Incidence of Induced Abortions and the Severity of Abortion-related Complications in Kenya

Between 2015 and 2019, 121 million unintended pregnancies occurred annually worldwide, with 61% of these pregnancies ending in induced abortions (1). Of these abortions, about 45% (~25 million) were unsafe, heightening the risks to the health and well-being of women (2). The vast majority of unsafe abortions (97%) occur in low and middle-income countries, including in the African sub-regions (2).

In much of Africa, abortions are legally restricted and only allowed under a limited set of conditions (3). Nonetheless, evidence continues to show that abortion rates across the African sub-regions have either stagnated or slightly risen over the last two decades, even with declining rates of unintended pregnancies (1,4). Further, a 2014 WHO study suggested that unsafe abortion remains one of the leading causes of maternal mortality globally (contributing to 4-13% of maternal deaths) and a significant contributor to a range of morbidities (5).

In Kenya, abortion is similarly restricted and only permitted if, in the opinion of a trained health professional, there is a need for emergency treatment, the life or health of the mother is in danger, or if permitted by any other written law (6). The most recent national study on abortion in Kenya (2012) suggested that the vast majority of women needing abortions resort to clandestine and mostly unsafe abortion methods (7). The 2012 study reported a relatively high case-fatality rate at; 266 deaths per 100,000 unsafe abortions (7). Survivors can suffer lifelong severe morbidities, and some require treatment, prolonged hospital stays and intensive care, and attendance by highly skilled, yet scarce, health providers (8). Evidence demonstrates that abortion-related morbidities and deaths are preventable with improved access to safe abortion and family planning services (9).

Recent changes in the abortion landscape may be influencing abortion-related morbidity and mortality, as well as care-seeking behaviors. Over the past decade, access to medication abortion (MA) from pharmacies, drug shops, or other informal sources has increased dramatically, even in contexts where abortion is highly legally restricted (10). Available research suggests high levels of safety among abortions induced using MA, with the vast majority of cases resulting in complete abortions with little evidence of severe health complications (11). Despite these low levels of adverse health outcomes, several factors may be leading women to seek postabortion care after taking MA when this care is not clinically indicated, including insufficient information on what to expect after taking MA, wanting confirmation that the abortion is complete, or a desire to interact with a medical provider in the formal healthcare system. Both of these outcomes, abortion-related morbidity and mortality and increases in postabortion care-seeking behavior after MA, result in substantial and avoidable costs to public health systems (12).

The progress towards reducing the maternal mortality rate (MMR) has been slow in Kenya. The MMR of 355 maternal deaths/100,000 live births is still far from the target of below 70/100,000 live births committed to in the Sustainable Development Goals (SDGs) by 2030 (13). Evidence is critical in accelerating policy and programming towards reducing maternal mortality. Twelve years ago, a study by the Ministry of Health, the African Population and Health Research Center (APHRC), and the Guttmacher Institute reported close to 464,690 induced abortions in Kenya in 2012 (7), and about 75% of women experienced complications that needed care within health facilities (14).

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