Key Social Norms Take-aways Despite restrictive legal, structural, and socio-normative contexts in the DRC, this study highlights community attitudes toward abortion as multifaceted rather than wholly condemnatory. While abortion stigma is widespread—rooted in moral, religious, and gendered ideals about womanhood and motherhood—community discussions revealed empathy for women who induce abortions in specific contexts, such as rape, poverty, or spousal neglect. Most notably, the nearly unanimous support for post-abortion care (PAC), even among those who oppose abortion morally, demonstrates a crucial normative opening. These findings suggest potential to shift social norms toward more compassionate and rights-based views on abortion and PAC, particularly by focusing on individual stories and shared values around preserving life.

Objectives To explore community perceptions of women who induce abortions and their access to post-abortion care in six rural health zones in North and South Kivu, DRC, in order to inform programming aimed at reducing stigma and improving access to care.

Methods The study employed qualitative research using 24 focus group discussions (FGDs) with 246 participants—men and women from different age groups—in six rural health zones. FGDs explored attitudes toward induced abortion, reasons for abortion, and perceptions of PAC. Transcripts were thematically analyzed using NVivo, and coding reliability was ensured through double-coding and inter-rater agreement.

Results Initial reactions to induced abortion were overwhelmingly negative, with women who induce labeled as immoral or criminal. Participants described social consequences such as ostracism, gossip, and loss of marriage prospects. However, attitudes softened during discussion, particularly when abortion was framed in the context of rape, poverty, or health risks. Participants also consistently emphasized that all women should receive PAC, regardless of how the abortion occurred. Many expressed willingness to help women access care, citing shared community values around preserving life and health.

Conclusions Abortion stigma persists in North and South Kivu, yet community perceptions are more nuanced than typically assumed. The widespread recognition of the need for PAC and the empathy expressed in certain scenarios provide entry points for normative change. Interventions should prioritize community engagement to address abortion stigma and improve access to care, aligning legal reforms with social attitudes to reduce maternal morbidity and mortality.