Induced abortion in Kenya: its determinants and associated factors

Abstract

In a study involving 1077 women who were admitted and treated for incomplete abortion and its related problems at eight hospitals (seven district and one mission hospitals) in six of the eight provinces of Kenya, between October 1988 and March 1989, 169 (15.7%) had illegally induced unsafe abortion, based on their own history and clinical findings. The illegally induced unsafe abortions were common among both rural and urban dwellers, and women from almost all social and economic strata were involved. However, they were more common among the youth (< 25 year olds), school girls, those with high formal education, in formal employment, and not currently married. Majority (90.4%), of the induced group said their pregnancies were unwanted, as compared to only 29.1% of the non-induced (p < 0.05). The main determining factor for termination of pregnancy amongst these women appeared to be the fact that it was unwanted and/or unplanned, either because of inappropriate timing, the type of man responsible, the relationship itself and the social and economic implications thereof. This is contributed to by poor contraceptive use inspite of very good awareness, and/or desire to use. There is urgent need to integrate abortion care and related services into the overall reproductive health care and as a part of the broader safe motherhood initiative in Kenya. In addition it is necessary to revise the legal provisions on abortion so as to make them more relevant. Appropriate management of adolescent fertility, should be undertaken with the aim of reducing the extent of illegally induced unsafe abortion with attendant sequealae.

PIP: As part of a larger survey of the epidemiology of unsafe abortion in Kenya, 1007 women admitted to 8 hospitals in 6 of Kenya's 8 provinces during October 1988-March 1989 for incomplete abortion or its complications were interviewed. 169 of these women (15.7%) were considered to have undergone induced abortion (115 women who admitted to interfering with their pregnancy and 57 women who had clear physical evidence of an attempt at pregnancy termination). The induced abortion rate ranged from 0.9% at the Malindi coastal district hospital to 36.4% at the only mission hospital (Chogoria) in the study. Although adolescents (10-19 years old) comprised 15.2% of the total study group, 29.6% of induced abortion patients were in this age group. 22.9% of the total study group, compared with 70.4% of the induced group, were unmarried. There was a steady increase in the proportion of women with induced abortion with increasing educational level, from 4.7% of those with no formal education to 26.3% among those with a college or university education. Induced abortion patients were significantly more likely than those in the broader group to be students (14.8%) or employed in the formal sector (13%). Contraceptive prevalence at the time of conception of the index pregnancy was 12.1% in the broader group and 23.1% in the induced abortion group. 37.8% of induced abortion patients, compared with 50.2% of non-induced women, reported to the hospital within 24 hours of initial symptoms of abortion. Finally, complications were more prevalent in the induced abortion group and included sepsis (34.3%), anemia (17.8%), genital injury (16.6%), and hemorrhage (12.4%). The one death in the induced abortion group was attributable to severe septicemia. The 15.7% induced abortion rate identified in this study is considered to be an underreport, as suggested by the finding that 38.6% of the total study group stated their pregnancy was unwanted.