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Abortion Incidence and Severity of Complications in Kenya 2022, Prospective Morbidity Survey (PMS)

Kenya, 2023
Health and Well-Being (HaW)
Kenneth Juma
Last modified June 04, 2025 Page views 3303 Documentation in PDF Metadata DDI/XML JSON

Identification

IDNO
DDI-KEN-APHRC-KAS-PMS-2022-v1.0
Title
Abortion Incidence and Severity of Complications in Kenya 2022, Prospective Morbidity Survey (PMS)
Subtitle
Prospective Morbidity Survey (PMS)
Country
Name Country code
Kenya KEN
Abstract
Background: Unsafe abortion remains a significant cause of maternal morbidity and mortality in many African countries, including Kenya. In Kenya, abortion is legally restricted except when the life or health of a pregnant woman is in danger and in cases of rape or incest. The restrictions around abortion, pervasive stigma and negative attitudes of healthcare providers often increase the risks of unsafe abortion. Ten years ago, a study by the Ministry of Health, the African Population and Health Research Center (APHRC), and the Guttmacher Institute reported close to 464,690 induced abortions in 2012. Given the time that has passed since that study, and changes in the landscape of abortion in Kenya (e.g., the availability of medication abortion drugs, enactment of the 2017 Health Act that defined "trained providers" to include nurses and midwives, and the 2019 High Court ruling that reinstated the withdrawn Standards and guidelines for reduction of maternal mortality from unsafe abortion), policymakers and advocates in Kenya have raised the need for another national abortion incidence study.
Objectives: To determine the incidence of induced abortions and the severity of abortion-related complications in Kenya.
Methods: The proposed study will employ a quantitative cross-sectional design. The study will have four separate surveys: i) a nationally representative Health Facility Survey (HFS) to estimate the number of women who receive post-abortion care (PAC) following abortion complications, ii) a Knowledgeable Informants Survey (KIS) to collect information on the proportion of all women having abortions who receive facility-based treatment for abortion-related complications, iii) a Respondent-Driven Sampling survey (RDS) of women who have had an abortion to understand abortion incidence and safety, and iv) a Prospective Morbidity Survey (PMS) to provide the data necessary to describe characteristics of women receiving treatment for abortion complications, the severity of complications, the type of treatment received, and the delays in access to PAC. The PMS will also include a limited component involving clinical data abstraction from the medical charts/records of PAC clients.
Utility of study: Evidence generated will contribute to a greater understanding of the incidence of induced abortions and the magnitude and severity of abortion-related complications. The evidence will support investment and decision-making toward addressing the contributors of unsafe abortions and unintended pregnancies, improving access to quality PAC services, and ultimately improving adolescent and maternal health in Kenya.

Version

Version Date
2024-11-11
Version Notes
N/A

Scope

Keywords
Keyword
Abortion
Induced Abortion
Spontaneous Abortion
Safe abortion
Unsafe Abortion

Coverage

Geographic Coverage
National coverage
Unit of Analysis
women receiving treatment for abortion complications
Universe
Women receiving post abortion care (patient survey) and their care providers (providers' survey).

Producers and sponsors

Authoring entity/Primary investigators
Agency Name Affiliation
Kenneth Juma African Population and Heath Research Center
Producers
Name Affiliation Role
Margaret Giorgio Guttmacher Institute Co-Investigator and a Senior Research Scientist
Yohannes Dibaba Wado African Population and Heath Research Center Co-Investigator and a Senior Research Scientist
Jesse Philbin Guttmacher Institute Senior Research Associate
Sherine Athero African Population and Heath Research Center Research Officer
Esther Mutuku African Population and Heath Research Center Data analyst
Boniface Ushie African Population and Heath Research Center Co-Investigator and an expert researcher
Hellen Akinyi African Population and Heath Research Center Data Documentarist
Isaiah Akuku African Population and Heath Research Center Data Manager
Bonface Ingumba African Population and Heath Research Center Data Governance Officer
Funding Agency/Sponsor
Name Abbreviation Role
Hewlett Foundation Funder
Norwegian Agency for Development Cooperation NORAD Funder
Other Identifications/Acknowledgments
Name Affiliation Role
Ministry of Health,Kenya MOH Ministerial partners

Sampling

Sampling Procedure
The sampling strategy for the PMS is drawn from a representative sample of Levels II-IV health facilities to prospectively observe for 30 days for women admitted or seen for PAC in Kenya. Inclusion of all Level V and VI facilities. A randomized sample was drawn of Level II-IV facilities from within the Health Facility Survey facility list. We aimed to observe 430 facilities in total for the PMS. Within the selected health facilities, all women admitted or treated for post-abortion complications during the 30 days were recruited and interviewed by relevant healthcare providers in charge of PAC. The healthcare providers recruited patients at the point of service and interview those who consent to participate about their reproductive history and their abortion pathways. Interview was also done on their providers to explore the nature of their complications and the treatment offered. In addition, the data collectors accessed the medical charts of the PAC patients to extract data related to reported diagnoses, laboratory measurements, and management procedures undertaken.
Deviations from the Sample Design
There were several deviations from the sample,these included facilities that were not sampled but data was collected from them and others were sampled but data was not collected. we also had other facilities that were nonresponce due to the following reasons:facility closed down, facility does not exist, facility is non operational, facility does not offer post abortion care, insecurities reason and facility does not offer sexual reproductive health services.
Response Rate
79.8%
Weighting
The weighting process ensured accurate representation of the universe by addressing ineligibility, nonresponse, and misclassification. The list of participating facilities was obtained from PMS, MRR, and tally sheets. Facilities at levels 5 and 6 that did not respond to the Health Facility Survey (HFS) were excluded. The universe was corrected based on the percentage of sampled facilities that did not offer PAC (Post Abortion Care), with adjustments stratified by region and level. Misclassified facilities were reassigned to their correct levels to refine the universe. Additionally, the universe was adjusted to account for ineligible facilities or those not participating in certainty-sampled levels (levels 2). Adjusted universe sizes were recalculated for each region and level using the formula: Adjusted universe size = original universe size × (1 - ineligibility rate). Where ineligibility rate is the proportion misclassified.
Sampling weights were recalculated using the corrected universe sizes derived from the HFS sample frame. For HFS, the sample weight was calculated as sample weight = corrected universe size / sample size. The HFS composite weight therefore incorporated misclassification adjustment (PAC provision) and non-response weights adjustment. For PMS, the sample weight was calculated as sample weight = HFS sample size / PMS sample size. Participation weights were also calculated to account for facilities responding to the HFS.
Composite weights integrated sampling, participation, and survey response adjustments. For Component 2, the composite weight incorporated weights from HFS and was calculated as PMS composite weight = PMS sample weight × Participation weight × HFS composite weight. This final adjusted composite weight accounted for sampling design, survey participation, and nonresponse adjustments.

Data Collection

Dates of Data Collection (YYYY/MM/DD)
Start date End date
2023-06-07 2023-09-22
Mode of data collection
Face-to-face [f2f]
Supervision
The Interview was conducted by a team of field interviewers. Each team included 6 interviewers, in addition to 1 team lead.

The supervisor's role was to coordinate field data collection and manage teams. They also assigned tasks to interviewers, spot-checked work, maintained control documents, and sent completed questionnaires and progress reports to the central data portal.
Frequent Field visits were made after every two weeks for period of data collection by the Kenya abortion members
Type of Research Instrument
The questionnaire was written in english with a primary purpose of the PMS was to provide the data necessary to describe the characteristics of women receiving treatment for abortion complications, the type of treatment received for complications, and the delays in access to post-abortion care. Since the completeness of medical records for PAC patients varied from facility to facility, the PMS relied on a facility-based, prospective approach for data collection. The study population were women receiving PAC (patient survey) and their care providers (providers' survey).

Data Processing

Cleaning Operations
the software used was survey CTO for data colllection, the data was later downloaded in STATA format.
Other Processing
N/A

Data Appraisal

Estimates of Sampling Error
N/A

Data access

Contact
Name Affiliation Email
African Population and Heath Research Center APHRC datarequest@aphrc.org
Conditions
All non-APHRC staff seeking to use data generated at the Center must obtain written approval to use the data from the Director of Research. This form is developed to assess applications for data use and facilitate responsible sharing of data with external partners/collaborators/researchers. By entering into this agreement, the undersigned agrees to use these data only for the purpose for which they were obtained and to abide by the conditions outlined below:

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"This research uses livelihoods data collected under the longitudinal Nairobi Urban Health and Demographic Surveillance System (NUHDSS) since 2006. The NUHDSS is carried out by the African Population and Health Research Center in two slums settlements (Korogocho and Viwandani) in Nairobi City."

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Citation requirement
Use of the dataset must be acknowledged using a citation which would include:
- the Identification of the Primary Investigator
- the title of the survey (including country, acronym and year of implementation)
- the survey reference number
- the source and date of download

Metadata production

Document ID
DDI-KEN-APHRC-KAS-PMS-2022-v1.0
Producers
Name Abbreviation Role
African Population and Health Research Center APHRC Documentation of the DDI
Date of Production
2024-11-11
Document version
Version 1.0(NOVEMBER 2024)