Complications from unsafe or incomplete abortions are a major cause of hospital admissions and maternal mortality in Kenya, and they strain the already overburdened public sector health care system. The World Health Organization estimates that complications of abortion contribute to 4% of maternal mortality in developing countries. The 2004 report, ''A National Assessment of the Magnitude and Consequences of Unsafe Abortion in Kenya," indicates that more than 300,000 unsafe abortions are performed each year, causing an estimated 20,000 women and girls to be hospitalized with related complications including chronic pain, pelvic inflammatory disease, tubal occlusion and secondary infertility.
In an effort to foster positive change in the availability and use of postabortion care (PAC) services and decrease the chances of repeat abortion among PAC clients, IntraHealth International and partners in the PRIME and PRIME II projects developed a pilot program to train privatesector nurse-midwives in PAC services. After several Nairobi-based nurse-midwives attended a seminar on PAC held by PRIME in early 1997, they asked PRIME and the Nursing Council of Kenya (NCK) to help them respond to the needs of women suffering from abortion complications. Following the two-year pilot program (1998-2000), PRIME II implemented a scale-up in two phases from 2000 to 2004.
Private nurse-midwives are an ideal cadre for scaling up PAC services in Kenya as they are the major source of prenatal care, family planning and other reproductive health services in many parts of the country. Their role at the primary level meshes with the government’s strategy to decentralize health care and expand the role of the private sector. Because many private nurse-midwives own their facilities, they represent the potential for a national, financially sustainable base of non-hospital PAC services. Perhaps most importantly, they are experienced providers who must spend 10 years in public, private or mission institutions before being licensed for private practice.
The pilot program introduced a comprehensive approach to primary-level PAC services. In addition to providing treatment for potentially life-threatening complications from unsafe or incomplete abortions, the nurse-midwives counsel clients about family planning and contraceptive options. They also offer selective reproductive and other health services either at their clinics or via referral to another accessible facility.
The strategy to reach the underserved populations of Kenyan women with PAC services relies on building community support and awareness, especially since PAC services have the potential to become controversial and even confused with abortion itself. Maintaining the confidentiality of clients and providing nonjudgmental counseling and treatment is essential to ensuring that women in need seek these services.