Challenges Facing Post-Abortion Care Health Providers

August 12, 2015

*Lisa, a Form 2 student went to Mbagathi District Hospital in Nairobi in excruciating pain, with her parents in tow. She was attended to at the general casualty unit, and as doctors did preliminary consultations, she refused to reveal the real reason she was in pain. After much probing, Lisa eventually opened up saying that she had just procured an abortion at a nearby slum.  The medical examination showed that she had a perforated uterus. Lisa was rushed to theatre for surgery where doctors found heaps of cotton wool lodged in her womb. They also drained numerous amounts of pus. The only option was a hysterectomy which meant that she had to undergo an operation to have her uterus removed. Three days after surgery, she developed septicaemia and was severely anaemic and there wasn’t much anyone could do. Doctors referred her to Kenyatta Hospital for further treatment. Unfortunately, Lisa died on arrival at the hospital.

Lisa’s story is just one example of the many cases on unsafe abortion that medical providers in Nairobi County deal with on a daily basis. In Kenya, unsafe abortion is a leading cause of death and injury to women. According to a report by the African Population and Health Research Center (APHRC), in 2012, close to half a million induced abortions occurred in Kenya.  Adolescents and young women aged less than 25 years, constituted almost half of patients who received care for severe complications of induced abortions. These young women were also less likely to receive contraceptives or and counseling upon discharge, and were more likely to be treated with less safe abortion care procedures.

Handling the complications resulting from unsafe abortion places undue pressure on Kenya’s health care system. District hospitals and clinics receive a huge number of patients who have carried out self-induced abortions or who obtained abortions from people who are not professionally trained. As *James, a medical worker at one of the health facilities in Nairobi’s Eastlands, noted, “We don’t have the capacity to treat severe cases of post-abortion complications. Even when some women come in to procure a medical abortion, they have to go through the general casualty which offers no privacy.”

*Noreen, a health worker at another Nairobi health facility said, “Our gynaecology ward is so small. We are unable to deal with all post-abortion care cases. We receive many young girls from colleges and universities, but they don’t have the funds to procure a medical abortion.”

In an effort to improve the provision of modern post-abortion care (PAC) to young women, APHRC, in partnership with KMET, trained 22 health providers drawn from 14 health facilities in 6 out of the 9 sub-counties of Nairobi County. In an interview with Monica Oguttu, the Executive Director of KMET and one of the facilitators, explained “We need to empower health service providers as advocates to speak for the voiceless. This training is to provide them with information on three interventions: prevention of unintended pregnancies, prevention of unsafe abortion and knowledge of safe providers and post-abortion care.”

The five-day training workshop exposed providers to youth-friendly post-abortion care. The providers were trained on how to observe minimum standards of youth friendly services, including non-restrictive policies, non-judgmental and respectful staff, adequate privacy and confidentiality, and the ability to offer wide range of sexual and reproductive health services and contraceptive methods. As part of the training, providers developed post-training action plans to guide them in the provision of youth friendly post-abortion care services. At the end of training, the county reproductive health coordinator promised to work with the providers to implement their community sensitization activities to raise awareness about youth friendly post-abortion care services and gain support for community-based sexual and reproductive health education programs for young people. She also promised to incorporate the training in their calendar and develop supervisory visits to the health facility to ensure the youth are receiving YPAC services.

“We’ve received important skills here that we wouldn’t get anywhere else. However, the Kenyan government needs to set up a strict legal framework on unsafe abortion and the reproductive health of adolescents.” said *James.

The government has been working with stakeholders to develop Policies, Standards and Guidelines for Reducing Maternal Morbidity and Mortality in Kenya. These guidelines are expected to include post-abortion care service provision.


*names have been changed to protect privacy