Healthcare providers’ perspectives on Rwanda’s 2018 revised abortion law: a qualitative study from Kirehe district

Rwanda’s 2018 revised abortion law aimed to improve access to safe abortion care for vulnerable groups like rape survivors and minors. However, significant gaps persist in understanding how healthcare providers’ perceptions and attitudes influence the delivery of safe abortion services. This study explores healthcare providers’ perspectives on the law and how their perspectives influence their implementation of the law in Kirehe District. A qualitative study was conducted in 2023 using semi-structured interviews with 19 healthcare providers (doctors, nurses, and midwives) in Kirehe District, Rwanda. Participants were purposively sampled. Data were analyzed thematically using a socio-ecological framework to examine individual, institutional, and policy-level influences on healthcare providers’ understanding and implementation of the revised abortion law. Healthcare providers acknowledged the law’s potential to improve access to safe abortion care, especially for rape survivors and minors. However, concerns about ‘false rape’ claims and moral or religious objections led to delays in care. Institutional barriers, including inconsistent training and a lack of clear guidelines for provider refusal of abortion care, hindered the effective implementation of the law. These challenges exposed a gap between the law’s progressive intent and its practical application. Healthcare providers’ perspectives on Rwanda’s abortion law impact its implementation, with personal beliefs, ethical dilemmas, and legal uncertainties causing delays. Strengthening provider training and trust with patients is crucial. Findings inform advocacy and efforts to improve abortion care access, with global implications for reproductive health policies in low- and middle-income countries facing similar challenges.