Agency in young people's unsafe abortion trajectories in Papua New Guinea.

Unsafe abortion is a preventable contributor to maternal morbidity and mortality, particularly for young unmarried women in low resource settings. In Papua New Guinea, abortion is legally restricted and highly stigmatised, limiting access to safe abortion and post-abortion care, resulting in unsafe abortion. This paper explores young people's lived experiences and agency in relation to unsafe abortion. We undertook qualitative research between 2019 and 2021 in rural, peri-urban and urban settings in Papua New Guinea and found that agency was enacted or constrained at different points along their abortion trajectories. Findings demonstrate the ways in which abortion was negotiated within (and outside of) young people's intimate relationships, while highlighting the social, temporal and emotional dimensions of this agency. By considering what agency means, and the different forms it takes, it is possible to identify critical support mechanisms and socio-structural changes that could support young people at different stages of their abortion trajectories, from accessing modern contraceptives to prevent unintended pregnancy, to seeking support for safe abortion. Moving forward, we call for greater attentiveness to young people's everyday lived experiences of sexual and reproductive health as a basis for understanding how to support them to safely prevent and manage unintended pregnancy.