How knowledge shapes community stigma and social support for women seeking abortion in the Democratic Republic of Congo: A cross-sectional study

Background

The Democratic Republic of Congo (DRC) bears one of the highest maternal mortality ratios globally (746 per 100,000 live births), with nearly 11% of deaths attributable to complications of unsafe abortion. Despite ratification of the Maputo Protocol and related national policies, access to safe abortion remains limited, largely due to entrenched stigma. Social support, encompassing emotional, informational, and instrumental assistance, is critical in shaping women’s abortion-seeking behaviors and health outcomes. This study examines the influence of community-level knowledge on stigma and social support for women seeking abortion care.

Methods

A cross-sectional survey was conducted from May 2024 to June 2024 among 1,715 adults in Kinshasa and North Kivu provinces. Analyses focused on a sub-sample of 574 respondents reporting familiarity with women who had undergone abortion. Structural Equation Modeling (SEM) was applied to estimate direct and indirect pathways linking community knowledge, stigma, and social support.

Results

Two core knowledge indicators, recognition of abortion as a safe medical procedure and awareness of legal conditions for access, were significantly associated with outcomes. A one-unit increase in knowledge corresponded to a 0.39-point increase in social support and a 0.19-point reduction in stigma. Enhanced knowledge promoted empathetic attitudes, reinforced practical support, and mitigated moralizing judgments toward women seeking abortion.

Conclusions

Strengthening community knowledge emerges as a strategic lever to reduce abortion-related stigma and enhance social support in the DRC. These findings underscore the importance of integrating stigma-reduction and knowledge-enhancement interventions into reproductive health programs to improve women’s access to safe and dignified abortion care.

Plain-Language Summary

In many communities, women who seek abortion face two big challenges: stigma (negative judgments and discrimination) and a lack of social support. These challenges often make it harder for women to get safe and respectful care.

This study looked at how knowledge about abortion, such as knowing that abortion can be safe medical procedure when performed by trained providers, and knowing the legal conditions under which it is allowed, affects stigma and social support in the Democratic Republic of Congo.

We used a survey, and a statistical method called structural equation modeling to understand the links between knowledge, stigma, and support. Our findings show that when community members have more accurate knowledge, women receive more support from their families and communities. For example, people are more willing to listen to them, help pay for care, or provide emotional encouragement. At the same time, increased knowledge reduces negative attitudes such as believing that women who have abortions are “bad mothers” or should be excluded from community life.

In short, better knowledge in communities leads to stronger support and less stigma. These results suggest that education and communication programs about abortion could play an important role in making communities more supportive and less judgmental toward women. Involving community leaders, health workers, and religious leaders in these efforts may help reduce stigma and improve access to safe abortion care in the DRC.