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Status of Maternal Health and Unsafe Abortion in Kenya


... infertility, traumatic pelvic injuries, obstetric paralysis, chronic PID, depression and ... prevent future unsafe abortion Counselling in early ... – PowerPoint PPT presentation

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Title: Status of Maternal Health and Unsafe Abortion in Kenya

Status of Maternal Health and Unsafe Abortion in
  • Prof Japheth Mati
  • Presented at
  • Stakeholders  Consultative Meeting on
  • for the reduction of morbidity and mortality from
  • Fairview Hotel, 28 September, 2011

September a rich month for maternal health news!
  • Dadaab- a Daily Prayer for Complication-Free
  • 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//

  • 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,

  • Elusive Joy for Mothers and Babies as Cartels Run
  • 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
  • Daily Nation on the Web 24 September 2011,

  • 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

  • Indicators of
  • Maternal Health in Kenya

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)
Fertility preferences among currently married
women (KDHS 2008-09)
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
  • 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

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

  • Unsafe Abortion

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.

A significant proportion of pregnancies are
unintended or mistimed.
Source SPECTRUM 2.38 Projections
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.

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
Thank you