Abstract
BACKGROUND: In Rwanda, legally induced termination of pregnancy (ToP) is permitted under specific conditions such as cases of rape, incest, being a minor, forced marriage or health-related issues. OBJECTIVES: To explore post-ToP mental health outcomes, the circumstances under which women seek ToP services and investigates their relationship with the presence or absence of psychological support. DESIGN: A quantitative approach using a cross-sectional design was used for this study. METHODS: Data collection recruited 305 women and girls who sought ToP services at eleven selected health facilities in Rwanda from June to August 2022. Life satisfaction, self-esteem, anxiety, and depression/grief were the outcome measures and were measured using the standardized tools. Binary logistic regression (adjusted odds ratios) was used to assess how the circumstances of seeking ToP and the presence or the absence of psychological support predicted mental health outcomes. RESULTS: The findings indicate that the primary reasons for seeking ToP services include rape, pressure from a partner and fear of missing educational opportunities. There was a strong association between circumstances such as rape and partner pressure with negative mental health outcomes. The study also revealed that only a small proportion of women who received post-ToP psychological support from family, community or healthcare providers, while the majority did not. The absence of psychological support was significantly linked to an increased likelihood of low self-esteem, anxiety, depression, and dissatisfaction with life. CONCLUSION: The circumstances under which women seek ToP services significantly impact their mental health post service provision. The findings underscore the critical role of post-ToP support in mitigating negative psychological outcomes. Hospitals should screen depression/grief and offer psychological care support for women undergoing ToP.