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Paper for the conference "Expanding Access: Advancing the Roles of Midlevel Providers in Menstrual Regulation and Elective Abortion Care"
South Africa 2 - 6 December 2001.

The paper in pdf-format


Kenya Country Report

Ms. Monica Oguttu

Dr. Peter Odongo

Table of contents

1. Country profile on abortion services

1.1 Country Overview and Magnitude of the Problem
1.2 Abortion Laws and Policies
1.3 Provider Profile
1.4 Organization of Abortion services
1.5 Knowledge and Perceptions of Abortion Services

2. Midlevel Providers’ Role in Abortion Services

2.1 Midlevel Providers in Kenya – Duties and Responsibilities
2.2 History of Postabortion Services in Kenya: the Increasing Role for MLPs
2.3 Scope of Post Abortion Care Practice of Midlevel Providers

3. Professional Organizations of Mid-level Providers

4. Advocating Abortion Service Provision by Midlevel Providers

5. Lessons Learned Related to Access to Safe Abortion Services

1. Country Profile on Abortion Services

1.1 Country Overview and Magnitude of the Problem

General Information on Kenya

Kenya covers an area of 582,000 sq. km. and is bordered by Ethiopia in the north, Sudan in the northwest, Uganda in the west, Tanzania in the south, Somalia in the northeast and the Indian Ocean along the eastern edge. The major religions are Christianity (66%) and Islam (6%). A total of 26% of the population adhere to traditional beliefs (CRLP, 1997).

Literacy in Kenya is 78%, with male literacy at 86% and female literacy at 70%. Agriculture remains the mainstay of Kenya’s economy, accounting for 26 percent of the gross domestic product. Tea, tourism, coffee and horticulture are the main foreign exchange earners.

Preliminary results from the 1999 census estimate Kenya’s population at 30,339,770 people, up from 23.2 million in 1989. Although there is a significant increase in rural-urban migration, Kenya’s population remains primarily rural (72%) while only an estimated 18% of the population lives in urban areas. Most of the urban population (89%) is concentrated in towns with populations of 10,000 or more. Kenya has a very youthful population with at least half being below the age of 15 years.

Reproductive Health for Women

Even while Kenya’s total fertility rate has declined to 4.7 (Kenya DHS, 1998), and modern contraceptive use has risen to 33% among currently married women (PRB, 2000), unplanned and/or unwanted pregnancies are still common. As a result, complications from incomplete abortion are still one of the leading causes of maternal mortality and morbidity.

Women in Kenya face many pressing health issues. The average life expectancy for women is 63 years, compared to 59 years for men. Violence against women is thought to be a serious problem though accurate statistics are lacking. Thirty-eight percent of Kenyan women age 15 – 49 have been circumcised. The proportion of women circumcised increased with age nearing 50% for women age 35 and above (KDHS, 1998).

The 1998 Kenya Demographic and Health Survey (DHS) reported that almost a quarter of Kenyan women have unmet need for family planning services – 13.4% for spacing and 25.6% for limiting births. Although one third of Kenyan married women are currently using a modern contraceptive method and 7% are using a traditional method of contraception, 48.3% of recent births were still unwanted or mistimed.

Kenya’s maternal mortality ratio is 590/100,000. (UNICEF and WHO, 1996). Unrecorded deaths in the rural communities make it likely that this is unreliable and underestimated statistic. One of the major causes of maternal mortality and morbidity in Kenya is unsafe abortion, which contributes to between 30% and 50% of the maternal mortality and morbidity. (USAID/REDSO, ESA, 1997).

Additionally, at least half of admissions in the gynecology wards are due to abortion complications. (Lema, et al., 1989; Rogo, 1993). Over her life time, a Kenya woman will bear 4.7 children and has 1:36 chance of dying from a maternal cause (Kenya Demographic and Health Survey, 1998).

Population Action International's (PAI) " Poor, Powerless and Pregnant" Index, which rates the status of women in different countries, rates Kenya at 45 "very poor" out of a possible score of 100. On PAI’s broader "human suffering index " Kenya is ranked as relatively poor with a score of 75 out of possible 100.


Selected country statistics

  • Total population 29,800,000 *
  • Crude Birth Rate 34/1,000 population
  • Crude Death Rate 14/1,000 population
  • % Annual Growth Rate 2.1%
  • Population Doubling Time 33 years.
  • Infant mortality Rate 74/1,000 live births
  • Total fertility Rate 4.7 children/woman
  • % Population under 15 years 44%
  • Maternal Mortality Ratio 590/100,000 live births **
  • % Urban Population 20%
  • Modern Contraceptive Prevalence Rate 32%

Source: 2001 World Population Data Sheet, Population Reference Bureau Inc.(except as indicated below)

* Preliminary results from Kenya’s 1999 census increase this number to 30,339,770.

* * WHO and UNICEF, Revised 1990 Estimates of Maternal Mortality: A New Approach by WHO and UNICEF (Geneva: WHO, 1996).

Reproductive Health and the Kenyan Government

Since independence, the Government has put in place numerous policies and strategies to improve the delivery of health care to the Kenyan people. Kenya was the first country in Sub-Saharan Africa to adopt an explicit population policy when the Family Planning Program was launched in 1967. In 1972, the program was integrated into maternal and child health services.

In order to further address demographic targets, Sessional Paper No. 4 of 1984 was issued to guide the implementation of a population policy that adopted a multi-sectoral approach to population education and service delivery. Following ICPD in 1994, the population policy guidelines were revised and updated to address emerging issues in reproductive health and to address the health needs of various target groups.

The 1994 Health Policy Framework outlines the Ministry of Health’s vision, policies and guidelines on population growth, equitable allocation of resources, creating an enabling environment for private sector and NGOs, increased community involvement and resource mobilization (Kenya’s Health Policy Framework, Ministry of Health, November 1994).

The Kenya National Reproductive Health Strategy was developed in 1996 to guide program implementation between 1997 and 2010. The strategy addresses the following key components:

  • Safe Motherhood and Child Survival
  • Management of STDs/HIV/AIDS
  • Meeting the unmet needs of family planning
  • Promotion of Adolescent and Youth Health
  • Management of infertility and cancer of reproductive tract
  • Gender issues and Reproductive Rights

The strategy is being implemented in the context of ongoing health sector reform efforts. The Revised Reproductive Guideline of 1997 has also included postabortion care (PAC) as one of the priority areas of reproductive health.

Sessional Paper No. 1 of 2000, The National Population Policy for Sustainable Development was recently passed. This paper expands on previous policy guidelines to incorporate other reproductive health needs, with an emphasis on the reduction of maternal mortality.

Additionally, there are goals for a further reduction of the total fertility rate to 2.5, as well as an increase in contraceptive prevalence rate to 62% by 2010 (Sessional Paper No. 1 of 2000: The National Population Policy on Sustainable Development, NCPD, Ministry of Planning and National Development, 2000).

1.2 Abortion Laws and Policies

The constitution of Kenya spells out the right to life of all people within its borders. The law therefore permits abortion only for "the preservation of the women’s life" as follows:

A person is not criminally responsible for performing in good faith and with reasonable care and skill a surgical operation upon any person for his benefit, or upon unborn child for the preservation of the mother’s life, if the performance of the operation is reasonable, having regard to the patient’s state at the time and to all the circumstances of the case. (SECTION 240 OF THE PENAL CODE)

Relevant sections of the Kenyan legal code which bear upon abortion include provisions regarding the procurement of abortion (Section 158 of the Penal Code), supplying implements of abortion (Section 160 of the Penal Code), and advertising drugs or appliances related to abortion (section 38 of the Pharmacy and Poison Act, Chapter 244), and are described in more detail below.

Procuring Abortion

Any person who, with intent to procure miscarriage of a woman, whether she is or not with a child, unlawfully administers to her or causes her to take any poison or other noxious thing, or uses force of any kind, or uses any other means whatever, is guilty of felony and is liable to imprisonment for fourteen years. (Section 158 of the Kenyan penal code)

Any woman who, being with child, with intent to procure her own miscarriage, unlawfully administers to her self any poison or any noxious things, or uses any force of any kind or uses any other means whatever, or permits any such a thing or means to be administered or used on her is guilty of felony and is liable to imprisonment for seven years. (Section 159 of Kenya penal code).

The two sections, while inflicting punishment on both the person performing the abortion and the woman in question, are slightly different. The former will be convicted whether the woman is or is not pregnant. In the latter case, the woman must be pregnant for the conviction to occur. Secondly the sentences are different for the two, although the offences are essentially the same.

Supplying implement of abortion

The penal code goes to state that:

Any person who unlawfully supplies to, or procures for any person any thing whatever, knowing that it is intended to be unlawfully used to procure the miscarriage of a woman whether she is or not with a child, is guilty of a felony and is liable to imprisonment for three years. (Section 160 of the penal code of Kenya).

Advertising drugs or appliances for abortion

Subject to the provision of this Act, no person shall take part in the publication of an advertisement referring to a drug appliances or article of any description in terms which are calculated to lead to the use of drug, appliance or article for procuring the miscarriage of women. (Section 38 of Pharmacy and Poisons Act of the Law of Kenya, Chapter 244, as revised in 1983). One convicted of conflicting with this section of the law, faces, on the first conviction of a fine of not more than one thousand shillings or not more than three months imprisonment or both the fine and the prison term. (Section 40 Of the Pharmacy and Poisons Act).

Although the law is fairly explicit and restrictive regarding abortion, there are few examples of enforcement. Clandestine, illegal abortions are being done in Kenya by the thousands and court cases under this section are very few indeed. Unfortunately, these unsafe abortions are the procedures that lead to high rates of abortion-related mortality in Kenya.

Abortions are also done in the private, formal health sector, recognizing the indication that "the woman’s life is in danger." It is difficult to define what this means in different situations. Another area of perceived flexibility relates to the provision of implements for abortion. The offence is said to occur when a person willing and knowingly supplies poison, drugs or instruments to be used for the purposes of abortion. However, it is possible to argue that the person supplying the implements did so without knowing that they were intended for use in an abortion, since many of the instruments used for abortion procedures may also be used for other "acceptable procedures."

1.3 Provider Profile

In Kenya, according to recent MOH data, there are an estimated 27,000 midlevel providers (2,300 clinical officers, and 24,600 nurses and nurse/midwives) and approximately 3,300 physicians. The midlevel providers (MLPs) are found at all levels of the health system, in both rural and urban settings, while the doctors are concentrated in the larger towns and cities.

As part of the government's overall plan to decentralize health care management, the Kenyan MOH has in the past decade allowed the licensing of MLPs for private practice. As a result, the number of private health facilities has increased dramatically.

Traditionally, midwives have conducted deliveries and only called upon a doctor in case of emergency. This practice continues today with midwives attending at 29.4% of rural births and 58% of urban births. Relatives and traditional birth attendants (TBAs) also assist at many deliveries. Physician attended births in only 10.6 % of rural births and 23.7 % of urban births (KDHS, 1998).

Midwives working in primary health care and maternity/nursing homes are responsible for a wide range of reproductive health services, including antenatal, family planning, counseling, and all deliveries. Between 1996 and 1999, several pilot projects to train midlevel providers to offer PAC were conducted by Ipas, the Population Council, the Ministry of Health, and the USAID funded PRIME program. The evaluation of these programs demonstrated that midlevel providers could offer PAC services efficiently, competently, and save women’s lives. These results are reflected in the MOH’s 1997-2010 Reproductive Health strategy, which calls for an expansion of the role of MLPs, notably in PAC.

Towards this end, the Ministry of Health is also finalizing a national curriculum on PAC, and discussions are underway to include PAC in pre-service training of midlevel providers. Simultaneously, several local, national and international organizations are involved in ongoing training of midlevel providers in PAC. These include KIMET, PRIME, AMKENI, Engender Health, and Ipas.

Table 2. Training of Providers in Postabortion Care

Type of provider

Total years of pre-professional education

Duration of professional medical training

Duration of pre-service training in abortion service delivery

Duration of in-service training in abortion

Duration of apprenticeship / on the job training

Training in clinical abortion procedures

Training in abortion counseling

Training in clinical abortion procedures

And abortion counseling

Training in clinical abortion procedures and abortion counseling


12 years

5 Yrs + ob/g training



Integrated in training

Integrated in post specialist training


12 yrs

3.5 yrs


2 weeks

2 wks

2 weeks


12 yrs

3.5 yrs + 1


2 weeks

2 wks

2 weeks

Clinical Officers

12 yrs



2 weeks

2 wks

2 weeks

1.4 Organization of Abortion Services

Primary health services are accessible all over the country through cost sharing. Postabortion care is available in five of the country's eight provinces, at varying levels of the health care system. For effective health service provision the first referral (District Hospital) refers any complications to the second referral (Provincial Hospital), which in turn refers to the third referral hospitals (National and Teaching Hospitals).

Most of the first referral Hospitals offer PAC services. The use of the manual vacuum aspiration (MVA) technique for evacuation of the uterus is sporadic, and dilatation and curettage (D&C) is used where MVA is not available or in later term pregnancies. All the provincial hospitals offer PAC services; six uses MVA for emergency treatment while two use D&C. The two tertiary referral and teaching hospitals offer PAC services.

In Western Kenya, Central, and Nairobi provinces the provision of PAC has been extended to the private sector and Mission health facilities where the midlevel providers offer the services.

Although abortion is highly restricted, it is widely known that safe abortion is available in private hospitals and clinics. Consultants, Medical Officers and MLPs using MVA or D & C (depending on the gestation) perform induced abortion procedures on "medical grounds". Cost varies widely according to the gestation, the institution where it is performed and the level of training of the provider.

In the public sector, safe abortion is never discussed unless it is on medical grounds. While in the private sector it is discussed freely and those with values against it, refer to their colleagues who offer safe abortion services. The private sector charges vary as per what the client can pay the provider. Some exploit the women who seek the services because they are desperate and also require total confidentiality and privacy.

Most women who can afford the option prefer to receive care from private practitioners because they are more sure of the confidentiality and quality services. In some facilities PAC, by definition, includes safe abortion services under 12 weeks gestation (menstrual regulation).

Table 3. Organization of Postabortion care

Level of Health Care System

Provider Types

Types of Services & Abortion Methods Provided

Maximum Gestation for Abortion

Management of Complications

Monetary Cost of Specific Services Provided



To Individ-ual

To Health Care System




Informa-tion and Referral

Up to 12 wks


US$ 6





& Clinical Officers

VA & counsel-ing

Up to 12 wks


US$ 6



First Referral

Doctors, COs and N/M

VA & Surgical

Up to 12 wks


US$ 6-12


Secondary and Tertiary


VA & Surgical

Up to 12 wks


US$ 12-20


Availability of Postabortion service delivery records

The only regular records available are on PAC services. Providers of induced abortion services do not keep records fearing repercussions for themselves or their clients. To protect themselves and their clients, the services are offered secretively. Even if safe abortion services have been offered, the records often read dysfunctional uterine bleeding or incomplete abortion.


Table 4. Availability of Postabortion Care service delivery records

Level of Health Care System

Are records kept?

Number of Abortions Provided

Number of Complications

Monetary cost of specific services provided


By type of provider

By Method

By Gestation

To individual

To health care system








District/First Referral



Secondary and Tertiary



1.5 Knowledge and Perceptions about Abortion

Medical providers, gynecologists in particular, have been the major supporters of more liberal abortion laws. At their 1993 Annual Scientific Conference the Kenya, the Obstetrics and Gynecologists Society (KOGS) reiterated their stand on this issue and passed a resolution asking the Minister for Health to present to the cabinet a paper on abortion as a health issue, highlighting the social, economical and health costs to the country resulting from unsafe abortion.

In 2000, the Director of Medical Services called for abortion to be legalized. This generated a lot of immediate reactions, and Kenyans in general shied away from a full-fledged debate at that time. Now the debate is once again with us. A recent report from the Kenya Family Health Programs (a large, 5 –year effort involving the MOH and many NGOs) argues that the social and medical evidence about the harm caused by unsafe abortion outweighs the perceived moral and legal need for retaining the anti-abortion law in books.

The report is based on a study undertaken by the Department of Standards and Regulatory Services within the MOH, and will be discussed in November 2001, at a national health services conference. This report has since been released to the press and has sparked off a whole debate on abortion. The debate has been going on for a month now. The pro-choice group argues that it is better to save one life than to lose two while the anti-abortion groups insist that life begins at conception and no one has a right of terminating that life except the Almighty.

Clients often learn about safe abortion services through friends or satisfied clients. Some of the providers are courageous enough to tell other clinic clients about the services. In areas where there are PAC providers, the clients can more easily access safe abortion services through linkage and networking among these providers.

Training in PAC has helped change the negative attitudes that some providers had towards abortion. The practical training sessions, where these providers experience first-hand the suffering of patients with complications of unsafe abortion, are probably responsible for this shift in attitude. Most of the providers are very positive after the training, and a majority is able to offer counseling to women who come with abortion related problems and refer those needing specialized care.

A 1998 study of unsafe abortion in Western Kenya found that many women avoided physicians for abortion services viewing doctors as "exploitive, greedy, and corrupt" as well as unsafe providers. Women also reported negative feeling about TBAs, CBDs, and herbalists who were seen as lacking both the necessary skills to provide safe services and appropriate facilities (PIWH, 1999).

2. Midlevel Providers and Abortion Services

2.1 Midlevel Providers in Kenya – Duties and Responsibilities

In Kenya those referred to as Midlevel providers (MLPs) are Clinical Officers, Nurses and Nurse/Midwives. Clinical Officers have been trained to be independent providers, yet obstetrics is often not a component of their three-year program. Nurses in Kenya attend school for 3.5 years. Nurse/Midwives receive an additional year of specialized training.

The numbers of specific cadre of midlevel providers in Kenya vary from one province to the other. But they form the backbone of the health service since they serve the rural and semi-urban communities, including the high-density peri-urban areas where doctors are difficult to find.

A PRIME survey in 1999 found that Kenyan clients have significantly greater access to nurses than physicians. There is one nurse for every 1,085 clients while there is only 1 physician for every 6,799 clients. Nurse/midwives facilities are often located in areas of high population density and close to communities making their services more accessible than physicians, 70% of whom are located in large urban areas (PRIME, 1999).

As mentioned earlier, some MLPs (Clinical Officers and Nurse/Midwives) are increasingly being trained to offer postabortion care services. The Ministry of Health, the Nursing Council of Kenya (NCK) and the National Nurses Association of Kenya are supportive of midwives being trained in PAC and then providing services. A few MLPs in the private facilities also offer safe abortion services, but no data is kept.

2.2 History of Postabortion Services in Kenya: the Increasing Role for MLPs

In the late 1980s, hospital-based studies in Kenya found that up to 35% of maternal mortality and 60% of hospital admission were related to unsafe abortion. These high rates were all the more alarming given they only reflected women who were able to enter public hospitals, masking those who sought care from private providers or worse, those who had no access to care.

In response, a pilot program was initiated at Kenyatta National Hospital in 1987 to improve and expedite care for women with abortion complications. It began as a program to train doctors in the safer manual vacuum aspiration technique (MVA) for uterine evacuation and replaced the D & C procedure, which contributed to lots of delays in offering treatment to women with abortion complications. Nurses were trained in support functions.

In 1990 the second component of PAC (linkages to family planning services) was introduced after seeing a number of women coming back with repeat unsafe abortion complication. Nurses played a larger role here, either participating in the family planning counseling directly or linking the clients to the family planning providers.

In 1992 the Ministry of Health adopted this broader approach to PAC and planned for decentralization. By 1995 PAC was extended to the Provincial hospitals. During this time the PAC providers were mainly doctors assisted by the nurses who cleaned the instruments.

Movement to train the nurse-midwives as PAC providers came from a variety different organizations, all of which had recognized the importance of involving the midlevel providers who are best placed in the communities. A survey of private nurse/midwives on why it is important for nurse/midwives at the primary care level to provide PAC services found that they believed that patients lack money to both pay a referral sites fees and transportation expenses; patients were unfamiliar with referral sites and feared poor quality of care, stigmatization, and delays in services (PRIME, 1999).

In 1996 FPIA funded a project "Expanding Opportunities for Preventing Unsafe Abortion" through the Private Practitioners Network in Western Kenya. In rapid succession, the project trained ob-gyn consultants, general physicians and MLPs in the provision of PAC services. This project entailed training, supportive supervision, and follow-up monitoring visits. Nurse/midwives were trained to provide emergency care using MVA; to provide postabortion family planning services; to refer patients needing specialized services; and to carry out community education and outreach. The community based distributors (CBDs) were also given a role in mobilizing the community and referring women to the PAC providers. The CBDs also make the contraceptives accessible to women who need the services, including the emergency contraceptives.

The Private Practitioners Network Model has been replicated by the PRIME project that is training nurse/midwives in Central, Nairobi and Rift Valley Province. Prior to this training, only two of the targeted facilities were offering MVA provided by nurse/midwives with physician supervision. The other 30 facilities referred postabortion patients to the district hospitals. Following the trainings, private nurse/midwives at 28 of the 32 facilities were providing PAC services.(PRIME, 1999).

Having nurse/midwives provide PAC services has been found to be beneficial on many fronts. Many private nurse/midwives facilities are located in the communities that they serve, providing easy access for clients. Having emergency PAC services available within the community can be life saving and reduces the burden on referral sites. Additionally, the providers often have positive interpersonal relationships with their clients. The PAC services provided by nurse/midwives in primary level clinics are of high quality and reasonably priced (PRIME, 1999).

Post Abortion Care in Public and Private Sector

Initially all the midlevel providers offering PAC services were from the private and NGO sectors. In 2000, the public sector requested to be involved and since then the training has since included them.

2.3 Scope of Post Abortion Care Practice of Midlevel Providers

Table 5. Midlevel Providers’ (clinical Officers and Nurse/Midwives) Scope of Practice

Type of Procedure

Offered by this Level of Provider (Y/N)? If "yes" specify method.

Method(s) of Pain Management Used

Type of Supervision Required when Performing the Procedure





Medical Abortion (specify different regimens used)


1st Trimester Surgical


Analgesics/ "Verbacaine"


Regular, facilitative supervison post-training

2nd Trimester Surgical


Emergency Treatment of Abortion Complication




Uterine Evacuation



Management of Spontaneous Abortion




Uterine Evacuation











3. Professional Organizations for Midlevel Providers.

In Kenya, a variety of professional associations exist for midlevel providers (Nurses, Nurse/Midwives and Clinical officers) namely:

  • Nursing Council of Kenya (NCK) – the regulatory body that controls the curriculum, training and Registration of all the trained Nurses and Midwives in Kenya.
  • National Nurses Association of Kenya (NNAK). Deals with the welfare of the Nurses.
  • Private Nurses Association.
  • Kenya Midwives Association.
  • Theatre Nurses Association.
  • Kenya Clinical Officers Association.

These associations offer a lot of support to their members especially if there are grievances or changes in their scope of work. NNAK has been very supportive of the training for nurse/midwives in postabortion care. If it were not for the support of NNAK, the Ministry of Health would not have authorized the training of nurse/midwives.

The Nursing Council of Kenya (NCK) is the regulatory body of the nursing profession. NCK has issued a statement supporting an expanded role of nurse/midwives in PAC. The Council also has called for including postabortion family planning, referral guidelines, and community education as core competencies in the basic nurse/midwife curriculum. Additionally, they have recommended that use of the MVA be taught in advance classes (PRIME, 1999). However, it is clear that both NCK and NNAK are more comfortable supporting PAC than safe abortion services.

4. Advocating Abortion Service Provision by Midlevel Providers

There is little public advocacy about safe elective abortion As mentioned earlier, women tend to learn about learn about the services through satisfied clients or friends. Most of the advocacy efforts have focused on the need to improve and extend postabortion care services.

The Federation of Women Lawyers in Kenya is working in conjunction with Ipas and the Kenya Medical Association to support gender sensitive reproductive health policies in Kenya. This project will address abortion law and policy and document the magnitude of unsafe abortion in Kenya. This will include addressing issues of access and thus midlevel providers. FIDA is currently in the process of introducing a bill to Parliament to liberalize abortion. The proposed law is intended to prevent the trauma of unwanted pregnancies and the tendency to seek unsafe back street abortionists.

5. Lessons Learned Related to Access to Safe Abortion Services

There is a strong demand for PAC services to be provided at the community level by nurse/midwives. The training of midlevel providers in PAC has increased access to high quality services to women with abortion complications, as well as referral for those in need of specialized services. This has decongested the referral sites and reduced the abortion-related caseload for hospital providers, thus saving resources for other needy conditions. Women are also receiving the necessary postabortion family planning services.

All of the providers at all levels in both the formal and informal sector have to be involved with different roles in making the services access to the women. The organizations interested in abortion projects must reach communities in the semi-urban and rural communities. These are the areas where the majority of Kenyan women live, but where there are virtually no doctors. Midlevel practitioners provide the available health care in these areas.

The success of midlevel providers offering PAC services may provide an opportunity to expand service provision to safe abortion services when the legal limitations are removed. The impact of community based PAC and safe abortion services on maternal mortality and morbidity could be significant.

Literature Cited

Center for Reproductive Law and Policy, International Federation of Women Lawyers (Kenya Chapter) F.I.D.A.-K. (1997). Women of the World: Laws and Policies Affecting Their Reproductive Lives-Anglophone Africa. New York, NY.

Kenya National Council for Population and Development (KNCPD), Central Bureau of Statistics, Office of the Vice President and Ministry of Planning and National Development. Kenya Demographic and Health Survey (KDHS) (1998). Nairobi, Kenya.

Lema, V., S. Kamau, and Khama Rogo. (1989). Epidemiology of Abortion in Kenya. Nairobi: Centre for the Study of Adolescents.

Ministry of Health. (1994). Kenya’s Health Policy Framework. Nairobi, Kenya.

Ministry of Planning and National Development. (2000). Sessional Paper No. 1 of 2000: The National Population Policy on Sustainable Development. Nairobi, Kenya.

Population Action International. (2001). Report Card 2001[www.populationaction.org]. Washington, D.C.

Population Reference Bureau. (1998). Women of Our World. Population Reference Bureau Data Sheet. Washington, D.C.

PRIME. (1999). "Postabortion Care Initiative for Private Nurses/Midwives." Presentations prepared for K-PAC Dissemination.

Rogo, Khama. (1993). "Induced Abortion in Kenya." Paper prepared for the International Planned Parenthood Federation. Nairobi: Centre for the Study of Adolescents.

Rogo, K., L. Bohmer; C. Ombaka. (1999). Community Level Dynamics of Unsafe Abortion in Western Kenya and Opportunities for Prevention: Summary of Findings and Recommendations from Pre-Intervention Research. Pacific Institute for Women’s Health. Los Angeles, California.

USAID, Regional Economic Development Services Office for East and South Africa. (1997).

World Health Organization and United Nations Children’s Fund. (1996). Revised 1990 Estimates of Maternal Mortality: A New Approach by WHO and UNICEF. Geneva, Switzerland.


Updated 19 June 2002