Hospitals unprepared for post-abortion care, study finds
Unsafe abortions, driven by restrictive laws and pervasive stigma, continue to claim lives and destroy futures.
A new study has lifted the lid on the unpreparedness of health facilities to deal with post abortion care in the country.
The study titled “Incidence of Induced Abortions and the Severity of Abortion-related Complications in Kenya released on Friday, shows only 18 percent of Level Two and Three facilities offer post-abortion care in the country, thus putting thousands of women at risk.
The study further indicates that only 24 percent of referral-level facilities could provide comprehensive post-abortion care (PAC) services.
Overall, 21 percent of health facilities (primary Level II and III facilities) that were expected to provide PAC services did not provide them.
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Providing more than three types of short-acting contraceptive methods was a key reason many facilities did not qualify as offering basic PAC services.
Notably, more primary facilities provided this service than referral facilities (70 vs 64 percent) and stock-outs were a major driver of this gap.
Only one in seven Level III (14 percent) and one in three Level III facilities (31 percent) could deliver all the components of basic PAC services.
Basic PAC
The study also further found that only eight percent of private non-profit or faith-based facilities and 14 percent of public facilities could provide all basic PAC services.
The study conducted between April 2023 and May 2024 was undertaken by African Population and Health Research Center (APHRC), the Norwegian Agency for Development Cooperation (NADC) and Guttmacher Institute.
Rift Valley and Nyanza and Western had the highest proportion of facilities capable of providing basic PAC services at 27 and 24 percent respectively.
Central, Nairobi and Eastern regions, on the other hand, had the lowest proportions at 12 and eight percent, respectively.
Services offered
It is, however, not all gloom as the study found that most facilities offered parenteral antibiotics, IV fluids and referral capacity, with availability in referral facilities surpassing that in primary facilities.
And while 95 percent of all referral facilities had at least one PAC-trained provider available, this was true for only 43 percent of primary facilities.
Most referral level facilities, however, offered long-acting reversible contraceptives (85 percent) and blood transfusion at 78 percent.
Among referral facilities, less than half were capable of providing surgical care.
A new study shows that more married and educated women who have children account for the groups with the highest induced abortion rates in Kenya.
Even with the recognition of the role of PAC in preventing abortion-related deaths and complications, the findings from this study shows that women still struggle to access post-abortion care in Kenya.
Only 18 percent of primary-level facilities could provide basic PAC services, while only about 25 percent of referral-level facilities could provide comprehensive PAC services.
Improvement needed
Kenneth Juma, a senior Research Officer at AHRC, said there is a need for the government to prepare and improve health facilities to handle post abortion care.
Mr Juma, who was also the Project Lead, noted that in many level four and five hospitals, women are not assured of getting post abortion care services.
“Health centres and dispensaries need to be well equipped to be able to take care of post-abortion cases. We also need to improve the capacity of the referral hospitals to make them well equipped to handle such cases,” said Mr Juma.
The Director General of the Health Ministry, Patrick Amoth, said unsafe abortion remains a public health challenge.
Dr Amoth added the government still lacks credible information on the landscape of abortion in Kenya.
“The state lacks credible information that shows characteristics of women who seek abortion-related care in health facilities, the nature of abortion-related complications that women present with, and the care they receive,” said Dr Amoth.
According to the study that saw 2,022 women interviewed across Nairobi, Mombasa, Kisumu and Nakuru counties, among all the women who received post abortion care, 1.4 experienced severe maternal outcomes including five women who died and eight were in a coma.
The study also shows 16.4 of respondents experienced potentially life-threatening complications with 28.5 being classified with moderate complications. About 53.7 percent had mild complications.
The report also indicates one in three women (34 percent) were using a contraceptive method when they became pregnant.
A further 62 percent, the study found, were using medication abortion as the most common method to end their pregnancies.
About 42 percent of women reported that they feared using contraceptive methods for fear of side effects or other health outcomes.
Almost one in 10 women (8 percent) reported using a harmful, unsafe method to procure an abortion.
Overall, the study says, about 1 in 3 women who had an abortion received post abortion care.
To ensure there are minimal casualties as a result of post abortion care, the study has proposed a raft of recommendations.
Among the recommendations include expansion of access to high-quality PAC services. Most women and girls consider primary facilities as the first point of care when seeking services.
The study also calls for the strengthening of the supply chain of medical supply of PAC, especially medical uterine evacuation drugs and contraceptive methods.
