BACKGROUND
In Kenya, the maternal mortality ratio remains high at 488 deaths per 100,000 live births with 35 per cent of
these deaths arising from unsafe abortion. Public debate on abortion and on proposals to liberalize the
abortion law has been on-going for several years in the country. With the passing of a new Constitution in
2010, there was renewed interest in the right to health and the need to reduce the high levels of maternal
morbidity and mortality arising from unsafe abortion in the country. In 2012, for instance, the Government
issued Standards and Guidelines for Reducing Morbidity and Maternal from Unsafe Abortion that emphasized
professional non-judgmental counseling and provision of safe options in cases of unplanned, risky or unwanted
pregnancies in line with the Constitution. The Constitution, on the other hand, stipulates that abortion is
permissible if in the opinion of a trained health professional, there is need for emergency treatment, or the life
or health of the mother is in danger or as determined by any other law. Apart from the legal and policy
discourses, medical abortion using a combination treatment of Mifepristone and Misoprostol has been
classified by WHO as a safe and effective method to stop a pregnancy up to 9 completed weeks since the last
menstrual period i.e. during the first trimester. The two drugs are registered in Kenya for various
indications, including treatment of incomplete abortion and miscarriage, treatment and prevention of
post-partum haemorrhage (PPH), treatment of intrauterine foetal death, cervical ripening, and as a
uterotonic drug to induce or increase uterine contractions. In spite of the developments, there is limited
understanding of the extent to which the changes have influenced the provision of medical abortion
information and services in the country, the acceptability of the practice among providers and clients, and the
content of care offered.
OBJECTIVES
The overall goal of the study was to generate evidence on the availability, use and quality of care for medical
abortion services in private facilities (pharmacies and clinics) in Kenya. The specific objectives of the study
were to: (1) understand the contextual and programmatic factors that influence or are likely to influence the
provision of medical abortion services in Kenya; (2) explore the perspectives (positive and negative) of various
stakeholders about abortion generally and the provision of medical abortion services specifically; (3) assess
the availability of Mifepristone and Misoprostol or other abortifacient as well as the skills and practices of
private providers; (4) examine the knowledge and attitudes of private providers regarding Mifepristone and
Misoprostol or other abortifacients; (5) determine the characteristics, choices and perceptions of clients
seeking abortion services from private clinics; and (6) explore the information and services given to clients
seeking medical abortion services from private pharmacies and clinics. Private facilities were targeted because
access to information and services on medical abortion in Kenya is mainly through private practitioners while
public health facilities mostly provide post-abortion care services. Private clinics are operated by the cadres of
providers that fall within the legal definition of a health professional including doctors, clinical officers, nurses
and midwives while registered pharmacists and enrolled pharmaceutical technologists are the only cadres of
health personnel qualified to dispense medicines and operate private pharmacies in the country.
METHODS
This was a cross-sectional study that was conducted between April and June 2013 in Nairobi, Kisumu and
Mombasa counties. The study involved: (1) key informant interviews with 19 senior managers from national
and locally-based international institutions representing policy, program, research and donor interests in
reproductive health in general and medical abortion in particular; (2) structured interviews with 235 pharmacy
workers in 235 private pharmacies; (3) 401 simulated client visits to 142 private pharmacies whose workers
participated in the structured interviews; (4) structured interviews with 45 in-charges of private clinics; (5) 141
observations of client-provider interactions during consultations in 32 of the 45 private clinics; and (6) 125 exit
interviews with clients seeking abortion services in the 32 private clinics. The interviews with key informants
were transcribed, typed in Word and analysed for content using NVIVO software. Analysis involved coding of
themes and categorizing the themes within a hierarchical framework of main and sub-themes. Quantitative
data from structured interviews with pharmacy workers, simulated client visits to pharmacies, structured
interviews with facility in-charges, observations of client-provider interactions, and exit interviews with clients
were entered in EpiData and analysed using STATA. Analysis involved simple descriptive statistics including
percentages, means and medians.