I wasn't sure it would work. I was just trying: The choice of abortion methods among young women in Kilifi county, Kenya, and the Atlantique department, Benin

Abstract Background Despite the increased availability of safe abortion methods in sub-Saharan Africa, women continue to use unsafe abortion methods that result in severe complications, lifelong disabilities, and maternal deaths. Barriers to safe abortion methods are largely attributed to restrictive abortion laws, low levels of awareness of safe abortion methods, poverty, and socio-cultural and health system barriers. Nonetheless, there is a paucity of data on the pathways toward the use of either safe or unsafe abortion methods, and especially the mechanisms of decision-making around choices of abortion methods. By answering the questions: which abortion methods do women use and why? Who and what influences their decisions? What can we learn from their decision-making process to enhance the use of safe abortion methods? We provide an in-depth analysis of the rationale behind the choice of abortion methods used by women in Kilifi County in Kenya and the Atlantique department in Benin. Methods We derive data from an ethnographic study conducted between January and August 2021 on lived experiences, social determinants, and pathways to abortion. Data were collected using in-depth interviews (IDIs) with 95 girls and women who had a recent abortion experience. Key informant interviews (KIIs) and Focused group discussions (FGDs) were also conducted. Data analysis was carried out through an inductive process. Results Our findings reveal that women used a variety of methods to procure an abortion including the use of herbs, high doses of pharmaceutical drugs, homemade concoctions, medical abortion drugs, and surgical abortion methods. Women used the different methods singularly, multiple times, and sometimes mixed them to achieve their final goal of pregnancy termination. The primary motivation for the use of different abortion methods was the pursuit of social safety (preservation of social relationships and avoidance of shame and stigmatization) instead of medical safety. Conclusion Our findings affirm the need to increase access to reliable and well-framed information about safe abortion methods. Abortion services should also consider both medical and social safety.