Women staring at death over poor post-abortion care
In 2023, out of the women who procured an abortion, a total of 304,159 women received post-abortion care for both induced and spontaneous abortions.
Only two out of every 10 primary-level health facilities in Kenya are equipped to provide basic post-abortion care (PAC) to women, a new study has revealed.
The study conducted by the Ministry of Health, the African Population and Health Research Center (APHRC), and the Guttmacher Institute found that just 18.3 per cent of facilities met the minimum criteria for delivering basic PAC services.
The remaining 81.7 per cent lack the necessary capacity, equipment, supplies, or trained personnel to adequately care for patients facing abortion-related complications.
Alarmingly, the situation is even worse in non-profit and faith-based health facilities, where only eight per cent can offer comprehensive basic PAC services, compared to 14 per cent of public health facilities.
As primary-level health facilities are usually the first port of call for most women and young girls, the access gap means countless girls and women suffer severe complications or even death simply because they cannot reach a facility equipped to provide timely, safe care.
Some of the services which the hospitals are unable to offer, yet are very crucial during post abortion care treatment, include removal of retained products of conception, parenteral antibiotics, uterotonics, IV fluids, short-acting contraceptives, no staff available who had received specialised PAC training, and could offer referral services.
“In Kenya, abortion is illegal, with only post-abortion care (PAC) permitted to manage complications from incomplete procedures. However, despite post-abortion care (PAC) being critical to averting death from abortion-related complications, thousands of women across the country still struggle to access and receive quality and comprehensive PAC,” says the report.
The study was conducted between April 2023 and May 2024 among the 2,022 women in Nairobi, Mombasa, Kisumu, and Nakuru counties, a representation of women’s diverse geographical and demographic characteristics.
According to the report findings, about one per cent of women treated for abortion-related complications in health facilities in Kenya experienced near misses and deaths, while about 16 per cent presented with potentially life-threatening complications, 29 per cent had moderately severe complications, and 54 per cent had mild complications.
The study titled Incidence of Induced Abortions and the Severity of Abortion-related Complications in Kenya, revealed that 792,694 women in the country procured an abortion in 2023.
This number, the study found, accounted for 57.3 per cent of induced abortions per 1,000 women aged 15-49.
The report assessed the capacity of health facilities to provide basic and comprehensive post-abortion care by collecting data on both the availability of PAC services, equipment, supplies, and staffing in facilities over the last six months, and the readiness to provide these services on the day of the survey.
Overall, 21 per cent of health facilities that were expected to provide PAC services did not provide PAC services, with level II at 26 per cent and level III at nine per cent.
Only one in seven Level II (14 per cent) and one in three Level III facilities (31 per cent) could deliver all the components of basic PAC services.
Rift Valley (27 per cent) and Nyanza and Western (24 per cent) had the highest proportions of facilities capable of providing basic PAC services, while Central & Nairobi (8 per cent) and Eastern (12 per cent) had the lowest proportions.
Ms Annet Nerima, programme manager at the Kenya Human Rights Commission, explains that facilities lacking the capacity to provide basic and comprehensive post-abortion care are putting thousands of lives at risk.
Only 24 facilities out of every 100 referral-level facilities provide the full package of comprehensive post-abortion care.
“Among referral-level facilities, the primary factor contributing to the reduced availability of comprehensive PAC was surgical capacity. The provision of short-acting contraceptives was similarly problematic for referral-level facilities,” reveals the study.
Most women (89.4 percent) reported using one method to end their pregnancy, with most of them preferring medication abortion (61.8 percent), which includes misoprostol alone or in combination with mifepristone.
Traditional methods were the next most used at 27 percent, followed by manual vacuum aspiration at 12.5 percent.
Known harmful methods were rare, with only eight percent of women reporting doing something such as inserting something sharp into the vagina or drinking a caustic substance to end their pregnancy.
Out of the women who procured an abortion, a total of 304,159 women received post-abortion care for both induced and spontaneous abortions in health facilities in the country in 2023. Most of these women were treated at public health facilities (51 per cent), and 69 per cent received care at primary-level facilities.
“These results suggest that public and primary facilities bear a high burden of providing PAC services in Kenya,” the study says.
The treatment rate was highest in the Eastern region (27.1 per 1,000), followed by Nyanza and Western regions (24.9 per 1,000) and Nairobi and Central regions (23.3 per 1,000).
The Rift Valley region has the lowest abortion complication treatment rate, of 16.9 per 1,000 Women of Reproductive Age (WRA). Of the 304,159 women who received post-abortion care in Kenya in 2023, approximately 256,620 were for complications of induced abortion, while the remaining 47,540 were for complications of spontaneous abortion.
To strengthen PAC service provision and address the gaps in service delivery, the report recommended political will, strategic investment, and research to expand access to high-quality PAC services.
“Most women and girls consider primary facilities as the first point of care when seeking services. It is thus critical to upgrade the capacity of primary-level facilities to provide all essential basic PAC services through staff training and the availability of PAC equipment and supplies,” says the report.
It recommends: “Strengthening the supply chain of medical supplies for PAC, especially medical uterine evacuation drugs and contraceptive methods, while promoting continuous training of health providers on PAC to strengthen service delivery.”
