Top

BMC Pregnancy and Childbirth

Published in:

Open Access 01-12-2016 | Research article

Previous induced abortion among young women seeking abortion-related care in Kenya: a cross-sectional analysis

Authors: Caroline W. Kabiru, Boniface A. Ushie, Michael M. Mutua, Chimaraoke O. Izugbara

Published in: BMC Pregnancy and Childbirth | Issue 1/2016

Abstract

Background

Unsafe abortion is a leading cause of death among young women aged 10–24 years in sub-Saharan Africa. Although having multiple induced abortions may exacerbate the risk for poor health outcomes, there has been minimal research on young women in this region who have multiple induced abortions. The objective of this study was therefore to assess the prevalence and correlates of reporting a previous induced abortion among young females aged 12–24 years seeking abortion-related care in Kenya.

Methods

We used data on 1,378 young women aged 12–24 years who presented for abortion-related care in 246 health facilities in a nationwide survey conducted in 2012. Socio-demographic characteristics, reproductive and clinical histories, and physical examination assessment data were collected from women during a one-month data collection period using an abortion case capture form.

Results

Nine percent (n = 98) of young women reported a previous induced abortion prior to the index pregnancy for which they were receiving care. Statistically significant differences by previous history of induced abortion were observed for area of residence, religion and occupation at bivariate level. Urban dwellers and unemployed/other young women were more likely to report a previous induced abortion. A greater proportion of young women reporting a previous induced abortion stated that they were using a contraceptive method at the time of the index pregnancy (47 %) compared with those reporting no previous induced abortion (23 %). Not surprisingly, a greater proportion of young women reporting a previous induced abortion (82 %) reported their index pregnancy as unintended (not wanted at all or mistimed) compared with women reporting no previous induced abortion (64 %).

Conclusions

Our study results show that about one in every ten young women seeking abortion-related care in Kenya reports a previous induced abortion. Comprehensive post-abortion care services targeting young women are needed. In particular, post-abortion care service providers must ensure that young clients receive contraceptive counseling and effective pregnancy prevention methods before discharge from the health care facility to prevent unintended pregnancies that may result in subsequent induced abortions.

Sedgh G, Singh S, Shah IH, Åhman E, Henshaw SK, Bankole A. Induced abortion: incidence and trends worldwide from 1995 to 2008. Lancet. 2012;379(9816):625–32. doi:10.1016/S0140-6736(11)61786-8.CrossRefPubMed

World Health Organization (WHO). Unsafe abortion: global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008. Geneva: WHO; 2011.

Grimes DA, Benson J, Singh S, Romero M, Ganatra B, Okonofua FE, et al. Unsafe abortion: the preventable pandemic. Lancet. 2006;368(9550):1908–19.CrossRefPubMed

Ministry of Health. Kenya national post abortion care curriculum: Trainer’s manual. Nairobi: Ministry of Health; 2003.

Evens E, Otieno-Masaba R, Eichleay M, McCarraher D, Hainsworth G, Lane C, et al. Post-abortion care services for youth and adult clients in Kenya: a comparison of services, client satisfaction and provider attitudes. J Biosoc Sci. 2014;46(1):1–15. doi:10.1017/S0021932013000230.PubMed

Herrick A, Kuhns L, Kinsky S, Johnson A, Garofalo R. Demographic, psychosocial, and contextual factors associated with sexual risk behaviors among young sexual minority women. J Am Psychiatr Nurses Assoc. 2013;19(6):345–55. doi:10.1177/1078390313511328.CrossRefPubMed

Zolna M, Lindberg L. Unintended pregnancy: Incidence and outcomes among young adult unmarried women in the United States, 2001 and 2008. New York: Guttmacher Institute; 2012.

Hubacher D, Olawo A, Manduku C, Kiarie J, Chen P-L. Preventing unintended pregnancy among young women in Kenya: prospective cohort study to offer contraceptive implants. Contraception. 2012;86(5):511–7. doi:http://dx.doi.org/10.1016/j.contraception.2012.04.013.CrossRefPubMed

Mumah J, Kabiru CW, Mukiira C, Brinton J, Mutua M, Izugbara C, et al. Unintended pregnancies in Kenya: a country profile [STEP UP Research Report]. Nairobi: African Population and Health Research Center; 2014.

10.

Center for Reproductive Rights. The World’s Abortion Laws 2016. 2016. http://worldabortionlaws.com/index.html. Accessed 17 Feb 2016.

11.

African Population and Health Research Center (APHRC), Ministry of Health (MOH), Ipas, Guttmacher Institute. Incidence and complications of unsafe abortions in Kenya: Key findings of a national study. Nairobi: APHRC, MOH, Ipas, Guttmacher Institute; 2013.

12.

Collier J. The rising proportion of repeat teenage pregnancies in young women presenting for termination of pregnancy from 1991 to 2007. Contraception. 2009;79(5):393–6. doi:10.1016/j.contraception.2008.11.014.CrossRefPubMed

13.

Tietze C. Repeat Abortions--Why More? Fam Plann Perspect. 1978;10(5):286–8. doi:10.2307/2134382.CrossRefPubMed

14.

Fisher WA, Singh SS, Shuper PA, Carey M, Otchet F, MacLean-Brine D, et al. Characteristics of women undergoing repeat induced abortion. CMAJ. 2005;172(5):637–41. doi:10.1503/cmaj.1040341.CrossRefPubMedPubMedCentral

15.

Thapa S, Neupane S. Risk factors for repeat abortion in Nepal. Int J Gynaecol Obstet. 2013;120(1):32–6. doi:10.1016/j.ijgo.2012.07.016.CrossRefPubMed

16.

Heikinheimo O, Gissler M, Suhonen S. Age, parity, history of abortion and contraceptive choices affect the risk of repeat abortion. Contraception. 2008;78(2):149–54. doi:http://dx.doi.org/10.1016/j.contraception.2008.03.013.CrossRefPubMed

17.

Stone N, Ingham R. Who presents more than once? Repeat abortion among women in Britain. J Fam Plann Reprod Health Care. 2011;37(4):209–15. doi:10.1136/jfprhc-2011-0063.CrossRefPubMed

18.

St John H, Critchley H, Glasier A. Can we identify women at risk of more than one termination of pregnancy? Contraception. 2005;71(1):31–4. doi:10.1016/j.contraception.2004.07.003.CrossRefPubMed

19.

Prager SW, Steinauer JE, Foster DG, Darney PD, Drey EA. Risk factors for repeat elective abortion. Am J Obstet Gynecol. 2007;197(6):575.e1–6. doi:10.1016/j.ajog.2007.04.007.CrossRef

20.

Rose SB, Lawton BA. Impact of long-acting reversible contraception on return for repeat abortion. Am J Obstet Gynecol. 2012;206(1):37.e1–e6. doi:10.1016/j.ajog.2011.06.102.CrossRef

21.

Ngo TD, Keogh S, Nguyen TH, Le HT, Pham KHT, Nguyen YBT. Risk factors for repeat abortion and implications for addressing unintended pregnancy in Vietnam. Int J Gynaecol Obstet. 2014;125(3):241–6. doi:http://dx.doi.org/10.1016/j.ijgo.2013.11.014.CrossRefPubMed

22.

Ziraba AK, Izugbara C, Levandowski BA, Gebreselassie H, Mutua M, Mohamed SF, et al. Unsafe abortion in Kenya: a cross-sectional study of abortion complication severity and associated factors. BMC Pregnancy Childbirth. 2015;15(1):34.CrossRefPubMedPubMedCentral

23.

Mentula MJ, Niinimäki M, Suhonen S, Hemminki E, Gissler M, Heikinheimo O. Young age and termination of pregnancy during the second trimester are risk factors for repeat second-trimester abortion. Am J Obstet Gynecol. 2010;203(2):107.e1–e7. doi:http://dx.doi.org/10.1016/j.ajog.2010.03.004.CrossRef

24.

Ali MM, Cleland J, Shah IH. Causes and consequences of contraceptive discontinuation: evidence from 60 demographic and health surveys. Geneva: World Health Organization; 2012.

25.

Dodoo FN, Zulu EM, Ezeh AC. Urban–rural differences in the socioeconomic deprivation-sexual behavior link in Kenya. Soc Sci Med. 2007;64:1019–31.CrossRefPubMed

26.

Kabiru CW, Beguy D, Undie C, Zulu E, Ezeh AC. Transition into first sex among adolescents in slum and non-slum communities in Nairobi, Kenya. J Youth Stud. 2010;13(4):453–71.CrossRefPubMedPubMedCentral

27.

Kamndaya M, Thomas L, Vearey J, Sartorius B, Kazembe L. Material deprivation affects high sexual risk behavior among young people in urban slums, South Africa. J Urban Health. 2014;91(3):581–91. doi:10.1007/s11524-013-9856-1.CrossRefPubMedPubMedCentral

28.

Stanfors M, Larsson C. Women’s education, empowerment, and contraceptive use in sub-Saharan Africa: findings from recent demographic and health surveys. Afr Pop Stud. 2014;28(2):1022–34.

29.

Altman M, Schöer V, Rama N, editors. Education and youth employment in sub-Saharan countries: Linkages and policy responses. African Economic Research Consortium Workshop on Youth and Unemployment, March 21–22, 2013; 2013; Kigali, Rwanda.

30.

Justad-Berg RT, Eskild A, Strom-Roum EM. Characteristics of women with repeat termination of pregnancy: a study of all requests for pregnancy termination in Norway during 2007–2011. Acta Obstet Gynecol Scand. 2015;94(11):1175–80. doi:10.1111/aogs.12714.CrossRefPubMed

31.

Cohen SA. Repeat abortion, repeat unintended pregnancy, repeated and misguided government policies. Guttmacher Policy Rev. 2007;10(2):8–12.

Title: Previous induced abortion among young women seeking abortion-related care in Kenya: a cross-sectional analysis
Authors: Caroline W. Kabiru
Boniface A. Ushie
Michael M. Mutua
Chimaraoke O. Izugbara
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: BMC Pregnancy and Childbirth / Issue 1/2016
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-016-0894-z

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Previous induced abortion among young women seeking abortion-related care in Kenya: a cross-sectional analysis

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2016

Effect of pregnancy intention, postnatal depressive symptoms and social support on early childhood stunting: findings from India

The influence of physical activity during pregnancy on maternal, fetal or infant heart rate variability: a systematic review

Enoxaparin for the prevention of preeclampsia and intrauterine growth restriction in women with a prior history – an open-label randomised trial (the EPPI trial): study protocol

Urinary iodine and thyroid determinants in pregnancy: a follow up study in Sri Lanka

The status of maternal and newborn health care services in Zanzibar

Perinatal health outcomes of East African immigrant populations in Victoria, Australia: a population based study