by Ruvani Jayaweera, Lilian Odhoch, Juliet Nabunje, Clement Oduor∙Carmela Zuniga, Bill Powell, Wyclife Barasa, Flavia Aber, Beatrice Nyalwal, Yohannes Dibaba Wado, Ramatou Ouedraogo, Jessica Kakesa, Tamara Fetters
eClinical Medicine, Volume 83, 103200, May 2025 Open access
Image: “Jerrycans” lined up outside a safe water tap station at Bidi Bidi. Thousands are used daily to deliver water to homes, schools and other facilities throughout the refugee settlement. Credit:Daniel Cusick/E&E News
Summary
Background: Access to abortion is a fundamental human right. The need for abortion services is amplified in complex humanitarian emergencies. However, most humanitarian agencies do not provide abortion services. There is a lack of data on the direct experiences of abortion of those living in displacement. This study aimed to describe abortion practices, safety, and incidence in two refugee settings.
Methods: Between March and October 2022, we surveyed 1201 women and girls with recent abortion experiences (past 5 years) 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 (16 in Bidibidi, 11 in Kakuma) to describe the availability of facility-based abortion services in these communities.
Findings: 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. Few participants 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 (95% simulation interval 20–106) and 55 per 1000 in Kakuma (95% simulation interval 19–119).
Only 5 of 27 health facilities (1 of 16 in Bidibidi, 4 of 11 in Kakuma) reported providing safe abortion services. 15 of 16 in Bidibidi and 9 of 11 in Kakuma reported providing post-abortion care.
Interpretation: Refugees in these two contexts have little access to WHO-recommended methods of abortion, and the need for safe abortion services is high.
Funding: This study was funded by Elrha’s Research for Health in Humanitarian Crises (R2HC) Programme. Elrha aims to improve health outcomes by strengthening the evidence base for public health interventions in humanitarian crises. R2HC is funded by the Foreign, Commonwealth & Development Office of the United Kingdom, Wellcome Trust, and the UK National Institute for Health Research.