Social and Structural Determinants of Unsafe Abortion in Kibera, Kenya: Implications for Young Women’s Reproductive Health Policy

Unsafe abortion is a leading cause of preventable maternal morbidity and mortality in Kenya, particularly in Nairobi’s informal settlements. This paper investigates unsafe abortions among adolescent girls and young women in Kibera—one of Africa’s largest urban slums—through a qualitative secondary data synthesis grounded in a Social Ecological Model (SEM) framework. This paper examines Kibera’s demographics and healthcare infrastructure, the socio-cultural and legal context influencing reproductive health decisions, and the health and social impacts of unsafe abortion. Nationally, an estimated 41.9% of pregnancies are unintended, and up to 14% of all pregnancies end in unsafe abortion [1], translating to about 2600 deaths annually. In Kibera, poverty, limited healthcare access, pervasive stigma, and restrictive abortion laws converge to intensify these outcomes. Approximately half of Kibera’s young women (ages 15 - 25) have experienced pregnancy—mostly unintended—amid widespread lack of contraceptive use and incidents of sexual violence [2] [3]. The resultant reliance on clandestine, unsafe abortion methods contributes substantially to maternal injuries and school dropouts in this community. This review uses the SEM’s multi-level lens (individual, interpersonal, community, institutional, and policy) to bring together research on what causes and leads to unsafe abortions in Kibera and finds interventions that have been shown to work. Key strategies emerge for multifaceted prevention: legal reforms and clear guidelines to enable safe services, strengthening youth-friendly reproductive healthcare delivery, comprehensive sexuality education and school re-entry policies for young mothers and community engagement to reduce abortion stigma. These interventions, pursued in an integrated manner, could significantly reduce unsafe abortions and their devastating impact on young women’s health and socio-economic futures in Kibera. The study underscores that improving adolescent reproductive health in slum contexts requires coordinated action across all levels—from empowering individual girls to enacting supportive national policies—and offers insights relevant to similar low-resource urban settings.