Married, educated, Christian women lead in abortions, new study finds
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.
Six out of ten married and educated women who had previously had babies now account for the groups with the highest induced abortion rates in the country, a new study has shown.
The study, released on May 2 and 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 percent induced abortions per 1,000 women aged 15-49.
Among the 2,022 women interviewed, a striking 58 percent (1,138) were married, of whom 32 percent had given birth to two or three children.
Women between 25-34 years represented the largest demographic group, contradicting stereotypes that abortion primarily affects younger, unmarried women.
According to the study, the abortion rate was highest in Nairobi and Central region (78.3 per 1,000), followed by Nyanza and Western (69.4), and the Eastern region (55.6), respectively.
The Coast and North Eastern region had the lowest abortion rate of 38.7 per 1,000 women of reproductive age.
The numbers, according to the study, were mainly caused by the increase in the number of unintended pregnancies, which was estimated to be a total of 1,435,988 in 2023.
The unintended pregnancy rate was 103.8 per 1,000 women of reproductive age.
The unintended pregnancy rate was highest for the Nyanza and Western Region (135.1 per 1,000) and lowest for Coast and North Eastern (71.7 per 1,000).
Over half of all unintended pregnancies, the study shows, end in an induced abortion.
From the findings, widowed or divorced women who procured abortion were 22 percent, while those never in a relationship were 19 percent.
Women without children who procured an abortion were 597, with 562 being those with one child.
The study revealed that the majority of post-abortion care patients were married women or living with a partner at 78.6 percent and young women aged 25-34 (41.8 percent), all had secondary-level education (37 percent), and identified as Christian (91 percent).
Further, about 66 percent had previously given birth, and 29 percent had four or more pregnancies in their lifetime.
The study revealed that the abortion incidence ratio rose from 30 to 48 per 100 live births in 2012 when such a study was last done.
This increase is not surprising given the expanded access to medication abortion drugs over the past 15 years in many settings.
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.
The majority of women (82 percent) only had one lifetime abortion. About two-thirds of women (66 percent) were not using any method of family planning when they became pregnant.
The most commonly reported reason for non-use of contraceptives was a fear of side effects or other health concerns (42 percent).
The study was conducted between April 2023 and May 2024 by the African Population and Health Research Center (APHRC) and Guttmacher Institute.
The Director General of Health, Dr Patrick Amoth, said unsafe abortion remains a public health challenge.
He said there is insufficient up-to-date and nationwide evidence on the incidences of induced abortions in the country.
Dr Amoth said the government still lacks credible information on the landscape of abortion in Kenya, the 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.
“The government has invested in multiple interventions to prevent unsafe abortions and their health consequences. These include availing modern contraceptives to prevent unintended pregnancies, developing appropriate clinical guidelines to support health providers in the delivery of health services, and training health providers on post-abortion care,” Dr Amoth said.
He noted the study highlights the incidence of induced abortions, the severity of abortion-related complications, and the preparedness of health facilities to provide comprehensive post-abortion care in Kenya.
Of the 2,022 women who participated in the survey, 42 percent of them were adolescents and young women aged 15-24 years, with about 12 percent being adolescents aged 15-19 years.
Kenneth Juma, a senior Research Officer at AHRC said the government needs to improve health facilities to handle post-abortion care.
Mr Juma, who was also the Project Lead, noted that only 18 percent of level two and three facilities are able to offer post-abortion care in the country thus putting thousands of women at risk.
He noted that in many level four and five hospitals, women are not assured of getting post-abortion care services.
“Many women still cannot have access to contraception services when they need them, which at times lead to unsafe abortions. 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.
He added that stigma associated with young women seeking contraception is largely to blame for some of the abortion cases.
“The society takes young women seeking contraceptive services as being very immoral yet they are sexually active. The government needs to conduct community education on contraception and also ensure access to post-abortion care is available and affordable,” he said.
Margaret Giorgio, a Research Scientist at Guttmacher said women gave a lot of reasons for procuring abortions, which include being unprepared to get a child and the high cost of raising a child.
“Many women said they aborted as they were not ready to get a child at the time they got pregnant. Most of those women seeking post-abortion care were married women,” said Ms Giorgio.
She noted while 92 percent of post-abortion care patients received family planning counselling, 56 percent of them left without a method of contraception.
“Some of them were opposed to contraception due to health complications while others said they wanted to become pregnant soon,” she added.
Overall, about 1 in 3 women who had an abortion received post-abortion care.
Approximately 58 per cent of women were currently in a relationship, 69 per cent had at least one child, and more than half (56 per cent had completed secondary school or higher.
The data collected in Nairobi, Mombasa, Kisumu, and Nakuru counties and their environs represented women’s diverse geographical and demographic characteristics.
Nairobi and the Central region led in the number of induced abortions at 3.86 per cent, followed by the Eastern region at 2.33 per cent.
Out of the women who procured an abortion, a total of 304,159 women received post-abortion care for both induced and spontaneous 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 1000), followed by Nyanza and Western regions (24.9 per 1000) and Nairobi and Central regions (23.3 per 1000).
The Rift Valley region has the lowest abortion complication treatment rate, of 16.9 per 1000 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.
Regarding the severity of abortion-related complications, 1.4 per cent of the women who were treated for post-abortion complications, experienced severe maternal outcomes.
About 16.4 per cent presented with potentially life-threatening complications, 29 percent had moderately severe complications, and 54 percent had mild complications.
“Compared to the 2012 study, the proportion of women with more severe complications has reduced significantly. One possible explanation for this finding is that access to post-abortion care services in Kenya has increased over the past decade, resulting in more women with less severe complications who can present at a health facility for post-abortion care,” said Yohannes Wado, a Research Scientist at APHRC, working under the Sexual, Reproductive Maternal, Newborn Child and Adolescent Health.
