"BACKGROUND: The recently promulgated 2010 constitution of Kenya permits abortion when the life or health of the woman is in danger. Yet broad uncertainty remains about the interpretation of the law. Unsafe abortion remains a leading cause of maternal morbidity and mortality in Kenya. The current study aimed to determine the incidence of induced abortion in Kenya in 2012. METHODS: The incidence of induced abortion in Kenya in 2012 was estimated using the Abortion Incidence Complications Methodology (AICM) along with the Prospective Morbidity Survey (PMS). Data were collected through three surveys, (i) Health Facilities Survey (HFS), (ii) Prospective Morbidity Survey (PMS), and (iii) Health Professionals Survey (HPS). A total of 328 facilities participated in the HFS, 326 participated in the PMS, and 124 key informants participated in the HPS. Abortion numbers, rates, ratios and unintended pregnancy rates were calculated for Kenya as a whole and for five geographical regions. RESULTS: In 2012, an estimated 464,000 induced abortions occurred in Kenya. This translates into an abortion rate of 48 per 1,000 women aged 15-49, and an abortion ratio of 30 per 100 live births. About 120,000 women received care for complications of induced abortion in health facilities. About half (49%) of all pregnancies in Kenya were unintended and 41% of unintended pregnancies ended in an abortion. CONCLUSION: This study provides the first nationally-representative estimates of the incidence of induced abortion in Kenya. An urgent need exists for improving facilities' capacity to provide safe abortion care to the fullest extent of the law. All efforts should be made to address underlying factors to reduce risk of unsafe abortion"
It is well recognised that unsafe abortions have significant implications for women's physical health; however, women's perceptions and experiences with abortion-related stigma and disclosure about abortion are Not well understood. This paper examines the presence and intensity of abortion stigma in five countries, and seeks to understand how stigma is perceived and experienced by women who terminate an unintended pregnancy and influences her subsequent disclosure behaviours. The paper is based upon focus groups and semi-structured in-depth interviews conducted with women and men in Mexico, Nigeria, Pakistan, Peru and the United States (USA) in 2006. The stigma of abortion was perceived similarly in both legally liberal and restrictive settings although it was more evident in countries where abortion is highly restricted. Personal accounts of experienced stigma were limited, although participants cited numerous social consequences of having an abortion. Abortion-related stigma played an important role in disclosure of individual abortion behaviour.
"BACKGROUND: Unsafe abortion is a leading cause of death among young women aged 10-24 years in sub-Saharan Africa. Although having multiple induced abortions may exacerbate the risk for poor health outcomes, there has been minimal research on young women in this region who have multiple induced abortions. The objective of this study was therefore to assess the prevalence and correlates of reporting a previous induced abortion among young females aged 12-24 years seeking abortion-related care in Kenya. METHODS: We used data on 1,378 young women aged 12-24 years who presented for abortion-related care in 246 health facilities in a nationwide survey conducted in 2012. Socio-demographic characteristics, reproductive and clinical histories, and physical examination assessment data were collected from women during a one-month data collection period using an abortion case capture form. RESULTS: Nine percent (n = 98) of young women reported a previous induced abortion prior to the index pregnancy for which they were receiving care. Statistically significant differences by previous history of induced abortion were observed for area of residence, religion and occupation at bivariate level. Urban dwellers and unemployed/other young women were more likely to report a previous induced abortion. A greater proportion of young women reporting a previous induced abortion stated that they were using a contraceptive method at the time of the index pregnancy (47 %) compared with those reporting No previous induced abortion (23 %). Not surprisingly, a greater proportion of young women reporting a previous induced abortion (82 %) reported their index pregnancy as unintended (Not wanted at all or mistimed) compared with women reporting No previous induced abortion (64 %). CONCLUSIONS: Our study results show that about one in every ten young women seeking abortion-related care in Kenya reports a previous induced abortion. Comprehensive post-abortion care services targeting young women are needed. In particular, post-abortion care service providers must ensure that young clients receive contraceptive counseling and effective pregnancy prevention methods before discharge from the health care facility to prevent unintended pregnancies that may result in subsequent induced abortions."
"OBJECTIVE: To explore how intimate partner violence (IPV) is associated with unintended pregnancy and abortion in primarily low- and middle-income countries. METHODS: Population data are presented from 17 518 ever-partnered women participating in the WHO Multi-country Study on Women's Health and Domestic Violence in 15 sites in 10 countries. Using multiple logistic regression analyses, associations between physical and/or sexual partner violence and abortion and unintended pregnancy were explored. RESULTS: Women with a history of IPV had significantly higher odds of unintended pregnancy in 8 of 14 sites and of abortion in 12 of 15 sites. Pooled estimates showed increased odds of unintended pregnancy (adjusted OR 1.69; 95% CI, 1.53–1.86) and abortion (adjusted OR 2.68; 95% CI, 2.34–3.06), after adjusting for confounding factors. Reducing IPV by 50% could potentially reduce unintended pregnancy by 2%–18% and abortion by 4.5%–40%, according to population-attributable risk estimate CONCLUSION:IPV is a consistent and strong risk factor for unintended pregnancy and abortion across a variety of settings. Unintended pregnancy terminated through unsafe abortion can result in death or serious complications. Therefore, reducing IPV can significantly reduce risks to maternal and reproductive health."
BACKGROUND: Although the experiences of unintended pregnancies and poor birth outcomes among adolescents aged 15-19 years in the general population are well documented, there is limited understanding of the same among those who are living with HIV. This paper examines the factors associated with experiencing unintended pregnancies, poor birth outcomes, and post-partum contraceptive use among HIV-positive female adolescents in Kenya. METHODS: Data are from a cross-sectional study that captured information on pregnancy histories of HIV-positive female adolescents in four regions of Kenya: Coast, Nairobi, Nyanza and Rift Valley provinces. Study participants were identified through HIV and AIDS programs in the four regions. Out of a total of 797 female participants, 394 had ever been pregnant with 24% of them experiencing multiple pregnancies. Analysis entails the estimation of random-effects logit models. RESULTS: Higher order pregnancies were just as likely to be unintended as lower order ones (odds ratios [OR]: 1.2; 95% confidence interval [CI]: 0.8-2.0) while pregnancies occurring within marital unions were significantly less likely to be unintended compared to those occurring outside such unions (OR: 0.1; 95% CI: 0.1-0.2). Higher order pregnancies were significantly more likely to result in poor outcomes compared to lower order ones (OR: 2.5; 95% CI: 1.6-4.0). In addition, pregnancies occurring within marital unions were significantly less likely to result in poor outcomes compared to those occurring outside such unions (OR: 0.3; 95% CI: 0.1-0.9). However, experiencing unintended pregnancy was not significantly associated with adverse birth outcomes (OR: 1.3; 95% CI: 0.5-3.3). There was also no significant difference in the likelihood of post-partum contraceptive use by whether the pregnancy was unintended (OR: 0.9; 95% CI: 0.5-1.5). CONCLUSIONS: The experience of repeat unintended pregnancies among HIV-positive female adolescents in the sample is partly due to inconsistent use of contraception to prevent recurrence while poor birth outcomes among higher order pregnancies are partly due to abortion. This underscores the need for HIV and AIDS programs to provide appropriate sexual and reproductive health information and services to HIV-positive adolescent clients in order to reduce the risk of undesired reproductive health outcomes.
"BACKGROUND: Over six million induced abortions were reported in Africa in 2008 with over two million induced abortions occurring in Eastern Africa. Although a significant proportion of women in the region procure more than one abortion during their reproductive period, there is a dearth of research on factors associated with repeat abortion. METHODS: Data for this study come from the Magnitude and Incidence of Unsafe Abortion Study conducted by the African Population and Health Research Center in Kenya in 2012. The study used a nationally-representative sample of 350 facilities (level II to level VI) that offer post-abortion services for complications following induced and spontaneous abortions. A prospective morbidity survey tool was used by health providers in 328 facilities to collect information on socio-demographic characteristics, reproductive health history and contraceptive use at conception for all patients presenting for post-abortion services. Our analysis is based on data recorded on 769 women who were classified as having had an induced abortion. RESULTS: About 16 % of women seeking post-abortion services for an induced abortion reported to have had a previous induced abortion. Being separated or divorced or widowed, having no education, having unwanted pregnancy, having 1–2 prior births and using traditional methods of contraception were associated with a higher likelihood of a repeat induced abortion. CONCLUSIONS: The findings point to the need to address the reasons why women with first time induced abortion do not have the necessary information to prevent unintended pregnancies and further induced abortions. Possible explanations linked to the quality of post-abortion family planning and coverage of long-acting methods should be explored. "
"BACKGROUND: Delays in seeking quality post-abortion care services remain a major contributor to high levels of mortality and morbidity among women who experience unsafe abortion. However, little is known about the causes of and factors associated with delays in seeking care among women who suffer complications of unsafe abortion. This study looks at factors that are associated with delays in seeking post-abortion care among women in Kenya. METHODS: Data for this study were from a nationally representative sample of 350 healthcare facilities that participated in the 2012 Incidence and Magnitude of Unsafe Abortion study in Kenya. Data included socio-demographic characteristics, reproductive health and clinical histories from all women treated with PAC during a one-month data collection period. RESULTS: Delay in seeking care was associated with women’s age, education level, contraceptive history, fertility intentions and referral status. CONCLUSIONS: There is need to improve women’s access to quality sexual and reproductive health information and services, contraception and abortion care. Improving current PAC services at lower level facilities will also minimize delays resulting from long referral processes. "
"BACKGROUND: Factors such as poverty, stigma, lack of knowledge about the legal status of abortion, and geographical distance from a provider may prevent women from accessing safe abortion services, even where abortion is legal. Data on the consequences of abortion denial outside of the US, however, are scarce. METHODS: In this article we present data from studies among women seeking legal abortion services in four countries (Colombia, Nepal, South Africa and Tunisia) to assess sociodemographic characteristics of legal abortion seekers, as well as the frequency and reasons that women are denied abortion care. RESULTS: The proportion of women denied abortion services and the reasons for which they were denied varied widely by country. In Colombia, 2% of women surveyed did Not receive the abortions they were seeking; in South Africa, 45% of women did Not receive abortions on the day they were seeking abortion services. In both Tunisia and Nepal, 26% of women were denied their wanted abortions. CONCLUSIONS: The denial of legal abortion services may have serious consequences for women's health and wellbeing. Additional evidence on the risk factors for presenting later in pregnancy, predictors of seeking unsafe illegal abortion, and the health consequences of illegal abortion and childbirth after an unwanted pregnancy is needed. Such data would assist the development of programmes and policies aimed at increasing access to and utilisation of safe abortion services where abortion is legal, and harm reduction models for women who are unable to access legal abortion services."
In this qualitative research, the author explored (in general) whether domestic violence and induced abortion feature in men's and women's sexual and reproductive health experiences. In particular, he explored whether and how gender roles influence reproductive decision-making behavior regarding contraception, unwanted pregnancy, and induced abortion. The study area was Wakiso district in central Uganda, which surrounds the capital city, Kampala. The author collected data using in-depth interviews and focus group discussions and analyzed them using grounded theory. Effects of unplanned pregnancy were perceived to be gender specific. Unintended pregnancy and induced abortion as a health Issue did Not concern men. Rather, what concerned them was spouses' contraception, which they often strongly opposed. Consequently, covert contraceptive use was common. The author describes a relation between domestic violence, Nonuse of contraception, unintended pregnancy, and induced abortion.
"Background: Abortion rates following unintended pregnancies is increasing in developing countries like Africa. Unsafe abortion is threatening the gains in reducing maternal mortality and achieving millennium development goal targets. Medication abortion is one of safe abortion interventions. Adequate level of knowledge among women of reproductive age groups contributes to prevention and control of unsafe abortion and the resulting mortality and morbidity. The aim of this study was therefore to assess knowledge, attitude and practices regarding medication abortion among regular undergraduate female students of the College of Social Sciences, Addis Ababa University. Method: A cross-sectional quantitative study supplemented by key informants’ interview was conducted between 1st of June to 5th of July 2013. The quantitative data were collected using structured, self-administered questionnaire and the qualitative data were collected by the principal investigator using interview guide. Results: The age of the study participants ranged from 18 to 25 years with a mean age of 20.6 ± 1.5. Three fourth of the respondents (159, 74.6%) knew what medication abortion meant where 11 (6.9%) and 97(61%) of them had high and low knowledge on medication abortion respectively. Majority (142, 66.7%) of the study participants would advise someone with unwanted pregnancy to undergo an abortion and 86 (40.4%) would consider abortion if they had unplanned pregnancy. From 21 respondents who had abortion experience, 13 (61.9%) used medication abortion. Conclusion: The study revealed that majority of the female undergraduate students in Addis Ababa University has low knowledge regarding medical abortion, though most of them have positive attitude towards medication abortion."