An assessment of knowledge, Attitude and practice on abortion among female patients in Nairobi: a case study of Kenyatta National Hospital and Marie Stopes Clinic
Mbugua, Margaret Wangari
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Abortion is a social stigmatizing and ostracization issue as well as an important reproductive health problem associated with high morbidity and mortality. Each year 3.7 million pregnancies are terminated in Africa, with 200,000 deaths occurring from complications associated with unsafe abortions. In Kenya abortion is illegal. Women carry out abortions using unsafe methods and therefore suffer post-abortal complications. No documented studies have been carried out to determine knowledge, attitude and practice on abortion among female patients suffering from complications associated with abortion, and those seeking abortion services. A descriptive cross-sectional study was carried out among patients admitted at KNH and those patients seeking abortion services at Marie Stopes family planning clinic (Eastleigh), in Nairobi. The study recruited 286 respondents, 92 from KNII and 194 from MS, proportionate and only those who had an abortion. Respondents were interviewed using structured open and closed-ended questionnaires for quantitative data. The questionnaires were pre-tested at KNH for clarification. Two focus group discussions were held with HCP for qualitative data, 1 fgd was held at MS with 10 KECN, five KECN from gynecological ward of KNH and five from FP clinic of MS. While the second fgd took place at gynecological ward of KNH for KRCHN, five from MS and live from KNH. All the HCP had worked in those areas for more than a year. The discussions were monitored by the researcher while the proceedings and tape recording were managed by the research assistant. Data was collected 3 days per every week for four months, then was processed using SPSS and analyzed using the chi-square test to determine associations between variables. The results of the study showed that most of the respondents (60.1%) were single, (32.7%) married. Majority of respondents (54.1%) had secondary education while (3.5%) had no formal education, (55.0%) were protestants, (30.5%) Catholics (12.1%) Muslims and (2.4%) atheist. Majority of respondents had first sexual intercourse at mean age of 19 years, (SD =2.46), number of sexual partners mean 1.89 = 2, (SD = 1.03), age at first pregnancy mean 21.34 years. (SD=2.77), number of times respondents aborted mean 1.32, (SD=0.73), 48.3% respondents reported that poverty and economic constraints were the factors that led to termination of pregnancies. The respondents had poor knowledge on emergency contraceptives (mean score 1.0385) (SD=0.8048), which was a contributing factor to unwanted pregnancies, (34.6%) had poor knowledge on complications related to abortion that contributed to admissions for treatment, had association between knowledge of abortion and level of education (p=.031), 62.5% respondents had poor knowledge on methods of terminating pregnancies, (mean score 0.41, SD=.60), that explained why women suffered complications related to induced abortion. There was a significant statistical relationship between where abortions were performed between respondents at KNI-I and Marie Stopes (p=0.000), 40.6% respondents reported that doctors were the main providers, religion had no statistical significance with abortion practice (p=0.132). After procuring abortion 74.6%, respondents felt satisfied while 3.6% felt depressed, 62.4% respondents perceived HCP as concerned people, majority of HCP appreciated respondents who practiced abortion while minority maintained that abortion was an illegal unethical and immoral practice. Conclusion, the study observed a high incidence of abortion practice despite respondents negative attitude, on daily basis an average of 15 pregnancies were terminated at Marie Stopes and 7 patients were admitted with abortion related complications at KNH. Recommendations, are that the findings of this study will be of value to Ministry of Health and other interested parties such as NGOs in drawing policies to address abortion issues, and in improving reproductive health programs through intensified health education.