Policy, law and post-abortion care services in Kenya

Abstract

BackgroundUnsafe abortion is still a leading cause of maternal death in most Sub-Saharan African countries. Post-abortion care (PAC) aims to minimize morbidity and mortality following unsafe abortion, addressing incomplete abortion by treating complications, and reducing possible future unwanted pregnancies by providing contraceptive advice. In this article, we draw on data from PAC service providers and patients in Kenya to illustrate how the quality of PAC in healthcare facilities is impacted by law and government policy.MethodsA cross-sectional design was used for this study, with in-depth interviews conducted to collect qualitative data from PAC service providers and seekers in healthcare facilities. Data were analyzed both deductively and inductively, with diverse sub-themes related to specific components of PAC quality.ResultsThe provision of quality PAC in healthcare facilities in Kenya is still low, with access hindered by restrictions on abortion. Negative attitudes towards abortion result in the continued undirected self-administration of abortifacients. Intermittent service interruptions through industrial strikes and inequitable access to care also drive unsafe terminations. Poor PAC service availability and lack of capacity to manage complications in primary care facilities result in multiple referrals and delays in care following abortion, leading to further complications. Inefficient infection control exposes patients and caregivers to unrelated infections within facilities, and the adequate provision of contraception is a continued challenge.DiscussionLegal, policy and cultural restrictions to access PAC increase the level of complications. In Kenya, there is limited policy focus on PAC, especially at primary care level, and no guidelines for health providers to provide legal, safe abortion. Discrimination at the point of care discourages women from presenting for care, and discourages providers from freely offering post-abortion contraceptive guidance and services. Poor communication between facilities and communities continues to result in delayed care and access-related discrimination.ConclusionGreater emphasis should be placed on the prevention of unsafe abortion and improved access to post-abortion care services in healthcare facilities. There is a definite need for service guidelines for this to occur.

Spatial and socio-economic correlates of effective contraception among women seeking post-abortion care in healthcare facilities in Kenya

“…Similarly, we established that patients treated in larger hospitals (Level IV-VI) were less likely to receive effective contraceptive methods after PAC. It has been demonstrated elsewhere that integrating PAC services with family planning reduces unsafe abortion by eliminating the risk of repeat abortion and increasing adoption of more effective contraceptives [36], and this has been a particular challenge in large hospitals, mainly due to poor patient follow-up especially when PAC and FP services are not offered under the same roof [37]. At a more contextual level, this call for service, including maternity care, is demonstrated further by the negative association between the community level of ANC service utilization and individual’s likelihood of adopting a highly effective contraceptive method.…”

Foreign assistance or attack? Impact of the expanded Global Gag Rule on sexual and reproductive health and rights in Kenya

“…While the Kenyan Constitution permits abortion to protect the health or life of a pregnant woman, 9 the circumstances under which abortion is criminalised in the Kenyan penal code are less clearly specified. 10 This inconsistency creates confusion among clients and providers regarding the legal status of abortion, 11 which, combined with widespread abortion stigma, [12][13][14] engenders significant barriers to safe and legal abortion 15 especially for young women and girls. 16 Unsafe abortion, meanwhile, is common: of the 464,690 reported induced abortions (48 per 1000 women of reproductive age) that took place in Kenya in 2012, the majority were unsafe.…”

Is there a difference in women’s experiences of care with medication vs. manual vacuum aspiration abortions? Determinants of person-centered care for abortion services

“…The 2010 amendment of Kenya’s Constitution expanded legal abortions in cases where the health of a woman is in danger; prior to this, restrictive policies only allowed abortions to protect the woman’s life [2]. The expansion of the law to include the “health exception” has the potential to expand access to safe abortions [3]; however, ambiguity around the law, including conflicts in the 2010 Constitution, which allows abortions in certain cases, and the penal code, which criminalizes abortions, results in inconsistent implementation [4]. The result of this legal and enforcement uncertainty is that clinicians are fearful of providing abortions and patients are stigmatized [4].…”

“…The expansion of the law to include the “health exception” has the potential to expand access to safe abortions [3]; however, ambiguity around the law, including conflicts in the 2010 Constitution, which allows abortions in certain cases, and the penal code, which criminalizes abortions, results in inconsistent implementation [4]. The result of this legal and enforcement uncertainty is that clinicians are fearful of providing abortions and patients are stigmatized [4]. In this context, while access to safe abortions exists, the quality of care for abortions remains an ongoing challenge.…”