The changing abortion legal and practice landscape in the DRC in recent years calls for a re-examining of induced abortion experiences. The current study provides population-level estimates of induced abortion incidence and safety by women’s characteristics in two provinces using direct and indirect approaches to assess indirect method performance. We use representative survey data on women aged 15–49 in Kinshasa and Kongo Central collected from December 2021 to April 2022. The survey had questions on respondents’ and their closest friends’ experience with induced abortion, including methods and sources used. We estimated one-year abortion incidence and proportion using non-recommended methods and sources overall and by background characteristics for each province separately for respondents and friends. The fully adjusted one-year friend abortion rate was 105.3 per 1000 women of reproductive age in Kinshasa and 44.3 per 1000 in Kongo Central in 2021; these were substantially higher than corresponding respondent estimates. Women earlier in their reproductive lifespan were more likely to have had a recent abortion. Approximately 17.0% of abortions in Kinshasa and one-third of abortions in Kongo Central involved non-recommended methods and sources according to respondent and friend estimates. The more accurate friend abortion incidence estimates indicate that women in the DRC often rely on abortion to regulate their fertility. Many use non-recommended means and sources to terminate, thus, significant work remains to actualise the commitments made in the Maputo Protocol to provide comprehensive reproductive health services that combine primary and secondary prevention services to reduce unsafe abortion and its consequences.

Background The Democratic Republic of Congo (DRC) legalized abortion in 2018 to preserve health and pledged to provide quality postabortion care (PAC), yet little is known about the availability of abortion care services and if facilities are prepared to provide them; even less is known about the accessibility of these services. Using facility and population-based data in Kinshasa and Kongo Central, this study examined the availability of abortion services, readiness of facilities to provide them, and inequities in access. Methods Data on 153 facilities from the 2017–2018 DRC Demographic and Health Survey Service Provision Assessment (SPA) were used to examine signal functions and readiness of facilities to provide services across three abortion care domains (termination of pregnancy, basic treatment of abortion complications, and comprehensive treatment of abortion complications). To examine PAC and medication abortion provision before and after abortion decriminalization, we compared estimates from the 2017–2018 SPA facilities to estimates from the Performance Monitoring for Action (PMA) data collected in 2021 (n = 388). Lastly, we assessed proximity to PAC and medication abortion using PMA by geospatially linking facilities to representative samples of 2,326 and 1,856 women in Kinshasa and Kongo Central, respectively. Results Few facilities had all the signal functions under each abortion care domain, but most facilities had many of the signal functions: overall readiness scores were > 60% for each domain. In general, readiness was higher among referral facilities compared to primary facilities. The main barriers to facility readiness were stock shortages of misoprostol, injectable antibiotics, and contraception. Overall, provision of services was higher post-decriminalization. Access to facilities providing PAC and medication abortion was almost universal in urban Kinshasa, but patterns in rural Kongo Central showed a positive association with education attainment and wealth. Conclusion Most facilities had many of the necessary signal functions to provide abortion services, but the majority experienced challenges with commodity availability. Inequities in accessibility of services also existed. Interventions that address supply chain challenges may improve facility readiness to provide abortion care services, and further efforts are needed to narrow the gap in accessibility, especially among poor women from rural settings.

Background Exclusive breastfeeding during the first six months of life yields enormous health outcomes for children, mothers and their families. With only 35% of exclusive breastfeeding (EBF) under six months, women in Kinshasa lag behind national and international goals. The drop in EBF is sharpest between three and four months postnatal. This exploratory study aimed at identifying and understanding the determinants of EBF at four months after birth. Methods This case-control study involved 80 EBF and 320 non-EBF women and applied bivariate and multivariate analysis to determine the association between independent variables and EBF. Results In multivariate analysis, the following maternal predictors were associated with EBF at four months postnatal: being in a union (aOR = 4.55; 95% CI: 1.30–11.27), early initiation of breastfeeding (aOR = 3.15; 95% CI: 1.29–7.70), breastfeeding information, education and counseling during antenatal care, after delivery, and at discharge (aOR = 2.96; 95% CI: 1.35–6.51), having planned for at least five months of EBF (aOR = 16.87; 95% CI: 7.11–40.03), favorable attitude to breastfeeding in public (aOR = 2.45; 95% CI: 1.12–5.37), and the absence of depression (aOR = 2.55; 95% CI: 1.17–5.54). Also significant was being the firstborn child (aOR: 4.53; IC à 95%: 1.20–17.02). Conclusions Policies and interventions aimed at improving the provision of EBF information, education and counseling during antenatal care and after childbirth, supporting mothers in planning for EBF, encouraging early initiation of breastfeeding right after birth, and identifying mental health issues, such as depression, could be beneficial in improving exclusive breastfeeding among mothers in Kinshasa and other provinces and communities lagging behind national and international breastfeeding goals.