Severity and management of postabortion complications in Kenya: results from a nationally representative cross-sectional survey

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INTRODUCTION: Complications from induced abortion are an avoidable cause of maternal morbidity and mortality. A nationally representative 2012 study estimated that 37% of postabortion care patients in Kenya experienced severe complications. This study provides updated estimates of postabortion complication management and severity in Kenya. METHODS: Data were collected on 4666 postabortion care cases in a nationally representative sample of health facilities (n=367). Abortion-related complications were classified as mild, moderate, potentially life-threatening (PLTC) or a severe maternal outcome (SMO). Adjusted Poisson regression was used to estimate the association between patient characteristics and experiencing a PLTC/SMO. RESULTS: 1.4% (95% CI 0.5% to 3.8%) of cases were classified as a SMO, 16.4% (95% CI 11.8% to 22.3%) as a PLTC, 28.5% (95% CI 21.5% to 36.8%) as moderate and 53.6% (95% CI 45.1% to 62.0%) as mild. Medical vacuum aspiration/electric vacuum aspiration was the most common uterine evacuation method (65.2%, 95% CI 54.0% to 74.9%), and 11.7% of cases (95% CI 7.1% to 18.5%) did not receive any uterine evacuation procedure. Experiencing a PLTC/SMO was associated with primary-level schooling or less (adjusted incidence rate ratio, aIRR 1.86, 95% CI 1.05 to 3.29), inability to meet household needs (aIRR 1.43, 95% CI 1.16 to 1.76), food insecurity (aIRR 1.65, 95% CI 1.21 to 2.24), using a non-recommended abortion method (aIRR 2.56, 95% CI 1.81 to 3.61) and seeking care from another source before arriving at the current facility (aIRR 2.06, 95% CI 1.14 to 3.73). CONCLUSIONS: Comparing the results of this analysis to the 2012 study reveals that the proportion of postabortion care patients experiencing the most severe outcomes has reduced over time and patients with mild complications more than doubled (from 23% in 2012 to 54% in 2023). This shift is likely a result of expanded primary care and increased access to medication abortion from informal sources. Despite this decline, severe postabortion complications remain an avoidable risk to women who induce abortions. Factors associated with these complications, including use of non-recommended abortion methods and economic vulnerability, underscore the need for interventions that enhance awareness around safe abortion methods and increase access to affordable healthcare.

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