A comprehensive study on induced abortions in Kenya has revealed a concerning trend. The study found a significant prevalence of abortions among married and educated women, particularly those with prior childbirth experience. Conducted by the African Population and Health Research Centre (APHRC), the Norwegian Agency for Development Cooperation (NADC), and the Guttmacher Institute, the research is titled "Incidence of Induced Abortions and the Severity of Abortion-related Complications in Kenya".
The study estimates that approximately 792,694 abortions were procured in Kenya in 2023. This translates to an abortion rate of 57.3 abortions per 1,000 women aged 15-49.
One of the most striking findings challenges common misconceptions about who seeks abortions. The study reveals that married women account for a substantial proportion (58%) of those seeking abortions. Among these married women, 32% had already given birth to two or three children. Furthermore, women aged 25-34 represent the largest age group seeking abortions, moving away from the stereotype that abortions primarily affect younger, unmarried individuals.
The primary driver of induced abortions is pointed to as unintended pregnancies. An estimated 1,435,988 unintended pregnancies occurred in Kenya in 2023, resulting in a rate of 103.8 per 1,000 women of reproductive age. This highlights a pressing need for improved access to comprehensive family planning services and education.
Regional disparities in abortion rates were also noted. Nairobi and the Central region recorded the highest rates (78.3 per 1,000), followed by Nyanza and Western (69.4), and then the Eastern region (55.6). The Coast and North Eastern regions had the lowest rate (38.7 per 1,000). These variations are thought to reflect differences in access to healthcare, cultural norms, and socioeconomic conditions.
Alarmingly, the study found that approximately two-thirds (66%) of women who procured abortions were not using any method of family planning at the time they became pregnant. The most commonly cited reason for not using contraceptives was fear of side effects or other health concerns (42%). This indicates a need for accurate information and counselling to address women's concerns about contraceptive use.
Regarding the methods used to terminate pregnancies, the majority of women (89.4%) reported using a single method. Medication abortion (using misoprostol alone or with mifepristone) was the most prevalent, used by 61.8%. Traditional methods were the next most common (27%), followed by manual vacuum aspiration (12.5%). Known harmful methods were rare (8%).
The study's findings have significant implications for public health policy and practice in Kenya. Dr. Patrick Amoth, Director-General of the Ministry of Health, acknowledged that unsafe abortion remains a public health challenge and stressed the importance of up-to-date nationwide evidence. He mentioned government efforts to prevent unsafe abortions through providing modern contraceptives, developing clinical guidelines, and training health providers on post-abortion care (PAC).
However, the study also revealed critical gaps in the availability and quality of PAC services. Kenneth Juma, a senior research officer at APHRC and the project lead, emphasized the need for the government to improve health facilities' capacity to offer PAC services. He noted that only 18% of Level Two and Three facilities can provide these services, putting thousands of women at risk, and that access is not assured even in many Level Four and Five hospitals. Mr. Juma also highlighted the stigma associated with young women seeking contraceptives as a factor contributing to unsafe abortions, emphasizing the need for community education on contraception.
Margaret Giorgio, a research scientist at Guttmacher, noted that women cite several reasons for procuring abortions, including being unprepared for parenthood and the high cost of raising a child. She also highlighted a gap in follow-up care: while 92% of patients received family planning counselling, 56% left without a method of contraception, suggesting a need for more effective counselling and access to a wider range of options.