Nigeria still records one of the highest rates of abortions globally, with an average of 25 per 1000 women of reproductive age ( Omo-Aghoja, 2010), and an estimated 1.25 million abortions annually ( Bankole et al., 2015). Induced abortion is usually a last resort while trying to deal with unintended pregnancy in about 56% of cases ( Bankole et al., 2015). Young people bear the greatest burden of induced abortions. In a study conducted in Ogun State, Nigeria, among abortion seekers, 43% of the women presenting for repeated induced abortion were aged 15–24 years ( Lamina, 2015a). This high proportion also indicates that they might not have received adequate post-abortion care and counseling that should have included offering them contraceptives. Furthermore, young people often do not have the financial means to procure abortions and are left with no other option than to obtain abortion services from non-qualified persons at lower cost ( Olaide & Aderibigbe, 2014). Unsafe abortion is a very important cause of maternal mortality in Nigeria, and is estimated to account for about 11% of maternal deaths in the country ( Wekesah & Izugbara, 2017). Equally, induced abortion is more common in urban areas, mostly due to access to more health facilities and illegal abortion service providers as well as the increased economic pressure of urban life ( Lamina, 2015b).

Abortion laws in Nigeria are restrictive; a termination of pregnancy is a criminal offense except in instances where the mother’s health is in jeopardy. Therefore, community dialogue around the issue of abortion often revolves around legality and other social issues. Studies show that community members generally perceive induced abortion to be a common practice, especially in southwest Nigeria ( Ajayi et al., 2016; Oye-Adeniran et al., 2005). However, some cultural disapproval of induced abortion is present as it is perceived as the killing of a fetus or potential human being ( Jegede & Odumosu, 2003). This further constrains young people with an unwanted pregnancy to procure abortions from non-health professionals and in unsanitary environments. Moreover, the use of local abortifacients including bitter leaf water, herbal concoctions, lime, potash, ogogoro, (a local alcoholic gin) or other drinks such as salt and vinegar and so on frequently result in failed attempts or incomplete expulsion of the fetal products with dire consequences for the health of the pregnant woman ( Oye-Adeniran et al., 2005). Unfortunately, these “home remedies” have wide appeal among adolescents because they can be self-administered, often away from the prying eyes of other family members.

Population Media Center (PMC), an international non-profit organization that specializes in the development and implementation of communication programs for social change, planned the production of a new radio serial drama in the Yoruba language for southwest Nigeria to address issues of family planning, post-abortion care, and gender-based violence. In this regard, formative audience research (FAR) among married and unmarried youth in SW Nigeria was conducted to gather information about their attitudes and opinions concerning reproductive health (including abortion), and their perspectives and needs with regard to reproductive health information and services. The findings were used to help in developing understandable, high-quality, and culturally appropriate radio serial drama. Here, we report specifically on youth’s attitudes and opinions regarding abortion and abortion-related information and services.

This formative audience research (FAR) was a descriptive study that utilized qualitative research methods. The study was conducted in two local government areas (LGA) each in Ogun state (Abeokuta South and Odeda LGAs), Ondo state (Akure South and Akure North LGAs) and Oyo state (Ibadan North and Lagelu LGA); these are three of the six states in the southwest Nigeria geopolitical zone. In each study state, two LGAs, one predominantly urban and the other predominantly rural, were selected. The study states are the selected broadcast states for the proposed serial radio drama. The study LGAs were purposively selected from a list of predominantly rural and urban LGAs in the study states to represent the diverse radio listenership in the study states. Focus group discussions (FGD) were conducted with adolescents and young persons. Married, cohabiting or unmarried adolescents and young persons aged 15–25 years were eligible to participate in the study provided that they had spent one or more years in the study states. A constructivist/interpretivist research paradigm was adopted in this research to identify topics within abortion from the experiences of young people

Discussants were purposively selected to participate in the discussion sessions from communities within the study LGAs. Each FGD session had between 8 – 10 discussants; discussants were identified with the help of local community mobilization officers and community leaders who were familiar with the community members. The community mobilizers – who are usually very familiar with members of their communities – contacted persons who broadly fell into the study eligibility criteria a few days before each scheduled discussion session. On the day of each scheduled discussion session, the invited participants were reached by phone call to confirm their attendance and sessions were commenced once the minimum number required per session was achieved. Homogeneity of the various discussion groups was ensured in terms of age (15 – 19 years and 20 – 25 years), sex and marital status. In all, 16 FGD sessions were conducted to provide insights into issues around abortion in the study communities.

The tool for the study was developed around a vignette of a young woman who had gotten pregnant out of wedlock (see extended data ( Arije et al., 2020a)). However, the study guide also contained other questions that were relevant to other components of the larger formative audience research. The discussants were asked to provide their opinions about likely community attitudes towards the young woman in the vignette and underlying reasons for these attitudes. Research assistants were recruited among postgraduate students of medicine and social science of Obafemi Awolowo University, Ile-Ife, Nigeria. Training was conducted for the research assistants at a central location to ensure a common understanding of and familiarity with the instruments, and the techniques to be used. The training utilized didactic lectures, demonstrations, and role-playing to reinforce learning. Also, the research assistants had an opportunity for hands-on data collection and field procedures during the pre-testing of the methodology and instruments.

Discussions were held in the local language (Yoruba), pidgin English or English as appropriate for the discussants. All sessions were recorded with digital audio recorders. Recordings were transcribed verbatim and where Yoruba or pidgin English were used, these were translated into English but slangs and peculiar words were preserved as originally spoken. All transcripts were proofread comparing them with the recordings by persons different from those that conducted the transcription to confirm accuracy and correctness. All audio recordings are deleted from the recording device after copying out the recorded session. Recorded sessions were stored in a password protected computer. All transcribers and proof-readers were required to delete audio recordings and transcripts after they were returned to the researchers. We will archive the audio recordings for three years before deleting them permanently. All transcripts were de-identified to remove any personal identifiers.

An analytical framework and codes (including a code dictionary) were developed. Applying thematic content analysis, the ATLAS.ti 8 software was used for coding the transcripts. In all, five qualitative data analysts conducted the coding of the transcripts of this research. At the onset of coding, a code dictionary was developed from codes emerging for coding a randomly selected transcript (done by AOO; see extended data ( Arije et al., 2020a)). Following this, the code dictionary was reviewed and agreed upon at a conference by all coders. It was also agreed that new and emerging codes be expressly defined and communicated by the coder who proposed them. Transcripts were shared among coders to code based on agreed code definitions in the code dictionary. Subsequently, all transcripts were merged into one document and cleaned to remove redundant materials or codes. Coding was used to breakdown the transcribed data into units of meaning or concepts which were categorized, labeled, and subsequently organized into themes and sub-themes. Following more refinements and by linkages and integration of categories around a core, the emerging constructs were used to gain insight into abortion-related issues among the participants. All transcripts are provided as underlying data ( Arije et al., 2020b).

Ethical clearance for this study was obtained from the institutional review boards in the State Ministry of Health in each of the three study states before the commencement of the study (Ogun State: Document reference No. HPRS/381/292 Ondo State: Protocol reference No. OSHREC/05/03/2019/122; Oyo State: Document reference No. AD/13/479/1145). Written informed consent was also obtained from each research participant after the study had been properly explained to them. In this regard, the (translated) consent form was read to participants who do not understand English in their local language by the trained research assistants. Assent was obtained from participants less than 18 years after written informed consent was obtained from their parents/guardians. Participants who are unable to write or sign after consenting to participate in the study were requested to thumb-print on the consent form. Confidentiality was assured by ensuring that there are no personal identifiers on any data instrument, and only research personnel had access to the data.

There was a nearly equal distribution across sex (male, female), marital status (unmarried, married/cohabiting) and age group (15 – 19 years, 20 – 25 years).

Several studies from Nigeria show that members of society generally consider an abortion as wrong especially from a moral, religious and medical point of view ( Omideyi et al., 2014; Oye-Adeniran et al., 2005), as was found in the present study. Many consider it a sin against God and whoever commits it is a murderer. A lot of the communication around abortion was in the context of unsafe abortion. This stems from the fact that current abortion laws limit the conditions for legal abortion and a lot of people’s awareness about abortion has been from cases of complications from unsafe abortion. As a result, most abortions are considered unsafe. Also because of complications of unsafe abortion, community members often link infertility in women to a possible history of abortion and stemming from past waywardness.

The reasons females procure abortion are similar to those found in other studies, including shame, covering up pre- or extra-marital affairs, limiting family size, and financial considerations ( Cadmus & Owoaje, 2011). However, Otoide et al., (2001) reported fear of future infertility as an overriding factor in adolescents’ decisions to rely on induced abortion. This is linked to belief that hormonal contraceptives cause delayed return of fertility or outright infertility. While this was not seen in this current study, it may underlie the practice of using abortion as a form contraception as reported by these authors. There was a condemnation of abortion, similar to the findings of Mitchel et al. (2006) in Kenya among adolescents and Patel & Kooverjee (2009) in South Africa. Additionally, for some in this study, abortion was not an option, irrespective of the circumstances of the pregnancy, especially when non-medically related. They consider what was done as done (i.e., the pregnancy) and desire acceptance from immediate family members and the community at large.

Some females are unsurprisingly more sympathetic towards those that might have committed abortion or intend to procure abortion, compared with males. Females are no doubt more likely to be sympathetic about abortion because it affects them directly. Omideyi et al. (2014) found in their study that unmarried males were not punitive about abortion as long as the woman “used a qualified doctor.” The cost of procuring abortion is one of the most important factors that determine where a woman will seek induced abortion. The finding in this study that younger women are likely to be charged more gives insight into the challenges of unplanned pregnancies among young people, and why contraceptive education for youth ought to be promoted.

As in this study, participants in other studies have suggested capital punishment for anyone who procures or perform abortion ( Mitchell et al., 2006). Many view abortion as a crime, some even see it as murder. This likely derives directly from and contributes to abortion stigma in Nigeria, particularly towards young people. Results from a multi-country qualitative study among women of reproductive age revealed that the society disapproves strongly of abortion and persons who procure induced abortion as they are viewed as promiscuous and irresponsible ( Tsui et al., 2011). While this study was limited to community-level perspectives, literature reports that young people also experience abortion-related stigma in health facilities. A study that assessed individual-level abortion-associated stigma among clients who had experienced abortion in Nigeria reported that 43% of the clients had experienced abortion-related stigma ( Oginni et al., 2018). Abortion-related stigma is more common in adolescents and youth as compared with older women in the reproductive age group. A multi-center study among clients who obtained post-abortion services revealed that women aged 24 years and below were more likely to experience individual level abortion-related stigma than their older counterparts ( Oginni et al., 2018).

Abortion-related stigma often affects young people’s choices about where to obtain abortion services and disclosure practices. The observation has also been made that young girls requiring post-abortion care often experience stigmatization and refusal of care in some public health care facilities ( Hebert et al., 2013). Adolescents requiring post-abortion care (PAC) were often neglected this care, and attending staff were punitive and stigmatizing ( Lamina, 2013). There have been efforts in recent times to institutionalize PAC as well as shift the discourse beyond PAC to comprehensive abortion care (CAC). In this regard, several international non-governmental organizations (NGOs) have been championing this cause through the support of the creation of national policy documents for PAC, training of health workers on PAC, and in some cases CAC, in both private and public health facilities. Hord & Wolfe (2004) recommend that such actions that will make high-quality abortion care available and assessable especially at the primary health care level to the extent permitted by law need to be prioritized.

In conclusion, this study has shown that the general public looks unfavourably on abortion but personal opinions are likely to be based on whether it directly involves one as in the case where females were more favourably disposed to it than males. Young people have greater negative experiences when procuring abortion ranging from cost and stigmatization especially when there are complications. Since this study was conducted to support the development of a radio serial drama, we make some recommendations. The radio drama should address the issue of unintended pregnancy in adolescents and youth, focusing on providing information about contraception and how to negotiate safe sex. Information concerning facilities and sites where adolescents can receive counselling and reproductive health services in their communities may be necessary. Affected adolescents and young persons and the larger society will benefit from messages aimed at encouraging pregnant girls to return to school. Nigerian society also needs to be further sensitized to be more compassionate, to reduce stigma and to provide support to pregnant adolescents or mothers to ensure positive health outcomes for affected adolescents and young persons.

¹ Year 3 of junior secondary school