Kenya’s 2010 abortion law impacts contraceptive use and fertility rates
This study assesses the impact of Kenya’s 2010 abortion law liberalization on modern contraceptive use and number of recent births (births in the past 5 years ) among women of reproductive age in Kenya.
College of Health researcher(s)
Abstract
Introduction
Prior research suggested that liberation of abortion laws in Sub-Saharan Africa (SSA) was associated with fewer abortion complications and deaths. However, few studies have examined the association of abortion law liberalization with modern contraceptive use and fertility rates among women in SSA. In this study, we assessed the impact of Kenya’s 2010 abortion law liberalization on modern contraceptive use and number of recent births (births in the past 5 years ) among women of reproductive age in Kenya.
Methods
Data from three rounds of the Demographic and Health Surveys (2003–2016) for Kenya, Tanzania and Uganda were used for the analysis. We used the differences-in-differences estimator to assess the impact of the policy change in Kenya using Tanzania and Uganda as the control group. We performed multivariable logistic and Poisson regressions to estimate the adjusted odds ratios (aOR) and adjusted prevalence rate ratios (aPRR) with 95% confidence interval (CI) for modern contraceptive use and number of recent births respectively.
Results
A weighted sample of 117,163 women aged 15–49 years was used for the analyses. Modern contraceptive use increased from 25.4% and 19.4% to 39.1% and 27.2% for the intervention and control groups, respectively, in the post-intervention period. In contrast, the mean number of recent births declined from 0.71 and 0.88 to 0.63 and 0.80 for the intervention and control group, respectively in the post-intervention period. We found that Kenya’s 2010 abortion law liberalization was associated with more people using modern contraception (aOR, 1.22; 95% CI 1.11, 1.34) and fewer recent births (aPRR, 0.95; 95% CI 0.91, 0.98).
Conclusion
Our findings suggest that Kenya’s 2010 abortion law was surprisingly associated with higher use of modern contraceptives. Reforming restrictive abortion laws may indirectly improve use of contraceptives in Sub Saharan African countries.
Plain language summary
Many countries in Sub Saharan Africa (SSA) have laws that prohibit legal termination of pregnancy (abortion) except when the pregnancy poses danger to the life of the woman. These laws, known as abortion laws, are often associated with high level of unsafe abortion practices and its related complications. Our study sought to examine the impact of Kenya’s 2010 abortion law on modern contraceptive uptake and number of recent births (births in the past 5 years). We used three rounds of cross sectional data from the Demographic and Health Surveys (DHS) in Kenya, Tanzania, and Uganda for the analysis. DHS data are mostly collected every five years with standard questionnaire across implementing countries. To assess the impact of Kenya’s abortion 2010 law, we used Tanzania and Uganda as the control group. We found that the change of the abortion law (from highly restrictive to moderately restrictive) was associated with an increase in the uptake of modern contraceptive methods among women in Kenya. Furthermore, change of the law was also associated with women in Kenya having fewer births (births that occurred five years prior to the surveys). Our study suggest that changes in laws that permit legal termination of pregnancy on broader grounds without restrictions in SSA countries, may help improve the use of reproductive health services such as modern contraceptives.
Frequently Asked Questions: Kenya's 2010 Abortion Law and its Impact
What was the main objective of the study?
This study aimed to evaluate the effects of Kenya's 2010 abortion law liberalization (which expanded the grounds for legal abortion from only saving a woman's life to include health reasons) on two key reproductive health indicators: modern contraceptive use and the number of recent births (within the five years preceding the surveys) among women of reproductive age in Kenya.
What methodology did the researchers use to assess the impact of the law?
The researchers employed a quasi-experimental method called the difference-in-differences (DiD) estimator. This involved comparing changes in modern contraceptive use and recent births over time between Kenya (the intervention group, which experienced the law change) and Tanzania and Uganda (the control group, which did not have a similar legal reform during the study period). Data from multiple rounds of the Demographic and Health Surveys (DHS) conducted between 2003 and 2016 in these three countries were analyzed using multivariable logistic and Poisson regressions to account for other influencing factors.
What were the key findings regarding modern contraceptive use after the law change in Kenya?
The study found a statistically significant association between Kenya's 2010 abortion law liberalization and an increase in modern contraceptive use among women of reproductive age. Specifically, they estimated a 22% increase in the odds of using modern contraception after the law change, even after adjusting for other factors. This finding was contrary to some prior assumptions that liberalized abortion laws might lead to a decrease in contraceptive use.
What were the key findings regarding fertility rates (number of recent births) after the law change in Kenya?
The research indicated that Kenya's 2010 abortion law liberalization was associated with a small but statistically significant decrease (approximately 5%) in the number of recent births among women of reproductive age in Kenya. This suggests that the law change might have contributed to lower fertility rates in the country.
How does the study explain the surprising finding of increased contraceptive use following abortion law liberalization?
The study suggests that contraception and abortion are complementary rather than substitutes. Increased access to legal abortion may have also been accompanied by increased post-abortion contraceptive counseling and services, leading to greater uptake of modern methods to prevent future unintended pregnancies. Additionally, a broader understanding of reproductive health rights and options might have empowered women to utilize both abortion and contraception as tools for family planning.
Why were Tanzania and Uganda chosen as the control group for this study?
Tanzania and Uganda were selected as the control group because they shared several similarities with Kenya prior to the 2010 law change. These included geographical proximity, some cultural similarities (like the presence of Swahili), similar historical legal frameworks regarding abortion (inherited from Great Britain), democratic governance, and comparable healthcare systems with a dominant public sector. These similarities helped to ensure that any differences observed in reproductive health outcomes after 2010 were more likely attributable to Kenya's policy change rather than pre-existing differences between the countries.
What are the potential policy implications of this study's findings for other Sub-Saharan African countries?
The study suggests that reforming restrictive abortion laws in Sub-Saharan Africa may not only reduce unsafe abortions and related complications but could also indirectly improve the use of modern contraceptives. This implies that policymakers in countries with highly restrictive abortion laws should consider liberalization as part of a broader strategy to improve reproductive health service utilization, enhance women's health outcomes, and potentially lower high fertility rates, alongside strengthening contraceptive programs.
What are some limitations of the study that should be considered when interpreting the results?
The study acknowledges several limitations. The data collection periods for the pre- and post-intervention periods did not perfectly align across the three countries, although time trends were controlled for. The study could not account for all potentially influencing factors, such as women's specific knowledge of abortion laws, country-level contraceptive policies, and the supply and accessibility of both contraception and abortion services. Finally, the reliance on self-reported data introduces the possibility of recall bias, although this was expected to be minimal due to the nature of the questions.