Study Reveals High Abortion Rates Among Married Christian Women in Kenya

A comprehensive study on induced abortions in Kenya has revealed a concerning trend, indicating a significant prevalence of abortions among married and educated women, particularly those with prior childbirth experience. 

The research, conducted by the African Population and Health Research Centre (APHRC), the Norwegian Agency for Development Cooperation (NADC), and the Guttmacher Institute, sheds light on the intricate factors driving this phenomenon, including unintended pregnancies, limited access to family planning, and socioeconomic pressures. The study, titled "Incidence of Induced Abortions and the Severity of Abortion-related Complications in Kenya," estimates that approximately 792,694 abortions were procured in Kenya in 2023, translating to a rate of 57.3 abortions per 1,000 women aged 15-49. 

One of the most striking findings of the study is the demographic profile of women seeking abortions. Contrary to common misconceptions, the study reveals that married women account for a substantial proportion (58%) of those seeking abortions, with 32% of these women having already given birth to two or three children. Furthermore, women aged 25-34 represent the largest age group seeking abortions, challenging the stereotype that abortion primarily affects younger, unmarried women. 

The study points to unintended pregnancies as a primary driver of induced abortions, with an estimated 1,435,988 unintended pregnancies occurring in Kenya in 2023. This translates to an unintended pregnancy rate of 103.8 per 1,000 women of reproductive age, highlighting the pressing need for improved access to comprehensive family planning services and education. Regional disparities in abortion rates were also evident in the study. Nairobi and the Central region recorded the highest abortion rates (78.3 per 1,000), followed by Nyanza and Western (69.4), and then the Eastern region (55.6). 

The Coast and North Eastern regions had the lowest abortion rate of 38.7 per 1,000 women of reproductive age. These regional variations likely reflect differences in access to healthcare, cultural norms, and socioeconomic conditions. Alarmingly, the study reveals that approximately two-thirds (66%) of women who procured abortions were not using any method of family planning at the time they became pregnant. The most commonly cited reason for non-use of contraceptives was fear of side effects or other health concerns (42%), highlighting the need for accurate information and counselling to address women's concerns about contraceptive use.

The study also sheds light on the methods used to terminate pregnancies. The majority of women (89.4%) reported using a single method, with medication abortion (misoprostol alone or in combination with mifepristone) being the most prevalent (61.8%). Traditional methods were the next most common (27%), followed by manual vacuum aspiration (12.5%). While known harmful methods were rare (8%).

The study's findings have significant implications for public health policy and practice in Kenya. Dr. Patrick Amoth, Director-General of the Ministry of Health, acknowledges that unsafe abortion remains a public health challenge and emphasises the need for up-to-date and nationwide evidence on the incidence of induced abortions. He highlights the government's efforts to prevent unsafe abortions through the provision of modern contraceptives, the development of clinical guidelines, and the training of health providers on post-abortion care.

However, the study also reveals critical gaps in the availability and quality of post-abortion care (PAC) services. Kenneth Juma, a senior research officer at APHRC and the project lead, emphasises the need for the government to improve health facilities' capacity to offer PAC services. He notes that only 18% of Level Two and Three facilities are able to provide such services, putting thousands of women at risk. Moreover, women in many Level Four and Five hospitals are not assured of receiving PAC services.

The study also highlights the stigma associated with young women seeking contraceptives, which contributes to unsafe abortions. Mr. Juma emphasises the need for community education on contraception and the importance of ensuring that PAC is accessible and affordable. Margaret Giorgio, a research scientist at Guttmacher, notes that women cite several reasons for procuring abortions, including being unprepared for parenthood and the high cost of raising a child. 

She also highlights the fact that while 92% of patients received family planning counselling, 56% left without a method of contraception, indicating a need for more effective counselling and access to a wider range of contraceptive options.