Pregnant despite protection: Startling data on contraceptive failures in Kenya
A woman uses emergency pill. One in three women using emergency contraceptive pills conceives, according to research findings.
What you need to know:
- Study reveals urgent need for contraception access, education, and improved post-abortion care nationwide.
- High abortion rates linked to contraceptive failures, access issues, stigma, and limited post-abortion care.
One in three women using emergency contraceptive pills and injectables gets pregnant, according to new research findings.
A report by the Africa Population and Health Research Centre (APHRC) shows that 35 per cent of women on emergency contraceptive pills conceive, as do 31 per cent of those on injectables. Titled Incidence of Induced Abortions and the Severity of Abortion-related Complications in Kenya, it says that in 2023, unintended pregnancies were 1,435,988.
The other contraceptives include implants, condoms, intrauterine devices, tubal ligation, vasectomy and natural family planning. The report did not cover the percentage of women using these methods.
The study also reveals that among women who were not using contraception, 42 per cent cited fear of side-effects, later pregnancy failures, or other health concerns. About two-thirds said they did not use any contraceptive because they wanted to get pregnant or opposed family planning. About 17 per cent said they were interested in using a method but needed more time to consult with their partner, decide on which method to use, or wait until their body recovered from pregnancy loss.
The study, whose findings were released a fortnight ago, interviewed 2,022 women from Nairobi, Kisumu, Mombasa and Nakuru counties on their abortion experience and post-abortion care seeking behaviour. It was conducted between April 2023 and May 2024 by APHRC, the Norwegian Agency for Development Cooperation, and Guttmacher Institute. Its findings lift the lid off abortion, revealing that 792,694 women in Kenya procured an abortion in 2023. This number accounted for 57.3 per cent induced abortions per 1,000 women aged 15–49.
Post-abortion care
The report further indicates that many women going to hospital for post-abortion care did not leave the health facilities with a contraceptive because of service availability and quality issues. Some 12.7 per cent of this group did not receive counselling about contraception and a further 3.4 per cent reported staffing shortages or stock-outs of their preferred contraceptive.
The Health Director General, Dr Patrick Amoth, says the survey provides a compelling rationale that expanding access to modern and effective family planning and contraception services is essential to preventing unintended pregnancy and unsafe abortion. “Investing in access to effective family planning and contraception would generate critical gains, including a return on investment by eliminating the significant resources expended while providing treatment for complications for unsafe abortion,” he says.
Kenneth Juma, a senior research officer at APHRC and study project lead, notes that stigma associated with young women seeking contraception is largely to blame for some of the abortion cases. “Society takes young women seeking contraceptive services as being immoral, yet they are sexually active. The government needs to conduct community education on contraception and ensure access to post-abortion care is available and affordable,” he says.
Among the 2,022 women interviewed, a striking 58 per cent (1,138) were married. Of this number, 32 per cent had given birth to two or three children. Women aged 25–34 represented the largest demographic group, contradicting stereotypes that abortion primarily affects younger, unmarried women. Abortion rate was highest in Nairobi and Central (78.3 per 1,000), followed by Nyanza and Western (69.4), and Eastern (55.6). Coast and North-Eastern had the lowest abortion rate of 38.7 per 1,000 women of reproductive age.
Margaret Giorgio, a research scientist at Guttmacher, observes that some women opposed contraception citing health complications, while others said they wanted to become pregnant soon. “Many women said they aborted as they were not ready to get a child at the time they got pregnant. Most of those women seeking post-abortion care were married women,” she says.
She notes that while 92 per cent of post-abortion care patients received family planning counselling, 56 per cent of them left without a contraceptive method. The study also exposes the unpreparedness of health facilities to deal with post-abortion care. Only 18 per cent of level 2 and 3 facilities can offer post-abortion care, thus putting thousands of women at risk, it says. It indicates that only 24 per cent of referral facilities can offer comprehensive post-abortion care.
Overall, 21 per cent of health facilities (level 2 and 3 facilities) expected to provide post-abortion care did not provide them. Providing more than three types of short-acting contraceptives methods was a key reason many facilities did not qualify to offer basic post-abortion care. Notably, more primary facilities provided this than referral facilities (70 vs 64 per cent) and stock-outs were a major driver of this gap.
Only one in seven level 2 (14 per cent) and one in three level 3 facilities (31 per cent) could deliver all the components of basic post-abortion care. The study also found that only 8.0 per cent of private non-profit or faith-based facilities and 14 per cent of public facilities could provide all basic post-abortion care.
