The magnitude of abortion complications in Kenya

Abstract

Objective To estimate and describe the magnitude of abortion complications presenting at public hospitals in Kenya. Design Cross-sectional descriptive study.Setting Hospital-based.Population Records of all women presenting prior to 22 weeks of gestation with abortion-related complications at selected hospitals during a three-week study period. All public tertiary and provincial hospitals were included; stratified random sampling was employed to select a subset of 54 district hospitals nationwide. Methods Data collectors identified 809 patients with abortion complications on all hospital wards and completed a standardised questionnaire for each by extracting information from the patient's hospital record. Main outcome measures Incidence, aetiology, morbidity and mortality of abortion complications.Results Most women (80%) presented with incomplete abortion. Approximately 34% of the women had reached the second trimester of pregnancy. Adolescents (14 -19 years old) accounted for approximately 16% of the study sample. Manual vacuum aspiration was used to manage 80% of first trimester cases. The projected annual number of women with abortion complications admitted to public hospitals in Kenya is 20,893. The case fatality rate was estimated to be 0.87% (95% CI 0.71 -1.02%), so an estimated 182 (95% CI 148 -213) of these women die annually. The annual incidence of incomplete abortion and other abortionrelated complications per 1000 women aged 15 to 49 years is projected to be 3.03. Conclusions The high rate of abortion-related morbidity and mortality documented in the study highlights the critical need to address the issue of unsafe abortion in Kenya.

Caring for Women with Abortion Complications in Ethiopia: National Estimates and Future Implications

“…In the 2002 Kenyan study, women in the second trimester had elevated odds of presenting with moderate or severe morbidity and, as in this study, accounted for almost all abortion-related deaths. 23 We found that women in the second trimester tended to be from rural areas, suggesting that rural women have relatively poor access to safe, legal abortion services, and that they face challenges in obtaining timely postabortion care. Providing women with better access to postabortion care and safe abortion services, and ensuring that these services are well-known in communities, should result in simpler, safer abortion procedures at earlier gestations and in more timely receipt of postabortion care.…”

“…In a 2002 study conducted in a nationally representative group of government hospitals in Kenya, a country with a highly restrictive abortion law, the proportion of all women with high-severity complications (28%) was similar to that in our study (27%). 23 However, the morbidity rate in Kenya likely would have been lower if private hospitals and health centers had been included in the analysis (as in our study), because women with more serious complications tend to go to public hospitals if they can. In South Africa, researchers examined abortion complications in a nationally representative sample of public hospitals in 1994, when the country's abortion law was still restrictive, and in 2000, after the new constitution allowed abortion on demand.…”

“…The methodology, which was developed by a WHO task force, has been adapted and used to measure the severity of abortion-related complications in countries as diverse as South Africa, Cambodia and Kenya. 8,[19][20][21][22][23] For this study, we reviewed data collection instruments from Kenya and Cambodia and revised them on the basis of input obtained from a panel of experts and investigators.…”

Self-Reported Abortion-Related Morbidity: A Comparison of Measures in Madhya Pradesh, India

“…Although the levels of morbidity we found were high, they are within the range reported in other research in India 15,16 and other settings. 5,30,31 This is important because accurate measurement in larger-scale quantitative surveys will allow for the collection of data that are more representative of the general population, and these data will provide policymakers with information on the prevalence of abortion-related morbidity within large population groups, on its effects on women's lives and on the determinants of such morbidity.…”

A Critical Appraisal of Laws on Second Trimester Abortion

“…Even though it is thought that first trimester abortion deaths are declining in Kenya, the data on second trimester complications underscore the need to make second trimester procedures safer as well. 6 The Soviet Union was the first in the world to make abortion legal on request, in 1920. In Russia today, however, many second trimester abortions have remained unsafe even though the law allowed them on a wide range of grounds until 2003.…”