard to social stigma, a student may find it difficult to carry a pregnancy
because of outside forces like stigma where they are alienated and treated differently just because
they got pregnant while in school. This can lead to abortion. Relationship problems also lead to
abortion. This is so because students who are in more stable relationships with supportive
partners are most likely to decide and keep the baby unlike those with problems in their
relationship. Relationships where the male partner is not accepting of the situation is most likely
to bring about the idea and procuring of abortion.

5.3.2 Abortion Experience

Analysis of data indicated that a majority, 64 students (39.26%), reported the experience to have
been traumatic. This may be because of the psychological effects, such as guilt, that are brought
up by undergoing the procedure. 52 students (31.90%) reported the experience to be slightly
traumatic, followed by 28 students (17.18%) who reported the abortion experience to be not
traumatic. The last group, which comprised of 19 students (11.66%), reported the abortion
experience to have been very traumatic. There was a difference noted in abortion experience
between the two genders. Most respondents who reported having had very traumatic and
traumatic abortion experiences were female students while most male respondents reported the
experience to have been slightly and not traumatic. This may be because it is usually the females
who have to go through the process, the stigma they may go through, sadness, shame emptiness,
anger, both from the self and others, the guilt, the anger and self-blame. While the males may
sometimes offer little or no support, do not go through physical processes involved in abortion
procurement therefore are not as much affected by the experience. These experiences agreed

37
with the studies on Abortion as a Traumatic Experience (Coleman, Reardon, Strahan & Cougle,
2005) a perspective that argues that abortion is a uniquely traumatic experience because it
involves a human death experience, specifically, the intentional destruction of one’s unborn
child, and unacknowledged grief. The view of abortion as inherently traumatic is illustrated by
the statement that “once a young woman is pregnant, it is a choice between having a baby or
having a traumatic experience (Reardon, 2007).

5.3.3 Abortion Procedure

Data analysis showed that 44.17% of the respondents reported to have used surgical vacuum
abortion procedure. This could be because when used correctly it can remove all contents in the
uterus. The second majority, which comprised of 33.13% of the total sample population
indicated to not knowing the procedure that had used. This could be because of lack of
knowledge of safer abortion procedures or being ignorant of the safest procedure they could have
chosen. 11.04% of the sample population reported to have been medically induced, while the
rest, 11.66% reported they had used other abortion methods. These findings revealed that suction
abortion, also known as surgical vacuum abortion, is the most common abortion method and is
safer compared to the other abortion methods. It is also the most preferred abortion method. It is
also safer because it is done in a hospital setting and the individual receives medical care. The
study also indicates that most of the students are not keen of their reproductive health as they did
not know the methods used on them during abortion. Others who used other methods could also
have used methods that were not safe. In cases where the abortion was medically induced, this
could have been because the fetus posed danger to the life of the mother and thus necessary for
its removal.

5.3.4 Social Support

The data collected during analysis indicated that the majority, 67.48% of the sample population
did not receive social support. This could be because of the stigma associated with early
pregnancy especially among students. 32.52% of the total population responded to have received
social support before, during and after abortion. 74.85% of the total population agreed that social
support is important. This could be because when an individual is undergoing a complex
procedure which involve both their physical and psychological well-being, in this case abortion,

38
when they are supported they know they are not alone and this lessens the burden of their
adversity, unlike when they have to face it on their own. On the other hand, 25.15% of the total
study population responded that social support was not important. This could be because other
people are good at handling difficult situations on their own, or maybe because they do not have
people they think could help them in such situations. 5.3.5 Social Stigma

The findings of the study indicated 107 respondents (65.64%) of the total sample population
experienced social stigma. On the other hand, 56 respondents (34.56%) indicated to have not
gone through social stigma. Based on these findings, it is imperative to understand just how
much social stigma can affect an individual before, during and after an abortion procedure.
Women who face stigma during a pregnancy are more likely to develop self-defeating thought
and a negative view of self. This can greatly lead to abortion procurement.

5.3.6 Relationship Problems

Analysis of the data indicated that 89 respondents (54.60%) were in problematic relationships.
Also, 74 respondents (45.40%) of the total sample population were in stable relationships. Based
on the analyzed data, we can see a small difference between those in problematic relationships
and those in stable relationships. This can serve as an indication that partner support is essential
especially when one gets unintended pregnancy. Also, it can be an indication that an individual
can decide to carry out an abortion, whether or not their relationship has no problem.

5.4 Psychological Well-being

This section will discuss findings and conclusions of the various psychological issues affecting
students in Kenyatta University with regard to abortion.

5.4.1 Anxiety experienced Before, During and After Abortion

The findings of the study indicated that students would experience higher levels of anxiety
before abortion procedure which gradually reduced after the procedure. In Group A which
comprised of female students, anxiety levels were 9.3 which denoted borderline abnormal
anxiety levels. This could be because they are the ones to carrying the fetus, who are to go
through the physical procedure. This causes anxiety, fear, panic thinking about whether or not
one is doing the right thing and how it may affect one in future. In Group B which comprised of
male participants, the mean HADS anxiety levels were 7.2 denoting normal anxiety levels. This

39
could be because men, whether or not they are offering moral and social support are not going
the physical procedure. They may not be so anxious about what abortion could cause in the
future unlike women, they may not feel heavily the emotional and psychological impact of
abortion.

5.4.2 Depression
Data analysis indicated that Group A (female participants), experienced both mild, moderate and
severe levels of depression. The results were as follows: severe 12 participants (7.4%), moderate
34 students (20.8%) while mild 44 participants (27%). On the other hand, Group B participants
(males) mild and moderate depression levels. The results for the two were as follows: mild
36.5% which included 58 participants and moderate 9.2% which comprised of 15 students. This
results indicated that female participants experienced severe levels of depression probably
because of the emotional disturbances brought about by abortion. These may include self-blame,
guilt, lack of social support, relationship problems and social stigma. On the other hand, men
also experienced some levels of depression. This could especially comprise of men who were
greatly concerned of the well-being of their women who were about to procure abortion. The
results, therefore, are a great indication that not only women experience the emotional effects of
abortion but also men do.

5.4.3 Guilt and Anger

Data analysis indicated the various guilt and anger levels experienced by the respondents. For
proper data analysis, the responses were divided into two groups; Group A (Females) and Group
B (Males). In the 1st group, 51 respondents (56.67%) reported borderline anger and guilt after
abortion. 27 respondents (30%) experienced intense anger and guilt levels while 12 respondents
(12%) reported to have experienced normal guilt and anger levels.

In the 2nd group, 9 respondents (12.33%), experienced intense levels of anger and guilt, 41
respondents (56.16%) experienced borderline anger and guilt levels while 23 respondents
(31.51%) experienced normal guilt levels. This indicates that both male and female participants
experienced guilt and anger due to abortion. Comparing the results of both groups, female
participants 30% experienced intense guilt and anger levels while male participants who
experienced intense guilt and anger levels were 12.33%. There is a notable difference and this
may be based on the fact that women may indulge more in self-blame compared to men.

40
5.5 Psychological Interventions
The following statements were used to collect data on the various psychological interventions
and the results indicated the following:

122 participants (74.85%) of the total population were in agreement with the statement Social
Support Services are somewhat relevant before, during and after abortion. On the other hand, 41
respondents (25.15%) were against the statement. This is an indication that either they do not
have appropriate social support, or they have been left to deal with the experience alone therefore
they do not see the importance of it.

With regard to the 2nd statement: Counseling helps with the coping of a woman after abortion,
131 participants (80.37%) were in agreement. On the other hand, 32 participants (19.63%) most
of which were male participants, disagreed with the statements. This could be because most male
are not comfortable sharing information, especially one to do with abortion, and its effects to
others. On the other hand, females do better talking about their problems and seeking counseling
is one way that helps them cope better.

With regard to the statement: Lack of Partner and Parental support is detrimental to recovery,
121 participants (74.23%) agreed to it. On the other hand, 42 participants (25.77%) of the study
population disagreed to the statement.

With regard to the statement: Addressing Social Stigma Is important for coping after abortion,
103 participants (63.19%) responded yes, while 60 participants (36.81%) responded no.

With regard to the statement: Addressing abortion stigma is relevant for post-abortion recovery,
97 participants (59.51%) responded yes while 66 (40.49%) participants responded no.

From the above observations, we can conclude that both social support services, counseling,
addressing stigma, both from internal and external factors and post-abortion care is important for
recovery after abortion.

5.5.1 Suggested Psychological Interventions

Data analysis from the study indicated that respondents suggested ways that may promote
psychological well-being among students in the University. Among the psychological

41
interventions identified were sexual and reproductive health education, assertiveness skills
training, training on self-awareness, life-coaching, guidance and counseling.

5.6 Conclusions of the Study

The following conclusions were drawn from this study

The study found out that majority of the students, both male and female are affected
psychologically by abortion, although female respondents were mostly affected.

Psychological interventions such as social support, counseling, post-abortion care and addressing
stigma are important for coping after abortion, and they lessen the psychological impact of an
abortion experience.

Some students who end up procuring abortions tend to neglect knowledge of the various abortion
procedures and this could be detrimental.

The students suggested various psychological interventions that can be put in place to reduce the
psychological effects of abortion. These included: sexual and reproductive health education,
assertiveness skills training, training on self-awareness, life coaching, guidance and counseling.

5.7 Recommendations
Based on the views of the study findings, the following major recommendations are made:

1. There is need for Sexual and Reproductive Health Training, both in organized students’
workshops and in classrooms. This will help disseminate proper information with regard
to reproductive health, services being offered by the school such as matters of family
planning to avoid incidences where students get unintended pregnancies forcing them to
abort.
2. There is need for sensitization about counseling services, especially those offered in the
University such as Peer Counseling and Wellness Centre. This will help students be able
to access those services and get to talk about some of the challenges they may be facing
in cases where they are pregnant and do not know how to go about it.
3. The school’s Wellness Centre in Conjunction with the Centre for Gender Equity and
Equality (CGEE) & Kenyatta University Students Association (KUSA), should work
together in increasing distribution of Condoms in students’ washrooms and hostels, since

42
 many students from the sample population indicated to be residing inside school
premises. This may limit incidences of early pregnancies.

5.8 Suggestions for Future Research

Based on the study, the following suggestions have been made for farther studies and research:

1. The study should be carried out in other local universities to determine if similar findings
will be obtained.
2. That similar studies be conducted in universities in different countries to establish more
on psychological impacts brought about by abortion.
3. That more studies be carried out on abortion and mental health.
4. That similar studies be conducted using different methodology to find out similarity of
results.

43
 REFERENCES

Adler, N.E., David., H.P, Major BN., Roth, S.H., Russo., N.F, Wyatt., G.E. Psychological
responses after abortion. Science. 1990; 248:41–44.
Adams, J., & Bonevski, B. (2001). Psychological Effects of Termination of Pregnancy: A
Summary of the Literature Review, 1970-2000. Psychological Consequences Review (Newcastle
Institute of Public Health). Pp 1-40.
African Population Health and Research Center (APHRC), Ministry of Health (MoH), Ipas,
Guttmacher Institute (2013). Incidence and Complications of Unsafe Abortions in Kenya: Key
Findings of a National Study. Nairobi, Kenya.

American Psychological Association Task Force on Mental Health and Abortion (2008). Report of

the APA Task Force on Mental Health and Abortion. Washington, DC: The American

Psychological Association.

APA Task Force on Mental Health and Abortion. (2008). Report of the APA Task Force on
Mental Health and Abortion. Washington, DC: Author.
Beck, C. T. (1995). Predictors of postpartum depression: An update. Nursing Research, 50(5),
275-285.
Blackmun, H.A. & Supreme Court of the United States. (1972). U.S. Reports: Roe V. Wade, 410
U.S. 113.
Berer, M. (2016). Abortion Law and Policy Around the World: In Search of Decriminalization.
Bonevski. B., & Adams. J. (2001). The Psychological Effects of Termination of pregnancy: A
Summary of Literature 1970-2000. Newcastle, Australia: Newcastle Institute of Public Health
2001.
Bracken, M.B., Hachamovitch, M., & Grossman, G. (1974). The decision to abort and
psychological sequelae. Journal of Nervous and Mental Disease.

44
Brady, G., Brown, G., Letherby, G., Bailey, J., & Wallace. L.M. (2008). Young women’s
experience of termination and miscarriage: a qualitative study. Human Fertility, 11(3), 186-190.
Brown, H. C., Jewkes, R., Levin, J., & Rees, H. (2003). Management of incomplete abortion in
South African public hospitals. BJOG: An International Journal of Obstetrics and Gynecology,
110(4), 371-377.
Cherry, K., Gans, S., (2019): How does the Cross-sectional Research Work?
Clare, A.W. and Tyrrell, J. (1994) Psychiatric aspects of abortion. Irish Journal of Psychological
Medicine, 11 (2), 92-98.
Cohen, S. (1992). Stress, Social Support and Disorder. In H.O.F, Veille & U. Baumann (Eds.).
The Meaning and Measurement of Social Support (pp. 109-124). Washington, DC: Hemisphere
Press.

Cohen, S. A. (2006). Abortion and mental health: Myths and reality. Guttmacher Policy Review,
9(3), 8-11, 16.

Coleman, P. K., Reardon, D. C., Strahan, T., & Cougle, J. R. (2005). The psychology of
abortion: A review and suggestions for future research. Psychology and Health, 20, 237-271.

Coleman, P.K. and Nelson, E.S. (1998) The quality of abortion decisions and college students’
reports of post-abortion emotional sequelae and abortion attitudes. Journal of Social and Clinical
Psychology, 17 (4), 425, 442.

Cotter, S.Y., Sudhinaraset, M., Phillips, B., Seefeld, C.A., Mugwangwa, Z., Golub, G., & Ikiugu,
E. (2021). Person-centered care for abortion services in private facilities to improve women’s
experiences in Kenya.” Culture, health & sexuality, 23, no. 2 (2021): 224-239.

Cougle JR, Reardon DC, Coleman P.K, (2005). Generalized anxiety following unintended
pregnancies resolved through childbirth and abortion: a cohort study of the 1995 National Survey
of Family Growth & Anxiety Disorder.
Cougle, J. R., Reardon, D. C., & Coleman, P. K. (2005). Generalized anxiety following
unintended pregnancies resolved through childbirth and abortion: A cohort study of the 1995
National Survey of Family Growth. Journal of Anxiety Disorders, 19, 137-142.
Cozzarrelli C, Major B, Karrasch A (2005). Women’s experiences of and reactions to
antiabortion picketing. Basic Appl Soc 22: 265–275.
Cunningham S, et al. (2010). Chapter 7: The morphological and functional development of the
fetus.

45
Curly, M., & Johnston, C. (2014). The Characteristics and Severity of Psychological Distress
After Abortion Among University Students: The Journal of Behavioral Health Services and
Research. 40(3).
Curly, M., & Johnston, C. (2014). Exploring treatment preferences for psychological services
after abortion among college students. Journal of reproductive and infant psychology, 32(3),
304-320.
De Roubaix, M. (2007). Ten years hence- has the South African choice on Termination of
Pregnancy Act, Act 92 0f 1996, realized its aims? A moral-critical evaluation. Medicine and law,
26(1), 145-177.
Dytrych, Z., David, P., & Matejeck, Z. (2003) Born Unwanted: Observations from the Prague
study. American Psychologist, 58(3), 224-229.
Edwards, M., Medina, M., Gelaye, B., & Zheng, Y. Validity of the Post-Traumatic Stress
Disorders (PTSD) Checklist in Pregnant Women. BMC Psychiatry 17, 179 (2017).
Eklund, L. and N. Purewal (2017). The Bio-Politics of Population Control and Sex Selective
Abortion in China and India. Feminism and Psychology. Volume 1, Issue 27. Accessed via
http://eprints.soas.ac.uk/23079/
Festinger, L. (1957). A Theory of cognitive dissonance. Stanford, CA: Stanford University Press.
Festinger, L. (1959). Some attitudinal consequences of forced decisions. Acta Psychologica, 15,
389-390.
FIGO. (2019): Safe Abortion is Healthcare.
Finer, L.B. and S.K. Henshaw, Disparities in rates of unintended pregnancy in the United States,
1994 and 2001. Perspectives on Sexual and Reproductive Health, 2006. 38(2): p. 90-96.
Finer, L.B., & Zoina, M.R. (2016). Declines in Unintended Pregnancy in the United States,
2008-2011.
Ganatra B, Tuncalp O, Johnston HB, Johnson Jr BR, Gulmezoglu AM, Temmerman M, (2012).
Concept to measurement: operationalizing WHO’s definition of unsafe abortion. Bull World
Health Organ. 2014;92(3):155.
Ganatra, B., and S. Hirve. (2002). Induced abortions among adolescent women in rural
Maharashtra, India. Reproductive Health Matters 101, no. 9: 76– 8
Gebreselassie H, et al., (2005): Caring for women with abortion complications in Ethiopia:
national estimates and future implications. Int Perspective Sex Reprod Health, 2010. 36(1): p. 6-
15.
Gleeson, R., Forde, E., Bates, E., Powell, S., Eadon-Jones, E., & Draper, H. (2008). Medical
students’ attitudes towards abortion: a UK study. Journal of Medical Ethics, 34(11), 783–787.
doi:10.1136/jme.2007.023416.

46
Global Impact Report 2018, London.: Marie Stopes International, 2019.
Gold, R.B., (2003). Abortion and Women’s Health: A Turning Point for America? The Allan
Guttmacher Institute, New York, 1990.
Greene, R.A., (4 August 2010). "Kenya's churches unite against draft constitution". CNN.
Retrieved 9 March 2019.
Grossman, G., Bracken. M.B., & Hachamovitch, M. (1974). The decision to abort and
psychological sequelae. Journal of Nervous and Mental Disease, 158(2), 154-162.
Guttmacher (2012). Abortion in Kenya. Retrieved 1 August 2012 from
http://www.guttmacher.org/pubs/FB_Abortion-in-Kenya.pdf
Guttmacher, S., Kapadia, F., Naude, J., & de Pinho, H. (1998). Abortion Reform in South Africa:
A Case Study of the 1996 Choice on Termination of Pregnancy Act. Special Report, 24 (4).

Hansard. (1973). House of Assembly Debates.

Henshaw, S., Sing, S., and Haas, T. (1999) The incidence of abortion worldwide. International
Family Planning Perspectives. 25 (Supplement). S30-S38

Henshaw, S.K. (1994). Recent Trends in the legal status of induced abortion. “ Journal of public
health policy, 15(2) 165-172.

Herrera, A.A., & Zivy, M. R, (2002): “Clandestine Abortion in Mexico: A Question of Mental as
well as Physical Health.” Reproductive Health Matters. 10(19): 95-102.

Huntington., S. (1996): Studies in Family Planning Vol 27, No.3 (May-June., 1996), pp. 155-
161.

1BM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0 Armonk, NY: IBM
Corp.

INED, (2002): Statistiques de l’aavortement en France. INED; INED/Annuaire 1987. Paris

Cedex 14, France.: Ed. INED Juin 1992

International Federation of Gynecology and Obstetrics (FIGO) 2019: The Global Voice for
Women’s health.

Jones RK and Jerman J, (2014). Abortion incidence and service availability in the United
States: Perspectives on Sexual and Reproductive Health, 2014, 46(1):3–14, doi:10.1363/46e0414

47
Jewkes, R & Rees, H., (2005): The Impact of Age on the Epidemiology of Incomplete Abortions
in South Africa after Legislative Change.

Klausen, S.M: Abortion Under Apartheid (2010); Oberman., M; Her body, Our laws (2018).

Klausen, S.M. “Reclaiming the White Daughters’ Purity’. Afrikaner Nationalism, Racialized
Sexuality and the 1975 Abortion and Sterilization Act in Apartheid South Africa”. Journal of
Women’s History. Vol.22, 2010, p.39-63.

Koumantakis. E., & Mavroforou. A. (2004). Adolescence and Abortion in Greece: women’s
profile and perceptions.

Kumar, A., Hessini, L., & Mitchell, E. M. (2009). Conceptualizing abortion stigma. Culture,
Health & Sexuality, 11, 625–639.

Lambert. W.E., Micks. E.A., & Edelman. A.B. Hydrocodone-acetaminophen for pain control in
first-trimester surgical abortion: a randomized control trial.

Larsen, L. “Induced Abortion”. South African Medical Journal. Vol. 53, 1978, p. 853-854.

Major, B. (2003) Psychological Implications of abortion – highly charged and rife with
misleading research (comment). Canadian Medical Association Journal, 168, 1257-1258.

Major, B., & Cozzarrelli, C. (1992). Psychosocial Predictors of adjustment to abortion. Journal
of Social Issues, 48(3), 121-142.

Major, B., & O’Brien, L. T. (2008): The Social Psychology of Stigma. Annual Review of
Psychology.

Mavrofou, A., Koumantakis, E., & Michalodimitrakis, E. (2004). Adolescence and abortion in
Greece: women’s profiles and perceptions. Journal of pediatric and adolescent gynecology, 17,
no 5 (2004): 321-326

McGill, M. Beidas, R.S., Stewart, R.E., Walsh, L., Lucas, S., Downey, M.M., & Mandell, D.S.
(2018). Free, brief and validated; Standardized instruments for low resource mental health
settings. Cognitive and Behavioral Practice, 22(1), 5-19.

McLeod, S. (2008). Social Identity Theory.

http://www.simplypsychology.org/social-identity-theory.html#sthash.UsNnjwtA.dpbs
48
McLeod, S. A. (2018, May 21). Attitudes and behavior. Simply Psychology.
https://www.simplypsychology.org/attitudes.html

Miller, S., L. R. Wherry, and D. G. Foster (2014). What Happens After an Abortion Denial? A
Review of Results from the Turnaway Study. American Economic Association Papers &
Proceedings.

Maiyaka, A.A., & Mohd Mokhtar, S.S. (2011). Determinants of customer behavioral responses:
A Pilot Study. International business research, 4(1). Pp. 193-197.

Mohammed, S. F Izugbara, C., Moore, A.M, Mutua., M., Kimani, M., Ziraba, A.K., Bankole, A,
Singh, S.D., Egesa, C. The estimated incidence of induced abortion in Kenya: a cross-sectional
study. BMC Pregnancy Childbirth. 2015; 15(1):185

Mohammed, D., Diamond-Smith, N., & Njunguru, J. (2018) Stigma and Agency: exploring
young Kenyan Women’s experiences with abortion stigma and individual agency. Reproductive
Health Matters, 26(52), 128-137

Mutua M, Kimani-Murage EW, Bankole A, Egesa, C., Singh, S.D., Ziraba AK, (2015). The
estimated incidence of induced abortion in Kenya: a cross-sectional study. BMC Pregnancy
Childbirth; 15:185–95. pmid:26294220.

Mutua, M.M., & Manderson, L. (2019). Policy, Law and Post-abortion care services in Kenya.

Njonjo, (2010). Kenya Youth Fact Book. Retrieved 1 August 2012 from
http://www.ieakenya.or.ke/publications/doc_download/16-kenya-youth-fact-book Pope Paul IV
(1968). Evangelium Vitae. Retrieved 1 August 2012 from
http://www.papalencyclicals.net/Paul06/p6humana.htm

Njunguru. J., Smith. N.D., & Mohammed. D. (2018). Stigma and Agency: Exploring young
Kenyan women’s experiences with abortion stigma and individual agency.

Nthangi, A. (2005). Attitudes Towards Abortion among university undergraduate students in two
selected public universities in Kenya: Implications for Counseling.

49
Pappas, I. O., Kourouthanassis, P. E., Giannakos, M. N., & Chrissikopoulos, V. (2016).
Explaining online shopping behavior with fsQCA: The role of cognitive and affective
perceptions. Journal of Business Research, 69, 794–803

Reardon, D.C. (2018). The Abortion and Mental Health Controversy: a comprehensive literature
review of common ground agreements, disagreements, actionable recommendations, and
research opportunities. SAGE Open Med. 6:2050312118807624. Doi:
10.1177/2050312118807624

Reardon, D.C. and Cougle, J.R. (2002) Depression and unintended pregnancy in the National
Longitudinal Survey of Youth: A cohort study. BMJ, 324, 151-152.

Reardon DC, Cougle JR, Rue VM, et al. Psychiatric admissions of low-income women following
abortion and childbirth. CMAJ 2003; 168(10): 1253–1256.
Saunders, M., Lewis, P., Thornhill, A., (2009): Research Methods for Business Studies.
Sedgh, G., Singh, S., & Hussain, R. (2012). Unintended Pregnancy: worldwide levels, trends and
outcomes. Stud Fam Plann 2010; 41: 241-50.
Sekaran, M., & Suseela, Y. (2011). Pregnancy-Induced Hypertension and Preeclampsia: Levels
of Angiogenic Factors in Malaysian Women.
Singh, S., et al., (2013). Adding it up: the costs and benefits of investing in family planning and
maternal and newborn health. Guttmacher Institute

Speckhard, AC., & Rue, V.M., (1992). Post-abortion Syndrome: An Emerging Public Health
Concern. Journal of Social Issues, 48(3), 95-119.

Steele, S.J. & Sutton, N. (1973). Social problems and unwanted pregnancy. In; Morris, N., ed.
Proceedings of the Third International Congress of Psychosomatic Medicine in Obstetrics and
Gynecology, London, 1971. Basle, Karger, 1972.

Sudhinaraset, M., Golub, G., Smith, N.D., Afulani, P.A., (2017): Development of a tool to
measure person-centered maternity care in developing settings: validation in a rural and urban
Kenyan population

Trueman. K., Mitchell. E.M., & Gabriel. M. (2005) Building alliances from ambivalence:
Evaluation of abortion values clarification workshops with stakeholders in South Africa. African
Journal of Reproductive Health. 9(3): 89-99.

50
Tajfel, H., & Turner, J.C. (1979). An Integrative Theory of Intergroup Conflict: The Social
Psychology of Intergroup Relations (pp. 33-47). Monterey, CA.

Thomas, K.R. (1992). Casey V. Planned Parenthood of Southeastern Pennsylvania: Pennsylvania

abortion law to be reviewed by the Supreme Court, (Washington, D.C.): Congressional Research
Service, Library of Congress, 1992.

Turner, J. C. (1999). H, Tajfel (ed.). "Social categorization and social discrimination in the
minimal group paradigm". Differentiation Between Social Groups: Studies in the Social
Psychology of Intergroup Relations. London: Academic Press: 235–250.

Vinney, C., Dill-Shackleford, K. E., Plante, C. N., & Bartsch, A. (2019). Development and
validation of a measure of popular media fan identity and its relationship to well-
being. Psychology of Popular Media Culture, 8(3), 296–
307. https://doi.org/10.1037/ppm0000188

World Health Organization, Unsafe Abortion: Global and Regional Estimates of the Incidence of
Unsafe Abortion and Associated Mortality in 2008, 2011: Geneva.

World Health Organization. 2007. Unsafe abortion: Global and regional estimates of the
incidence of unsafe abortion and associated mortality in 2003. 5th ed. Geneva, Switzerland:
World Health Organization.

World Health Organization. 2003. Safe abortion: Technical and policy guidance for health
systems. Geneva, Switzerland: World Health Organization.

Yamane, T (1973). Statistics: An Introductory Analysis. New York: Harper & Row

Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta
Psychiatrica Scandinavica, 67(6), 361–370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x

Ziraba A et al., (2009). Maternal mortality in the informal settlements of Nairobi city: What do
we know? Reproductive Health, Vol. 6, No. 6.

Ziraba AK, Madise NJ, Mills S, Kyobutungi C, Ezeh A. Maternal mortality in the informal
settlements of Nairobi city: what do we know? Reprod Health. 2009; 6:6.

51
Ziraba, Abdhalah Kasiira; Izugbara, Chimaraoke; Levandowski, Brooke A; Gebreselassie,
Hailemichael; Mutua, Michael; Mohamed, Shukri F; Egesa, Caroline; Kimani-Murage, Elizabeth
W (2015-02-15). "Unsafe abortion in Kenya: a cross-sectional study of abortion complication
severity and associated factors". BMC Pregnancy and Childbirth. 15. doi:10.1186/s12884-015-
0459-6. ISSN 1471-2393. PMC 4338617. PMID 25884662.

APPENDICES

APPENDIX 1: STATEMENT OF INTRODUCTION:

We are a group consisting of four Counseling Psychology students from Kenyatta University,
School of Humanities and Social Sciences, Psychology Department. Our research project topic is
about the Influence of abortion on psychological well-being of students in Kenyatta University.
Our research aims to find out more about some of the psychological impacts brought about by
abortion and the psychological interventions and measures that can be put in place to positively
impact the individuals. The responses from our respondents will be of great help toward coming
up with recommendations that can be put in place by the university’s Wellness Centre. The
researchers will uphold anonymity and confidentiality and the responses will only be used for
research purposes. The questionnaire consists of two sections, A and B and will take between 10-
20 minutes to complete the questionnaire.

APPENDIX 11: CONSENT FORM

PROJECT TITLE: INFLUENCE OF ABORTION ON PSYCHOLOGICAL WELL-BEING
OF STUDENTS IN KENYATTA UNIVERSITY

Dear participants,

Your names or personal information will not be presented with the information collected with the
research findings of this project. The information gathered in this study will only be used for
academic research purposes.

Consent to Take Part in Research

 I voluntarily agree to participate in this research study.

 I understand that even if I agree to participate now, I can withdraw at any time or refuse
to answer any questions without any consequences of any kind.
52
  I understand that I can withdraw permission to use data from my interview within two
weeks after the interview, in which case the material will be deleted.
 I have had the purpose and nature of the study explained to me in writing and I have had
the opportunity to ask questions about the study.

Signature of research participant……………………. Date…………………………….

APPENDIX 111: QUESTIONNAIRE

Section 1: BIO DATA

In this section, the questions are designed to gather data on participants’ gender, level of
education, their residential place and marital status.

Please TICK the most appropriate answer.

Age…………………………Department…………………………………………………

Year of Study: Year 1 Year 3

Year 2 Year 4

Gender: Female Other

Male Prefer not to say

Residential Area: In-Campus

Outside Campus
Marital Status: Married
Single
Cohabiting
Other

Section 2:
This section consists of FOUR parts. The first part is for gathering data on reasons and effects of
procuring abortion, the second and third part will gather data on some of the psychological
effects brought about by abortion, while the fourth part constitutes psychological interventions
that can be put in place.

53
Kindly note that some questions allow the selection of more than one option, please TICK
where applicable
PART A: REASONS FOR ABORTION
This section will gather data on reasons for procuring abortion.
1. Have you ever procured an abortion? YES…………………...NO………………….

If yes, kindly proceed with the questions below. If no, do you know of a student who has
procured an abortion?

YES

NO
2. What was/ were the reasons for procuring abortion(s)?

Economic Relationship Problems

Lack of social support Social Stigma Inconvenience with life plans

personal choice
3. How was the abortion experience?
Not traumatic Slightly traumatic
Traumatic Very traumatic
4. What type of abortion procedure was it?
Medically induced Surgical Vacuum
Other Do not know
5.

Did you/the person who procured an abortion receive social support? Yes No
6. If YES, would you agree with the statement that social support is important before,
during and after abortion?
Yes No
7.

If NO, would you say it would have been better to have received the social support? Yes
No

54
 8. Do you consider abortion morally right in a situation where the woman or girl is
pregnant as the result of sexual assault?
Yes No

9. If you agree with abortion in any circumstance, explain why

10. Should the father have a say in the choice of abortion?

Yes No Depends
If you said depends, explain why

PART B: ANXIETY AND DEPRESSION

In this section, the questions are for measuring anxiety and depression levels experienced
after having an abortion.
Kindly TICK the option that is closest to how you felt before, during and after abortion.
HADS ANXIETY
Strongly Disagree Agree Strongly
disagree agree

1. I feel tense or wound up

2. I get a sort of frightened

feelings like butterflies
in the stomach.

3. I get a sort of frightened

feeling as if something
awful is about to
happen.

4. I feel restless as I have

to be on the move.

5. Worrying thoughts go
through my mind.

6. I get sudden feelings of

panic.

7. I can sit at ease and feel

relaxed.

55
HADS DEPRESSION
Strongly Disagree Agree Strongly
disagree Agree
1. I feel as if I’m slowed
down.

2. I still enjoy the things I

used to enjoy.

3. I have lost interest in my

appearance.

4. I can laugh and see the

funny side of things.

5. I look forward with

enjoyment to things.

6. I feel cheerful.

7. I can enjoy a good book

or audio or TV program.

PART C: GUILT AND ANGER:

In this questionnaire, you will read about situations that people may go through on a daily
basis, followed by common reactions to those situations. Try to imagine your reaction in
such a situation, then indicate the likelihood of how you’ll react or have reacted in any of
the described ways.

Strongly Disagree Neutral Agree Strongly

disagree agree
1. Whenever I think about
the abortion experience I
feel angry and frustrated.

2. I feel overwhelmed with

sadness whenever I hear
somebody’s abortion

56
 experience.

3. I feel frustrated about

experiencing stigma from
people if they know I
procured an abortion.

4. I am a christian and my
religion does not permit
abortion therefore I have
experienced feelings of
sadness, shame,
frustration and guilt.

5. I feel not understood.

6. I still get angry when I

think of the past
experience.

7. I feel relief for having

procured an abortion.

PART D: PSYCHOLOGICAL INTERVENTIONS

The section below represents some of the psychological interventions that can be used to
address influence of abortion on psychological well-being among students in Kenyatta
University. Kindly TICK the option you feel most appropriate.

Strongly Disagree Agree Strongly

disagree agree

1. Social support services are somewhat

relevant before, during and after
abortion.

2. Counseling helps with coping of a

woman after abortion.

57
 3. Lack of partner and parental support is
detrimental to recovery.

4. Addressing social stigma is important

for coping with sensitive and silenced
health experiences after abortion
5. Addressing abortion stigma is relevant
for post-abortal recovery.

The section below contains open-ended questions for the participants on psychological
interventions. Kindly feel free to share your thoughts by answering the questions below.

1. In your own opinion, what do you think are some of the measures that can be put in place
to mitigate psychological effects of abortion?
2. Based on your personal experiences after abortion, what things would you want
addressed by the University’s Wellness Centre in regard to enhancing psychological
well- being during post-abortal period?

Dear Esteemed Participant,

We have greatly valued your participation in this study. If you have any concerns, kindly feel
free to contact us. Again, thank you so much for your effort and time.

With warm regards,

Research Participants.

APPENDIX 1V: THE STUDY WORK PLAN

Activity 2018/2019 2019/2020 2021

March Septem Decembe July Aug. Dec Jan-Feb-Mar July
ber r
To June

58
Proposal …………
Writing …………
Proposal ………
Presenta ….
tion ………
….
Proposal ……… …… …….
Correcti …. … …….
on ……… ……
…. …
Data ……
Collectio …
n ……
…
Data ……..
Analysis ……..
Data ……..
Presenta ……..
tion
Submissi ……..
on ……..
Graduati ………
on ………

APPENDIX V: THE STUDY BUDGET

No. Item Unit Quantity Rate Amount
(KES)
1. Printing and Binding Services Piece 2 1500 3000
2. Notebooks Piece 4 150 600
3. Pens Piece 10 20 200

59
4. Internet Bundles Person 4 1000 4000

5 Pilot Study Block 10 35 350

Fare cost 4 300 1200
TOTAL 9,350

60