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Abortion Incidence and Severity of Complications in Kenya 2022, Health Facilities Survey (HFS)

Kenya, 2023
Health and Well-Being (HaW)
Kenneth Juma
Last modified June 10, 2025 Page views 12303 Documentation in PDF Metadata DDI/XML JSON

Identification

IDNO
DDI-KEN-APHRC-KAS-HFS-2022-v1.0
Title
Abortion Incidence and Severity of Complications in Kenya 2022, Health Facilities Survey (HFS)
Subtitle
Health Facilities Survey (HFS)
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Act that defined "trained providers" to include nurses and midwives, and the 2019 High Court ruling that reinstated the withdrawn Standards and guidelines for reduction of maternal mortality from unsafe abortion), policymakers and advocates in Kenya have raised the need for another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
2024-07-05
Version Notes
N/A

Scope

Keywords
Keyword Vocabulary
Abortion This is the safe and legal termination of pregnancy before the fetus is capable of surviving outside the uterus.
Induced Abortion Termination of pregnancy through deliberate medical or surgical intervention. It can be either safe or unsafe.
Spontaneous Abortion Commonly known as a miscarriage. It is the loss of a pregnancy prior to 24 weeks of gestation, that is, before the fetus is usually viable outside the uterus.
Safe abortion This is abortion carried out using a method recommended by WHO, appropriate to the pregnancy duration, by someone with the necessary skills and in an environment that conforms to the required medical standards.
Unsafe Abortion WHO defined unsafe abortion as a procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking minimal medical standards or both.
Post Abortion Care (PAC) Provision of services after an abortion, including management of complications after an abortion, contraceptive counseling and services and linkage to other needed services in the community or beyond.
Incidence of abortion The number of induced abortions occurring in a given population or geographical area over a year.
Abortion rate Number of induced abortions per 1000 women of reproductive age (15-49) in a given population or geographical area over a period of time usually a year.
Abortion ratio Number of induced abortions per 100 live births in a given population or geographical area over a period of time usually a year.
Comprehensive Abortion Care Provision of information, abortion management (including induced abortion and care related to pregnancy loss), and post-abortion care. This is the minimum care referral facilities should be able to provide.
Basic Abortion Care Provision of induced abortion, care related to pregnancy loss, and post-abortion care. This is the minimum service that primary (and higher) facilities should be able to provide.
Maternal morbidity Short- or long-term health complications that result from being pregnant and giving birth.
Maternal mortality The death of a woman from complications of pregnancy or childbirth that occur during the pregnancy or within 6 weeks after the pregnancy ends.
Healthcare system A health system consists of all the organizations, institutions, resources and people whose primary purpose is to improve health. This includes efforts to influence determinants of health as well as more direct health-improvement activities.
Severity of complications This is a classification system used to assess the degree of morbidity of abortion often categorized into five sections; mild, moderate, severe, near miss and death.

Coverage

Geographic Coverage
National coverage
Unit of Analysis
knowledgeable healthcare providers
Universe
Senior health provider, who is knowledgeable about the provision of PAC

Producers and sponsors

Authoring entity/Primary investigators
Agency Name Affiliation
Kenneth Juma APHRC
Producers
Name Affiliation Role
Margaret Giorgio Guttmacher Institute Co-Investigator and a Senior Research Scientist
Yohannes Dibaba Wado APHRC Co-Investigator and a Senior Research Scientist
Jesse Philbin, Guttmacher Institute Senior Research Associate
Sherine Athero APHRC Research Officer
Esther Mutuku APHRC Data Analyst
Boniface Ushie Co-Investigator and a Senior Research Scientist
Hellen Akinyi APHRC Data Documentarist
Isaiah Akuku APHRC Data Manager
Bonface Ingumba APHRC Data Governance Officer
Funding Agency/Sponsor
Name Abbreviation Role
Hewlett Foundation HF 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 study population for the HFS is facilities that should theoretically offer PAC services based on the structure and functional operation of health facilities in Kenya. Health facility levels designated for PAC, according to the Kenya Essential Package of Health (KEPH), range from levels II to VI. These are also the facilities capable of offering normal delivery services to women. As of July 25, 2022, there were 13,931 operational and functional health facilities across Kenya from levels II to VI (capable of providing). Overall, there are six Level VI facilities and 47 Level 5 and county referral hospitals (these include 23 level V and 24 county referral hospitals) (We will include all Level V and VI facilities in the sample), 891 Level IV, 2225 Level III), and 10786 Level II (we will draw a proportionate sample of facilities within Levels II, III and IV). Altogether, we aim for a sample of 750 health facilities for the HFS component. We will divide Kenya into five regions for sampling purposes, following a previously used approach [50][51]. The emerging regions are 1) Coast and North Eastern, 2) Eastern, 3) Nairobi and Central, 4) Nyanza and Western, and 5) Rift Valley.
Within selected facilities, respondents will be those most qualified to answer questions about PAC caseloads and the types of cases seen at the facility. Depending on the facility, these might be senior administrators, heads of the OBGYN ward, or heads of private clinics, including medical doctors, nurses, and midwives.
Deviations from the Sample Design
The initial sample was 766 facilities for the survey. 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.After all the adjustment the remaning sample that was used was 694
Response Rate
The response rate was calculated in all the 5 regions against facility characteristics which included the facility ownership and facility level. The distribution was as follows: For Nairobi and Central we had 91.11, 81.82,80.00 for public, private for profit and private not for profit on the ownership side, for the Level of facility they had 84.62,91.30, 83.13, 83.33 and 66.67 for level 2,3,4,5 and 6 respectively. For Coast & North Eastern we had 100, 97.30 and 100 for public, private for profit and private not for profit on the ownership side, for the Level of facility they had 100,100,
97.78,100 for level 2,3,4 and 5 respectively. For Eastern we had 95.16, 94.74, 93.33 for public, private for profit and private not for profit on the ownership side, for the Level of facility they had 92.59, 100, 93.10,100 for level 2,3,4 and 5 respectively. For Nyanza & Western we had 100, 96.08,100 for public, private for profit and private not for profit on the ownership side, for the Level of facility they had 96, 100, 99.07, 100 for level 2,3,4 and 5 respectively. For Rift Valley we had 97.94, 95.83, 89.47 for public, private for profit and private not for profit on the ownership side, for the Level of facility they had 97.44, 93.55, 97.44, 93.33, 100 for level 2,3,4,5 and 6 respectively. The entries are pecentages.
Weighting
Sample weights were calculated for each of the Study Region focusing on the level of facility per region

Data Collection

Dates of Data Collection (YYYY/MM/DD)
Start date End date Cycle
2023-05-02 2023-06-12 1
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 KAS members
Type of Research Instrument
The questionnaire was written in english with a primary purpose of the HFS is to estimate the number of women who receive treatment in facilities for abortion-related complications.
The HFS will be a statistically representative survey of all health facilities in Kenya classified as having the capacity to provide PAC services. In each selected health facility, a senior health provider, who is knowledgeable about the provision of PAC, is interviewed. Participants are asked whether their facility provides treatment for complications following induced or spontaneous abortions. If the facility provides treatment, they are asked the number of abortion patients (induced and spontaneous abortions (miscarriages), combined) treated in an average month and in the past month. Specifying these two periods aims to increase the likelihood of accurate recall and accounting for month-to-month variation, as there is seasonality to abortions. To produce an estimate for the year, these two numbers are averaged and multiplied by 12.

Data Processing

Cleaning Operations
The software used was survey CTO for data collection which the datasets were directly downloaded from the surver itself to STATA and R Software
Other Processing
N/A

Data Appraisal

Estimates of Sampling Error
N/A

Data access

Contact
Name Email
African Population and Heath Research Center datarequest@aphrc.org
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Metadata production

Document ID
DDI-KEN-APHRC-KAS-HFS-2022-v1.0
Producers
Name Abbreviation Affiliation Role
African Population and Health Research Center APHRC The World Bank DDI Documentation
Date of Production
2024-07-05
Document version
Version 1.0(JULY 2024)