Why post abortion care is still out of reach for many Kenyan women

Access to post abortion care (PAC) by women in Kenya is still a struggle for many despite such services being key in preventing abortion related deaths and complications.

This is after a report released on Friday revealed that overall, 21 per cent of health facilities expected to provide PAC services did not provide them, the majority being either level 2 or 3 hospitals.

A survey released by the Africa Population and Health Research Center (APHRC) on Friday shows that among primary level facilities (dispensaries and clinics) that provided PAC, only 18 per cent of them could provide all the components of basic PAC services.

For primary-level health facilities in Kenya, to have met the criteria for providing basic PAC, they should have the ability to remove retained products of conception, parenteral antibiotics, and uteretonics, IV fluids and short-acting contraceptives.

They should also have staff available who have received specialised PAC training and should be able to offer referral services.

The report shows that only one in seven level 2 facilities and one in three level 3 facilities could deliver all the components of basic PAC services.

"Most facilities offered parenteral antibiotics, IV fluids, and referral capacity, with availability in referral facilities surpassing that in primary facilities," the report states.

"Consequently, the vast majority (81.7 per cent) could only offer some elements of basic PAC but not full compliment of basic PAC services," the report states.

According to the report, only a quarter (25 per cent) of referral health facilities could offer all comprehensive PAC services, which include all the basic services in addition to surgical procedures such as laparotomy, blood transfusion, and provision of long-acting contraceptive methods.

Data from the report shows that most referral facilities offering long-acting reversible contraceptives (85 per cent) and transfusions (78 per cent).

The report says that while almost all referral facilities (95 per cent) had at least one PAC-trained health provider available, this was true for only 43 per cent of primary facilities.

However, among referral facilities sampled, less than half (44 per cent) were capable of providing surgical care.

The report further shows that only eight per cent of private nonprofit and faith-based health facilities could provide all the basic PAC services.

Rift Valley (27 per cent) and Nyanza and Western (24 per cent) had the highest proportions of facilities capable of providing basic PAC services, the report says.

In its recommendations, the report has called for the strengthening of PAC services provision to address the gaps in service delivery.

"Most women and girls consider primary facilities as the first point of care when seeking services. It is thus critical to upgrade the capacity of primary-level facilities to provide essential basic PAC services through staff training and availing PAC equipment and supplies," the report recommends.

The report also calls for the establishment and strengthening of resilient referral systems for PAC patients, including the ability to facilitate referral for patients in need of additional care.

The report acknowledges that limitations to accessing and receiving high-quality PAC and post abortion family planning and counselling can lead to severe delays in receiving life-saving treatment, as well as repeat unintended pregnancies and induced abortions.

According to data in the report, one per cent of women treated for abortion related complications in health facilities experienced near misses and deaths, while about 16 per cent presented with potentially life-threatening complications.

The report further notes that experiencing delays in accessing post abortion care was associated with more severe outcomes.

These include seeking care at an informal provider prior to going to the health facility, not having enough money and road infrastructure problems.

The study was conducted jointly with the Guttmacher Institute and the Ministry of Health between April 2023 and May 2024.

It assessed the capacity of health facilities to provide basic and comprehensive post abortion care services by collecting data on the availability of PAC services, equipment, supplies and staffing in facilities over a period of six months.

It also assessed the readiness of the facilities to provide these services on the day of the survey.

A total of 694 health facilities were sampled, of which 648 participated in the survey.