Post Abortion Care[PAC] Study

This project is being conducted by K-MET and Karolinska Institutet. The project is taking place at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) and Kisumu District Hospital 8KDH) in Kisumu East District, Kisumu County of Nyanza Province in Western Kenya.

Unsafe abortion is defined by WHO as a procedure for terminating an unintended pregnancy either carried out by people lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both. Emergency treatment of complications from unsafe abortion as well as from spontaneous abortion, Post Abortion Care (PAC), is identified as an effective intervention to decrease maternal mortality globally.

In Kenya, PAC, provided by physicians, nurse-midwives and clinical officers, has been integrated at private reproductive health facilities since 1998. Misoprostol as treatment of incomplete abortion was launched I Nyanza Province in April, 2012. The involvement of midwives in medical (Misoprostol) treatment of incomplete abortion has, however, not been systematically evaluated. There is a need to determine whether midwives and physician can perform medical treatment of incomplete abortion equally safe and effective in Kenya.

It is estimated that 70,000-100,000 women die every year due to consequences of unsafe abortion. Complications from spontaneous abortions add to these mortality figures. The majority of pregnancy related deaths occur in low-income countries where induced abortion is restricted, unmet need for contraception high, and women’s status in society low. It is estimated that Africa caters for the highest rates of unsafe abortions globally. Family planning and increased access to safe abortion services are key interventions identified to achieve the Millennium Development Goal number five (MDG5).

The aim of this project is to study the safety, efficacy and effectiveness of medical treatment of incomplete abortion provided to women by physicians or midwives in Kisumu, Kenya. Also to study the outcome of post abortion contraceptive counseling provided by midwives and to explore perspectives on Post-Abortion Care (PAC) and contraception and women’s experiences of PAC contraceptive use.

The objectives of this project are presented through four clinically based sub-studies:

  1. To assess the effectiveness and safety of midwives in administering misoprostol for treatment of incomplete abortion as compared to physicians (sub-study I).
  2. To analyze post-abortion contraceptive use among clients who have received post-abortion contraception counselling from midlevel providers (sub-study II).
  3. To explore health care providers’ perception of PAC, contraceptive counselling and task shifting/sharing in PAC (sub-study III).
  4. To explore decision making in relation to induced abortion, contraceptive use and experiences of PAC among young women and their partners (sub-study IV).