Impact case study: Improving access to safe abortion in humanitarian settings in East Africa

Background

Unsafe abortion is a leading preventable cause of maternal death, with risks intensified in humanitarian settings where contraception, trained providers and safe services are limited. In refugee settlements in Kenya and Uganda, stigma, legal uncertainty and service gaps meant little was known about abortion incidence, methods used or opportunities to expand safe self-managed medication abortion.

The study

This mixed-methods, community-engaged study explored abortion experiences in Kakuma Refugee Camp in Kenya and Bidibidi Refugee Settlement in Uganda. It used respondent-driven sampling with 1,201 women and girls, qualitative interviews and focus groups, and assessments of 27 health facilities to examine abortion methods, complications, care-seeking, service availability and barriers to safer options.

Findings and impact

• Generated the first reliable population-based estimates of abortion incidence and safety in refugee settings.
• Estimated high annual abortion incidence: 55 per 1,000 women in Kakuma and 52 per 1,000 in Bidibidi.
• Found that 84% of reported abortions did not use WHO-recommended methods and only 5% took place in health facilities.
• Highlighted major gaps in access to safe abortion, self-managed medication abortion information and referral pathways.
• Informed provider training, community referral networks and the expansion of safe abortion hotlines into refugee settings.
• Contributed to Uganda’s rollout of the medication abortion CombiPack in public facilities and informed national policy dialogue.
• Strengthened refugee-led research capacity and influenced further studies in Uganda, Ethiopia and the Democratic Republic of the Congo.

Lessons learnt

• Strong community-engaged and user-centred approaches – including community advisory boards – built public trust and strengthened the credibility of outputs.
• Pre-existing networks of well-embedded local, national and international partners with complementary technical and contextual skills, expertise and capacity enhanced the effectiveness of engagement and supported the uptake of research findings

Partners

African Population and Health Research Centre, Ibis Reproductive Health, Ipas, International Rescue Committee, Resilience Action International.

Methodology

R2HC captures detailed case studies through a process that triangulates and validates evidence on uptake and impact. The case study methodology and full version of this summary case study including references are available on request. Outputs and resources from this study are available on the project page.