Stage-Specific Psychological Distress, Coping, and Social Support among Women Undergoing Pregnancy Termination in Rwanda: A Cross-Sectional Comparative Study.

BACKGROUND

Termination of pregnancy is a complex, emotionally charged experience. This study assessed psychological outcomes, including coping mechanisms and social support, among women undergoing pregnancy termination in Rwanda, aiming to identify predictors of psychological distress and resilience and to inform culturally sensitive, stage-specific interventions.

METHODS

A cross-sectional comparative design was employed among 305 women sampled once at different stages of the termination process (pre, peri, and post termination) across 11 district hospitals. Data were collected using validated instruments to measure distress, coping, and social support. Stage-specific comparisons were conducted using ANOVA (F tests), correlations, and linear regressions.

RESULTS

The peri-termination phase emerged as the most emotionally vulnerable, with elevated stress (F = 6.12, p = 0.003), depression (F = 5.03, p = 0.008), declining self-esteem (F = 3.78, p = 0.024), reduced adaptive coping (F = 2.45, p = 0.01), and lowest perceived support (F = 5.67, p = 0.01). Distress intensified into the post-termination phase, where stress and depression peaked. Regression models confirmed perceived stress (β = .41, p < 0.001), maladaptive coping (β = .29, p < 0.001), and lower perceived social support (β = -.16, p = 0.004) as significant predictors of anxiety (R2 = .52), and depression (R2 = .49). Overall, 28% of participants reported moderate-to-severe anxiety, 25% reported moderate-to-severe depression, and 33% reported high stress.

CONCLUSION

Findings underscore the need for integrated emotional support and empathetic provider communication, alongside community-based interventions to reduce stigma, promote recovery, contribute to Rwanda's maternal health strategy, and global efforts to humanize the service.