Severity and management of postabortion complications in Kenya: results from a nationally representative cross-sectional survey.

Abstract

A nationally representative cross-sectional survey evaluating 4,666 postabortion care (PAC) cases across 367 health facilities in Kenya demonstrates a significant decline in severe postabortion complications over the past decade, with severe maternal outcomes comprising 1.4% and potentially life-threatening complications accounting for 16.4% of cases, while mild complications doubled to 53.6%. Manual or electric vacuum aspiration remained the predominant uterine evacuation method (65.2%), though 11.7% of patients received no surgical or medical evacuation procedure. Multivariate analysis revealed that economic vulnerabilities including low educational attainment, inability to meet basic household needs, and food insecurity as well as the use of non-recommended abortion methods and experiencing delays by seeking care elsewhere prior to facility arrival, significantly increased the incidence of severe complications. While expanded primary healthcare and increased access to informal medication abortion have substantially reduced severe morbidity compared to 2012 benchmarks, severe complications remain an avoidable risk that necessitates targeted public health interventions to enhance community awareness of safe abortion practices and expand access to affordable reproductive healthcare.