Unsafe abortion in Kenya: a cross-sectional study of abortion complication severity and associated factors

Abstract

BackgroundComplications due to unsafe abortion cause high maternal morbidity and mortality, especially in developing countries. This study describes post-abortion complication severity and associated factors in Kenya.MethodsA nationally representative sample of 326 health facilities was included in the survey. All regional and national referral hospitals and a random sample of lower level facilities were selected. Data were collected from 2,625 women presenting with abortion complications. A complication severity indicator was developed as the main outcome variable for this paper and described by women’s socio-demographic characteristics and other variables. Ordered logistic regression models were used for multivariable analyses.ResultsOver three quarters of abortions clients presented with moderate or severe complications. About 65 % of abortion complications were managed by manual or electronic vacuum aspiration, 8% by dilation and curettage, 8% misoprostol and 19% by forceps and fingers. The odds of having moderate or severe complications for mistimed pregnancies were 43% higher than for wanted pregnancies (OR, 1.43; CI 1.01-2.03). For those who never wanted any more children the odds for having a severe complication was 2 times (CI 1.36-3.01) higher compared to those who wanted the pregnancy then. Women who reported inducing the abortion had 2.4 times higher odds of having a severe complication compared to those who reported that it was spontaneous (OR, 2.39; CI 1.72-3.34). Women who had a delay of more than 6 hours to get to a health facility had at least 2 times higher odds of having a moderate/severe complication compared to those who sought care within 6 hours from onset of complications. A delay of 7–48 hours was associated with OR, 2.12 (CI 1.42-3.17); a delay of 3–7 days OR, 2.01 (CI 1.34-2.99) and a delay of more than 7 days, OR 2.35 (CI 1.45-3.79).ConclusionsModerate and severe post-abortion complications are common in Kenya and a sizeable proportion of these are not properly managed. Factors such as delay in seeking care, interference with pregnancy, and unwanted pregnancies are important determinants of complication severity and fortunately these are amenable to targeted interventions.

Abortion as agentive action: reproductive agency among young women seeking post-abortion care in Uganda

“…Still, no matter the abortifacient, post-abortion care needs to be provided in a timely manner in order to save lives and prevent morbidity (Faúndes 2012). In Kenya, delayed care-seeking for abortion complications has been associated with lower age and lower education level and with increased severity of complications (Ziraba et al 2015); these findings are likely to be generalisable to the Ugandan setting. Thus, our findings expose young women's risk for morbidity and mortality due to abortion and underscore the need for access to affordable post-abortion care and interventions to reduce stigma.…”

Maus-tratos e discriminação na assistência ao aborto provocado: a percepção das mulheres em Teresina, Piauí, Brasil

“…Ele 10,[20][21][22] . Apesar de não se saber se essa demora acontece por discriminação contra a mulher por ter realizado um aborto, existem evidências que demonstram que o atraso em realizar o procedimento adequado para esvaziamento uterino aumenta as chances de complicações [30][31][32] . Durante a espera pela curetagem uterina, a informação de dor nem sempre foi suficiente para que a equipe de saúde ofertasse métodos farmacológicos para seu controle.…”

Providers, Unmarried Young Women, and Post‐Abortion Care in Kenya

“…; Ziraba, Izugbara et al. ). Evidence shows a continuing trend among Kenyan women and girls to obtain abortions outside formal facilities or with the support of unqualified providers, and to present at formal facilities for the management of the consequent complications (Evens, Otieno‐Masaba et al.…”

“…Public attitudes toward abortion remain largely negative in Kenya. The majority of women and girls seeking abortion therefore usually obtain it clandestinely and unsafely, often with negative sequelae (East Africa Center for Law and Justice 2012;APHRC et al 2015;Ziraba, Izugbara et al 2015). Evidence shows a continuing trend among Kenyan women and girls to obtain abortions outside formal facilities or with the support of unqualified providers, and to present at formal facilities for the management of the consequent complications (Evens, Otieno-Masaba et al 2014;Izugbara, Egesa, and Okelo 2015).…”

“…In Kenya, young women and girls comprised about half of the patients treated for complications of unsafe abortions in 2012 (APHRC et al 2013). In the same year and compared to their older counterparts, young abortion patients also experienced more severe complications of induced abortion (such as sepsis, shock, or organ failure); presented more often with repeat abortions; were less likely to receive contraceptives and counseling upon discharge; and tended to be managed with lowerquality abortion care procedures such as dilation and curettage (D&C), forceps, and digital (finger-only) evacuation (APHRC et al 2013;Mutua, Maina et al 2015;Ziraba, Izugbara et al 2015).…”