African Woman and Child Feature Service

A recent study at Kenyatta National Hospital has found close to two-thirds of those seeking post-abortion care services at the facility to be married women, demolishing the long held belief that this was a practice popular among unmarried or single women.

About 62 percent of the women who sought post-abortion care services and participated in the study were in a marriage union. They were followed by single women (22 percent), divorced or separated (12 percent) and widowed (4.4 percent). The high numbers of married women seeking post-abortion care services raises many issues.

One of it is it confirms the fact that the high unmet need of family planning in the country is making this women get unintended pregnancies that they later on abort. According to the most recent Kenya Demographic Health Survey, 2003, about 25 percent of the married women in Kenya have unmet need for family planning, 14 percent have unmet need for spacing and 10 percent have unmet need for limiting the number of children they desire.

The high number of married women procuring an abortion may also mean cases of infidelity are on the rise with women and men seeking to cover their tracks by flushing-out the fetuses before their spouses or partners discover. While the other reason might be the couple agrees to procure an abortion because they might not be able to cater for an extra mouth.

Equally glaring in the study, Acceptability of rapid HIV Test Screening Among Patients Presenting with Incomplete Abortion at Kenyatta National Hospital, is the education level of the women who present at the hospital with incomplete abortion.

Over 64 percent had primary level of education, 29 percent had secondary education, while about 7 percent had university or college education. Another shocking findings was 119 of the women were procuring an abortion for the second time, 15 were doing so for the third time; and 3 women were having their fourth abortion.

This vindicates pro-safe-abortion advocates who argue that making the practice illegal does not stop women from procuring an abortion. Instead, a broadened legal environment that allows women to access safe abortion when they need it can help the government to reach these women and even prevent repeat abortions.

Reproductive health experts argue these statistics shows those who procure first or repeated unsafe abortions with quacks and then rush to KHN for specialized attention are poor women with low education. The AWC learnt that a number of doctors in the city usually prescribe to these poor women abortion drugs or initiate the process, and then ask them to rush to KNH when they start bleeding.

Those with secondary or university education have some sources of income and are able to afford safe abortion from qualified medics whose charges are high and beyond reach of the poor women. Over 60 percent of the admissions in the hospital’s gynecology ward are women with incomplete abortions. Majority of them are poor. “Unsafe abortion is a problem of the poor and not the rich. There many cases married and working women have been willing to pay us gynecologists anything as long we can guarantee a safe abortion,” said a gynecologist who practices at one of the leading private hospitals in the city and who preferred not be named for the sake of his patients.

The study, which was designed to establish the HIV status of the women coming with incomplete abortions, also found a high number of those seeking post-abortion care services to be HIV positive.

HIV prevalence among women who presented with incomplete abortion stood at 31.8 percent, four times more than the national prevalence of 7.1 percent.

“The high prevalence level is worrying especially because majority of these women had not had an HIV test before,” says Dr Kizito Lubano, the supervisor of Dr Henry Chege, the student who conducted the study as part of fulfillment of his Masters Degree.

Of the 93 women who presented with incomplete abortion and who agreed to be tested for HIV, 27 returned positive results. Majority of them were married and young.

According to the study over 80 percent of them were aged between 15 and 29 years, indicating young women are not having safe sex with their sexual partners. Besides being young, they had primary level of education. Of the 27 who tested positive, 21 had attained only primary education, five had secondary education and one had university education.

The findings puts KNH hospital in a difficult situation where it has to not only invest huge sums of human and financial resources in managing the complication of unsafe abortion, but to also cater for the HIV needs of these women. Doctors attending to these women will have to handle differently from the previous practice.

“This levels of HIV prevalence among post-abortion care clients shows an opportunity where many infected could be identified and linked to prevention, care, and treatment programmes,” adds Dr Chege et al.

The researchers now propose for the integration of rapid HIV testing in the post-abortion care; provider initiated testing be encouraged, and HIV prevention messages to be disseminated at the primary school level, among others.

The HIV tests on women who participated in the study were conducted on voluntary basis, without the women being forced to go through them, say the researchers. Since majority, 67.9 percent of the 137 patients who studied agreed to know their HIV status, the scientists believe it would be easy to have the women tested if it is integrated in the post-abortion care services.

“Voluntary rapid HIV testing should be integrated into the post abortion care services as it is acceptable and the high HIV prevalence among post-abortion care clients provides an opportunity for linking to treatment programmes,” said the scientists while presenting their findings at the East, Central and Southern Africa Association of Obstetrical and Gynaecological Societies forum held recently in Mombasa.

What is however worrying is 65 percent of these women had not had an HIV test before. And perhaps had sex with men who also believed that they were HIV negative. The Kenya Aids Indicator Survey released last year found out that more than half of the Kenyan women and 75 percent of the men have not had an HIV test. Only 50 percent of urban residents and 29 percent of those in the rural areas had been tested for HIV by the time the study was being conducted.

Many of these are infected, and continue to infect other people secure in the belief that they are negative. The other painful confirmation being made by this study is majority of the young people are having unprotected sex exposing themselves to unwanted pregnancies and HIV or other viral infections.