Factors Associated with Utilization of Post Abortion Care Services among Women of Reproductive Age in Nairobi County- Kenya

Abstract

Unsafe abortions continue to be a major cause of maternal mortality worldwide. In Africa, the risk of death from an unsafe abortion is approximately 1 in every 150 procedures—drastically higher than the 1 in 150,000 risk seen in the USA and Europe. Globally, unsafe abortions are responsible for an estimated 80,000 maternal deaths each year, representing about 13% of all maternal deaths. In Kenya, abortion-related complications account for approximately 35% of maternal deaths, with Nairobi alone recording 31% of such deaths resulting from poorly managed abortions. This study sought to examine the individual-level factors influencing the utilization of post-abortion care (PAC) services, investigate PAC-seeking behaviors among women of reproductive age, evaluate user perceptions regarding the healthcare system’s capacity to deliver quality PAC services, and explore women's experiences in accessing and using PAC services within Nairobi County. A facility-based cross-sectional survey design was employed, utilizing quantitative data collection methods. The study included 239 women aged 18 to 49 years, achieving a 99% response rate. Data analysis was conducted using descriptive statistics, Pearson’s Chi-Square tests to identify significant associations (p<0.05), and bivariate logistic regression to assess the strength of associations between independent and dependent variables. The key findings indicated that several factors significantly influenced the utilization of post-abortion care (PAC) services. These included marital status (p=0.018), complications following pregnancy loss (p=0.021), prior awareness of PAC services (p=0.012), preference for the gender of healthcare providers (p=0.044), waiting time (p=0.008), and the affordability of services (p=0.000). Single women were 62.5% less likely to utilize PAC services compared to their married counterparts (Odds Ratio [OR] = 0.375). Additionally, women who were already aware of PAC services were more than twice as likely to seek care (OR = 2.318), while those satisfied with waiting times were twice as likely to access services (OR=2.055). In conclusion, marital status, prior knowledge of PAC, and service affordability were critical determinants of PAC service utilization. To enhance PAC uptake, targeted youth-friendly sensitization programs are essential to address barriers faced by unmarried women and improve community awareness of PAC services. Furthermore, healthcare facilities should ensure providers are adequately trained, implement community outreach initiatives, and streamline service delivery processes to reduce waiting times without compromising care quality. Finally, affordability of PAC services should be prioritized to mitigate financial barriers.