AGE SPECIFIC PRACTICES AND OUTCOMES IN WOMEN UNDERGOING UNSAFE ABORTIONS IN A RURAL COMMUNITY OF KENYA Joachim Osur Alloys Orago Isaac Mwanzo Elizabeth Bukusi

BACKGROUND AND PROBLEM STATEMENTBACKGROUND AND PROBLEM STATEMENT Unsafe abortions: – Cause 13% of maternal deaths in the world, 90% being in developing countries – In Kenya it is estimated that 465,000 unsafe abortions happen annually – Result in complications requiring hospitalization in over 20,000 women in Kenya annually

BACKGROUND AND PROBLEM STATEMENTBACKGROUND AND PROBLEM STATEMENT Severity of complications dependent on unsafe abortion practices The practices could be age dependent, call for age specific interventions Yet little is known about how age influences these practices This made this study necessary

STUDY OBJECTIVESSTUDY OBJECTIVES 1.To establish the reproductive profiles of women aborting unsafely 2.To identify age specific unsafe abortion practices 3.To determine age specific outcomes of unsafe abortion

MATERIALS AND METHODSMATERIALS AND METHODS Study Location: 3 public and 3 private health facilities offering PAC services in Siaya County Study design - Cross-sectional survey Sampling size calculation women undergoing abortions unsafely Distinguished using a set of criteria Sampling method - purposively and consecutively recruited if qualified according to the criteria for unsafe abortion

CRITERIA FOR UNSAFE ABORTIONCRITERIA FOR UNSAFE ABORTION CLINICAL FINDINGSDIAGNOSISCONCLUSION Temp <=37.2°C And no clinical signs of infection And no system or organ failure And no suspicious findings on evacuation Unlikely to be induced abortion Consider as spontaneous abortion unless the history suggests otherwise Temp °C Or offensive products Or localized peritonitis Likely to be induced abortion Consider as induced abortion unless history suggests otherwise Temp >=38°C; Or organ or system failure Or generalized peritonitis Or pulse >=120 beats/min; Or shock Or foreign body or mechanical injury on evacuation or self confession Highly likely to be induced abortion Treat as induced abortion

RESULTS Characteristics of women aborting unsafely 76% between 10 and 24 yrs (n = 243) 62% nulliparous (n = 199) 85% in first trimester (n = 272) All having PV bleeding at admission Other common symptoms – abdominal pain, fever, offensive products of conception 84% did not want to be pregnant, 14% unsure, 2% wanted to be pregnant

ReasonFrequency Proportion (%) Still in school/college Single, hoping to marry in future Man who caused pregnancy has a wife Protect man from embarrassment Parents will not tolerate the pregnancy507.4 Too young to be a parent466.8 Relationship problems355.2 Single and having other child/children274.0 Others263.8 Total Reasons for Unsafe Abortion

DECISION MAKING PROCESS FOR UNSAFE ABORTIONDECISION MAKING PROCESS FOR UNSAFE ABORTION Majority (88%) of women sought advice directly, 7% indirectly on what to do with pregnancy Logistic regression: type of person influencing the woman to abort unsafely made a significant contribution to the prediction (p =.022) Mother and man causing pregnancy greatest influencers

Younger person consulted a wider variety of social Contacts before deciding on unsafe abortion

ADVICE BY SOCIAL CONTACTSADVICE BY SOCIAL CONTACTS Social contacts: – advised on abortion 92% of the time – told woman to decide for herself 5.5% of the time – advised against abortion 2.2% of the time

Following consultation with social network: – 67% (n=213) owned decision to abort – 22% (n=73) said it was not their decision – 11% (n=34) were not sure of decision ownership – The main influencers in owning decision to abort – age, number of previous deliveries: younger person with fewer deliveries easier to influence (P≤ 0.05) Women’s Response to Advice by Social Contacts

METHODS USED TO PROCURE UNSAFE ABORTIONSMETHODS USED TO PROCURE UNSAFE ABORTIONS Methods used: First line method used Number of WomenProportion (%) Oral conventional medication Conventional medication self inserted into vagina309.4 Oral herbs226.9 Use of gadgets by self through the vagina134.1 Use of gadgets by someone else through the vagina72.2 Injection41.3 Others92.7 Method not known (possibly herbs)257.8 Total

CHOICE OF METHODCHOICE OF METHOD Range of methods used was dependent on age of woman, younger women tending to use a wider variety (p ≤ 0.05) There was no significant difference in choice of methods for 1 st and 2 nd trimester pregnancies (p = 0.19)

OUTCOMES OF UNSAFE ABORTIONOUTCOMES OF UNSAFE ABORTION Type of complication Number of womenPercent Death10.3 Hemorrhage requiring transfusion41.3 Haemorrage not requiring transfusion Pelvic infection185.6 Lower genital tract injury154.7 No complication Total Significant age difference in frequency of complications, tendency to be affected higher the younger the person (p≤ 0.05)

CONCLUSION The younger the person the easier it was to be influenced to abort unsafely Younger age associated with multiplicity of abortion methods Complications of unsafe abortion commoner the younger the age of the woman Complications severer the younger the age of the woman

RECOMMENDATIONS Preventing unwanted pregnancies in younger women be prioritized to avoid the risk of unsafe abortions Build skills of young people on how to deal with unwanted pregnancy to avoid catastrophic outcomes