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 womens 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 womens access to safe and dignified abortion care.