Status of Maternal Health and Unsafe Abortion in Kenya

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Status of Maternal Health and Unsafe Abortion in
Kenya

• Prof Japheth Mati
• Presented at
• Stakeholders  Consultative Meeting on
• STANDARDS AND GUIDELINES (SG)
• for the reduction of morbidity and mortality from
  
• UNSAFE ABORTION
• Fairview Hotel, 28 September, 2011

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September a rich month for maternal health news!

• Dadaab- a Daily Prayer for Complication-Free
  Births
• Dr. Beldina Gikundi's daily prayer is that the
  handful of malnourished pregnant Somali women who
  go into labour that day at the Dadaab refugee
  complex do not have complications, which might
  require a caesarean section.
• IPS News 19 September 2011
• http//allafrica.com/stories/201109200021.html

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• Mbale (Uganda) Doctors Held Over
• Death of Woman in Labour
• Police have arrested and detained six medical
  officers of Mbale Referral Hospital as it
  commenced an investigation into the death of a
  pregnant teacher and her baby two weeks ago.
  Cecilia Nambozo, the deceased, a teacher at
  Busamaga Primary School in Mbale Municipality,
  bled to death allegedly unattended to after
  failing to raise Shs300,000 the medical officers
  had reportedly asked for.
• The Monitor, 21 September 2011,
  http//allafrica.com/stories/201109210443.html

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• Elusive Joy for Mothers and Babies as Cartels Run
  Maternity
• The Report of the Task Force on Pumwani Maternity
  Hospital has been handed over to government
  authorities for action. Corruption, financial
  crisis, lack of critical supplies for mothers and
  babies, mistreatment of mothers, moral and
  ethical decadence, and absenteeism among doctors,
  are highlighted as some of the factors that have
  compromised the quality of services at the
  hospital.
• Daily Nation on the Web 24 September 2011,
  http//allafrica.com/stories/201109250047.html

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• Musyimi Calls for Caution On Abortion
• The Gachoka MP the Rev Mutava Musyimi has called
  for dialogue and inclusion of all stakeholders in
  the on-going debate by the Kenya Medical
  Practitioners regarding safe abortions.
• Nairobi Star (Nairobi) 20 September 2011
  allafrica.com/stories/201109210120.html

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• Indicators of
• Maternal Health in Kenya

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Progress towards achieving MDG 5in Kenya Target
Indicators 2003-2008/9
MDG Target KDHS 2003 KDHS 2008-9
5.1 Maternal Mortality ratio (deaths per 100,000 live births) 414 488
5.2 Proportion of births attended by skilled health personnel () 42 44
5.3 Contraceptive prevalence rate () 39 46
5.4 Adolescent birth rate () 23 18
5.5 Antenatal care coverage (percent made four visits) 54 47
5.6 Unmet need for family planning () 24.5 25.7 (approx 2.4 million women)
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Fertility preferences among currently married
women (KDHS 2008-09)
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Chronic Maternal Morbidity

• Chronic maternal morbidity has received less
  attention compared with maternal mortality
• Long-term physical, psychological, social and
  economic consequences
• Chronic ill-health anaemia, infertility,
  traumatic pelvic injuries, obstetric paralysis,
  chronic PID, depression and impaired
  productivity.
• Obstetric fistula (VVF and/or RVF)
• True incidence and prevalence of OF unknown
• AMREF estimates OF incidence at 3000 new cases
  annually with only 7.5 currently receiving
  treatment.

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Other factors that impact on maternal health

• Sexually transmitted infections have serious
  impacts on SRH which include maternal and
  perinatal morbidity and mortality. HIV/AIDS is a
  leading contributor to maternal mortality.
• Gender-based violence impacts profoundly on
  women's RH- STIs including HIV, unwanted
  pregnancies and unsafe abortion and their
  complications. One woman in four has been abused
  during pregnancy (UNFPA).
• Forced first sexual intercourse reported by 12
  percent of women (KDHS 2008-09) and 55 of
  violated women admitted to the Nairobi Womens
  Hospital are girls aged 0-15 years. SGBV against
  women and girls is a persistent occurrence in
  virtually all violent conflicts.
• Harmful practices early marriage and FGM have
  serious impacts on maternal health- maternal and
  perinatal mortality and morbidity resulting from
  labour complications. Obstetric fistula commonly
  associated with FGM

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• Unsafe Abortion

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Unsafe abortion- a public health concern

• In order to achieve MDG 5 on Improving Maternal
  Health, it is imperative that the issue of unsafe
  abortions is addressed.
• Unsafe abortion is an important contributor to
  the high maternal mortality rates in Kenya
• Granted unsafe abortion is simply one of several
  contributors to MMR, BUT it is one we know how to
  prevent- an important public health principle
• Incidence of unsafe abortion generally reflects
  the magnitude of unwanted pregnancies in any
  particular community.
• Unsafe abortion can be effectively minimized by
  ensuring women have easy access to contraceptive
  services, backed up by a positive legal framework
  that facilitates safe abortion.

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A significant proportion of pregnancies are
unintended or mistimed.
Source SPECTRUM 2.38 Projections
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The dilemma of failed contraception

• Nearly a half of Kenyan women (46) have chosen
  to practice contraception
• For anyone who chooses to practice contraception
  the hope is that it wont fail.
• The realisation that this is not so, though
  infrequent, is what sends the hapless woman
  seeking termination of pregnancy.
• Failure to access SAFE Abortion leaves her the
  option of UNSAFE Abortion
• Ensuring equity in access to safe abortion
  services should be a key public health strategy-
  reaching the marginalised communities, who are
  the main victims of Unsafe abortion.

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The three-tier scheme for the prevention of
abortion related morbidity and mortality
Level of prevention and objectives Interventions
Primary Prevention Prevent unwanted pregnancy a) Contraceptive information and counselling b) Contraceptive services
Secondary Prevention Prevent unsafe abortion Counselling in early pregnancy, respect informed choice Ensure access to safe abortion
Tertiary Prevention Post-abortion care manage complications prevent future unsafe abortion a) Clinical management of complications of unsafe abortion or incomplete abortion b) Contraceptive counselling and services
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Thank you