Knowledge of and preferred legal grounds for abortion in Kenya: a national cross-sectional telephone survey

Abstract

Inadequate knowledge of abortion law in restrictive settings impedes women’s access to safe services and engenders poor abortion perception and stigma among the general population. There is limited understanding of the public’s knowledge and support for abortion in Kenya. This study aimed to assess public knowledge of the current abortion law, factors associated with accurate knowledge, and to characterize the preferred conditions under which abortion should be legally permitted in Kenya. We conducted a nationwide cross-sectional survey using mobile phones to collect data from adults aged 18 or older. The sample was drawn from a database maintained by a mobile survey provider, with over 12 million telephone numbers across Kenya. We used a random digit dialing approach to select and recruit participants. Trained research assistants administered telephonic interviews using a structured questionnaire that had questions assessing knowledge of conditions for legally sanctioned abortion and legal conditions under which they would support abortion. We summarized continuous variables into means (standard deviations) and medians (interquartile range), while categorical variables (including for the outcomes) as proportions. We performed a survey-weighted quasi-Poisson regression model to assess associations between sociodemographic variables (such as age, sex, marital status, education among others) and the knowledge levels of abortion laws. We also conducted latent class analysis to characterize the preferred legal grounds around abortion by the Kenyan population. Of the 8,942 respondents, 76%, 74%, and 33% knew that the Kenyan law permits abortion when a woman’s life or health is at risk and when the pregnancy results from rape, respectively. Relative to males, females had 2% higher knowledge of abortion law (score ratio 1.02; 95% CI: 1.01–1.03), while those with secondary and university education were associated with 6% (score ratio 1.06; 95% CI: 1.01–1.12) and 8% (score ratio 1.08; 95% CI: 1.03–1.14) higher knowledge of abortion law respectively, compared to those with no education. Most respondents indicated support for abortion when a woman’s life (71%), health (64%), or mental health (43%) is at risk. About one-third would support abortions when pregnancy results from rape (29%) or incest (28%). The latent class analysis showed that most respondents (41%) preferred legalization of abortion for health and life reasons, whereas 30% opposed legalization of abortion under any circumstances. While knowledge of some legal grounds for abortion in Kenya is relatively high, important gaps remain, particularly regarding abortion following rape. Public support for abortion largely aligns with life- and health-related grounds, although a substantial proportion oppose abortion under any circumstances. Targeted dissemination of accurate information on abortion law is needed to address knowledge gaps and support informed public dialogue and policy engagement.