Some of the most important gains in abortion access and health outcomes are coming from expansions in where and how people can obtain care. Our latest global research looks into such shifts, including changes in the severity of postabortion complications in Kenya, abortion and unintended pregnancy among adolescent refugees in Uganda, and medication abortion sales without a prescription in Ethiopian pharmacies and drugstores.

The Severity of Postabortion Complications in Kenya 

A new study published in BMJ Global Health, conducted in partnership with the African Population and Health Research Center (APHRC), looked at the severity and management of postabortion complications in Kenya. It found that approximately 18% of postabortion care (PAC) patients experienced complications in 2023, which represents a significant drop compared to a similar study from 2012. Researchers attribute much of this change to better access to primary care and the growing availability of medication abortion.

Key findings:

• PAC patients experiencing the most severe complications dropped from 37.1% in 2012 to 17.8% in 2023, while those with mild to no complications more than doubled, from 22.9% to 53.6%.
• Using a non-recommended abortion method more than doubled the risk of a severe complication. Economic vulnerability and delays in accessing care also significantly increased this risk.
• Despite the improvement, researchers estimate roughly 54,000 women in Kenya experienced a severe postabortion complication in 2023. 

“Severe postabortion complications are almost always avoidable if governments do not neglect their mandate to ensure essential reproductive care is accessible to all women,” says Dr. Onikepe Owolabi, Vice President for Global Research and co-author. “Women in Kenya who used a non-recommended abortion method, or who couldn't afford care right away, faced a much higher risk of a severe health outcome. This underscores the need for greater investment in safe abortion care and advocacy.” 

Abortion and Unintended Pregnancy Among Adolescent Refugees in Uganda 

Uganda has one of the highest teenage pregnancy rates in the world, and barriers to contraceptive use have been well documented. However, there are few studies about these outcomes among a particularly vulnerable population in Uganda: adolescents living in refugee settlements. A new study in Conflict and Health, conducted in partnership with APHRC and Population Council Kenya as part of the Baobab Consortium, analyzed three 2023 surveys and found that, adolescents experience high rates of unintended pregnancy, and that after accounting for sexual activity, adolescent refugees in Uganda had the highest induced abortion rate compared to other women of reproductive age. Adolescent unintended pregnancy is associated with worse health outcomes and diminished socioeconomic opportunities. 

Key findings:

• Adolescents living in refugee settlements have the highest abortion rates when assessed among women who were recently sexually active.  
• Adolescents are also the least likely to end pregnancies in abortion. Researchers estimate that only 40.6% of unintended pregnancies among adolescent refugees will end in abortion, compared to 61.2% among 20- to 24-year-olds and 56.8% among women 25 and older.  
• Among refugees with postabortion complications who sought care, adolescents experienced more delays in realizing help was needed, especially for family or personal reasons. 

“Adolescents refugees face some of the highest reproductive health risks in the region, yet they are often the least likely to get the care they need. Expanding access to sexual and reproductive health information and services, including safe abortion care, is critical for making sure people can get safe, timely care,” says Dr. Margaret Giorgio, Principal Research Scientist and co-author. 

Who Sells Abortion Medications Without a Prescription in Ethiopian Pharmacies 

New research in Contraception, conducted in partnership with the St. Paul Institute for Reproductive Health and Rights (SPIRHR), looked into instances of pharmacies and drugstores in Ethiopia selling medication abortion pills without a prescription, despite prescriptions being required under current law.  The study used mystery clients — interviewers posing as women needing access to medication abortion pills — to attempt to purchase the medications at 600 outlets across Addis Ababa, with almost one quarter of visits resulting in a sale. The characteristics of the staff and the information they asked of the mystery clients were often determining factors in if a sale occurred. 

Key findings:

• Mystery clients who were asked about their marital status (single) or the reasons they were seeking abortion were more likely to be sold abortion medications, compared to those not asked their background or reasons.
• Lacking a prescription was not the main reason clients were turned away; rather they were mostly refused sales due to staff stating that the outlet does not stock medication abortion drugs (60.6%).
• Encouragingly, 80% of mystery clients not sold medication abortion were either referred elsewhere (63.6%), or received both information and referral (15.3%).

“Sales of medication abortion drugs are happening regardless of the law," shares Stephanie Küng, Senior Research Associate and lead author. "Our results show that pharmacies could be a key access point for safe abortion care; expanding current policies to include pharmacies in the abortion care infrastructure could greatly improve access and reduce inequities in care.” 

The Impact of Investing in Safe Abortion Care 

All three of these studies discuss the same core issue: when people lack access to safe abortion care, the costs, both human and financial, land on health systems and on the people themselves. Guttmacher’s Safe Abortion Calculator puts real numbers behind expanding access to safe abortion care. Users can select a country or region to see the current cost of unsafe abortion, then adjust the safety rate to see the potential savings and health impacts of investing more in safe abortion services.