NEW YORK (Thomson Reuters Foundation)- Kenya has one of the highest national abortion rates in the world and most abortions are unsafe, constituting a leading cause of preventable injury and death among women, a report by the Kenyan health ministry said.
There were nearly 465,000 induced abortions in Kenya last year, virtually all of them "clandestine" and unsafe procedures, the report said.
It put the Kenyan abortion rate at 48 per 1,000 women of reproductive age (15-49). This compares to a global abortion rate of 28 per 1,000 women and a rate of 29 per 1,000 women in Africa in 2008, according to the most recent figures available.
In addition, nearly 120,000 women in Kenya received care for complications resulting from from unsafe abortions in 2012.
"More than three-quarters of women who sought post-abortion care were treated for moderate or severe complications, including high fever, sepsis, shock, or organ failure," the report said. The severity of the complications often was exacerbated by delays in seeking care, the report found.
The most dangerous cases involved women aged 19 or younger, 45 percent of whom exhibited severe complications when they came to a health facility for post-abortion care.
Kenya's abortion laws were slightly loosened in 2010 under a new constitution. Previously, abortion was illegal unless three doctors, including a psychiatrist, certified that it was necessary to save the life of the mother, a requirement often difficult to meet, especially in rural areas where medical professionals are in short supply.
Under the new law, the opinion of only one healthcare professional is needed to decide that abortion is necessary because it is an emergency or because a woman's physical or mental health is endangered by the continuation of the pregnancy.
Unsafe abortion continues to be a leading cause of maternal morbidity and mortality in Kenya, claiming the lives of 266 women per 100,000 unsafe procedures. The mortality rate in developed regions is 30 per 100,000 unsafe abortions compared to about 460 per 100,000 unsafe procedures on the African continent.
Many women received unsafe abortions at the hands of untrained "clandestine" providers, due to fear of stigma or the inaccessibility of health facilities.
However, the report also found that less safe abortion procedures, such as dilation and curettage, remain in use in some Kenyan healthcare facilities, suggesting that improvement in the quality of care is needed.
Seven in 10 Kenyan women reported that they were not using modern contraception at the time of their pregnancy and one-third indicated to health providers that they had "interfered with the continuation of their pregnancy" before arriving at the healthcare facility, the report said.
"The high rate of induced abortion is associated with the high levels of un-met need for family planning and high unintended pregnancy among women in the country," the report said, noting that in 2008-2009 about 43 percent of births to women aged 15 to 49 were reported as unplanned.
Contraceptive use in Kenya was limited by a number of factors included affordability, accessibility, fear of side effects, stigma and cultural pressure, the study found.
"It is clear from the evidence in this report that improving women's access to affordable and effective family planning and/or contraception is key to preventing unintended pregnancy and unsafe abortion," Dr Francis Kimani, director of medical services for Kenya's Ministry of Health, wrote in his forward to the report.
Guttmacher Institute, a U.S.-based sexual and reproductive health research, policy and education organization and Ipas, a U.S.-based NGO concerned with safe abortion, assisted the African Population and Health Research Center and other Kenyan agencies with the report "Incidence and Complications of Unsafe Abortion in Kenya", issued in Nairobi on Wednesday.