Millions Affected as Emergency Contraceptives Prove Ineffective in Kenya

A new study conducted in Kenya has revealed a concerningly high failure rate of emergency contraceptive methods, alongside significant challenges in contraceptive access and post-abortion care across the country. The research, a collaborative effort by the Africa Population and Health Research Centre (APHRC), the Norwegian Agency for Development Cooperation, and the Guttmacher Institute, reveals critical shortcomings in the nation's reproductive healthcare system. The study, titled  Incidence of Induced Abortions and the Severity of Abortion-related Complications in Kenya, found that 35% of women relying on emergency contraceptive pills and 31% of those using injectable contraceptives still experienced unintended pregnancies in 2023, a year in which nearly 1.44 million unintended pregnancies occurred nationwide. 

These findings are compounded by the study's revelation that, in the same year, Kenya recorded an estimated 792,694 abortions. The high rate of abortions translates to a rate of 78.3 per 1,000 women in Nairobi and Central regions, the highest in the country, contrasting with the lowest rates of 38.7 per 1,000 in the Coast and North-Eastern regions. Fear of side effects and health concerns emerged as primary deterrents to contraceptive use, cited by 42% of non-users. Two-thirds of the respondents actively avoided contraception, either intending to conceive or opposing family planning altogether. 

An additional 17% expressed interest in contraception but desired more time for discussions with partners, consideration of their options, or recovery from previous pregnancy losses. Access to post-abortion care is severely constrained, with many women discharged from healthcare facilities without contraception due to shortages and inadequate services. Nearly 13% of patients received no contraceptive counselling, and another 3.4% faced challenges due to staffing shortages or a lack of available options.

Health Director-General Patrick Amoth emphasised the necessity for increased investment in modern and effective family planning methods to reduce unintended pregnancies and unsafe abortions. Improving contraceptive access, he argues, would not only mitigate abortion-related complications but also provide economic benefits by decreasing healthcare costs associated with post-abortion treatment. 

Kenneth Juma, a senior research officer at APHRC and the project lead, highlights the societal stigma that prevents young women from seeking contraception, underscoring the importance of community education on reproductive health and affordable post-abortion care. This stigma disproportionately affects sexually active young women who are hesitant to seek contraceptives due to moral judgments.

Contrary to the assumption that abortions primarily involve younger, unmarried women, the study reveals that married women constitute the majority of those seeking post-abortion care. Of the 2,022 women interviewed across Nairobi, Kisumu, Mombasa, and Nakuru counties, 58% were married, with 32% having two or three children, indicating that abortion affects a broad spectrum of Kenyan women.

Significant gaps exist in post-abortion care accessibility across Kenya’s healthcare facilities, particularly in lower-tier medical centres. Only 18% of level 2 and 3 healthcare institutions are capable of providing such care, placing thousands of women at risk. Even referral hospitals demonstrated gaps in service delivery, with only 24% capable of offering comprehensive post-abortion treatment. Disparities in healthcare accessibility are further evident in contraceptive availability at different levels of medical institutions. 

Many facilities struggle to meet minimum requirements for post-abortion care due to stock shortages and a lack of trained personnel. Primary healthcare centres were more likely to provide post-abortion services than referral hospitals, with 70% compared to 64%. However, many facilities fell short when offering a full range of contraception options, leaving many women without the necessary resources to prevent future unintended pregnancies. Only 14% of level 2 health facilities and 31% of level 3 facilities met the criteria for comprehensive post-abortion care.