Medical Abortion Self-Use in Kenya: Results from a process evaluation of women's experiences

BackgroundThe consequences of unsafe abortions weigh heavily on individuals, families, society, and health care systems. Developing countries continue to experience a high prevalence of mistimed and unintended pregnancies resulting in induced abortions that are largely unsafe. Globally, 25 million unsafe abortions take place every year [1]. In Africa, 3 out of 4 abortions are categorized as unsafe [2]. In Kenya, it is estimated that 464,690 induced abortions occur annually- 2 out of 3 of these are unsafe[3]. With the high prevalence of mistimed and unwanted pregnancies in Sub-Saharan Africa and Kenya in particular, unsafe abortions will be on the rise unless deliberate measures and policies are put in place to guarantee safe abortion procedures[4]. MethodIpas Africa Alliance embarked on the Medical Abortion Self-Use (MASU) project aimed at reducing morbidity and mortality tied to unintended pregnancies among women in the Counties of Vihiga, Kisumu, Busia, Siaya, and Trans Nzoia. To inform on the progress and the potential for scale-up of the project, Ipas commissioned a process evaluation. This evaluation adopted both qualitative and quantitative methods. This involved in-depth interviews (IDIs), Focus Group Discussions (FGDs), and face-face-interviews through a semi-structured questionnaire. ResultsFrom the analysis, those seeking medical abortion were mainly youths under 25 years of age. There was low awareness of safe abortion practices and the gestation period within which safe medical abortion (MA) can be safely done. Nearly half (47%) of the women and girls reported being coerced to take post-abortion contraceptives they never wanted. Further, MA costs were not only found to be expensive but also varied greatly across the Counties. Some MA users experienced medical complications attributed to the failure of pharmacists responsible to provide the correct dose and correct route of administration. On the other hand, youth champions were found to be few and not able to fully cover their areas and only have basic knowledge of MA self-use services. ConclusionThe IPAS MASU project intervention, in the five counties of Western Kenya namely Busia, Siaya, Vihiga, Kisumu, and Trans Nzoia, has increased access to safe Medical Abortion self-use, enhanced availability of MA drugs in pharmacies, the improved service delivery of MA services through regular training of pharmacists. Further, the project has enhanced awareness about MA services among young girls and women through trained Youth Champions and pharmacists, and the MASU project has significantly reduced cases of unsafe abortions and by extension deaths and medical complications associated with them. To realize more gains, the project needs to be scaled up within the five counties and beyond, specifically to target the rural areas where cases of unsafe abortion are still thought to be rampant.