Incidence and Safety of Abortion in Two Humanitarian Settings

Access to abortion is a fundamental human right and the need for abortion services is likely amplified in complex humanitarian emergencies and crisis settings. However, most humanitarian agencies do not provide abortion services to those in refugee camps or settlements. There is a lack of data on the direct experiences of abortion of those living in displacement. Between March and October 2022, we surveyed 1201 women and girls with recent abortion experiences from Bidibidi Refugee Settlement, Uganda and Kakuma Refugee Camp, Kenya using respondent-driven sampling (RDS). Participants completed an interviewer-administered survey. Population-based estimates of abortion experiences were weighted using the RDS-II estimator to account for the sampling design. We used the sequential sampling population size estimation method to estimate annual abortion incidence. We also conducted a health facility assessment of 27 facilities to describe the availability of facility-based abortion services in these communities. Among those with an abortion in the past 5 years, the most common methods of abortion were traditional herbs (81% in Bidibidi, 45% in Kakuma) and non-medication abortion pharmaceuticals such as painkillers and antimalarials. Very few reported using WHO-recommended methods of abortion (mifepristone in combination with misoprostol, misoprostol alone, or manual vacuum aspiration). Self-reported morbidity was high; nearly a quarter reported avoiding seeking post-abortion care. The estimated annual abortion rate was 52 per 1000 in Bidibidi and 55 per 1000 in Kakuma. Only 5 of 27 health facilities reported providing safe abortion services. Refugees in these two contexts do not have access to WHO-recommended methods of abortion, though the need for safe abortion services is high.