In the heart of Kenya, from the bustling urban center of Kiambu to the rural landscapes of Kakamega, a quiet revolution in the delivery of medical abortion services (also known as abortion with pills) is taking place through the Medical Abortion Self Use (MASU) project.
The consequences of abortions with unsafe methods weigh heavily on individuals, families, society and health care systems. In Kenya, maternal deaths directly associated with unsafe abortion are nearly 6,000 yearly. Western Kenya (counties of Nyanza and Western) are the highest after Rift Valley in incidences of abortions with unsafe methods, with the majority being under 25 years old.
It’s against this backdrop that Ipas Africa Alliance partnered with the Ministry of Health and Pharmacists/Pharmatech to launch the MASU project in 2021. It was aimed at reducing deaths and injuries tied to unintended pregnancies among girls and women in these counties. Research has shown that access to medical abortion greatly decreases the prevalence of complications related to unsafe abortion.
This initiative has not only empowered service providers with the skills, confidence, and tools to offer life-saving care but has also altered the landscape of reproductive health, bringing hope to girls and women who once had no place to turn.
Service providers faced immense challenges
Before the MASU intervention, service providers across the five selected counties—Kiambu, Kisumu, Trans-Nzoia, Bungoma and Kakamega—faced immense challenges. Each county, with its unique socio-cultural context, was plagued by the following:
- Lack of standardization, inadequate access to essential medications, and legal ambiguities
- Providers were fearful, unsure of how to navigate the complexities of offering safe medical abortion services, often resorting to unsafe methods, hearsay, and improvised solutions
- The cost of procuring medical abortion drugs was prohibitive, and bureaucratic processes added layers of difficulty.
The result? A health crisis that endangered the lives of countless girls and women.
- In Kiambu, service providers were forced to rely on traditional methods and struggled with inconsistent practices. The lack of proper guidelines created an atmosphere of fear, where even basic procedures like pregnancy tests were neglected, leading to errors and complications. For those tasked with providing these essential services, the absence of support systems left them vulnerable to legal scrutiny, forcing them to navigate their work with uncertainty.
- In Kisumu, providers leaned heavily on hearsay and outdated methods. Many were unaware of the existence of alternative, more effective options. Unsafe abortions were an unspoken reality, and the fear of legal repercussions drove providers underground, further complicating efforts to offer safe care.
- Trans-Nzoia providers found themselves isolated, with no platforms to share experiences or interact with others in the field. With little more than theoretical knowledge, they were hesitant to handle sensitive cases like schoolgirls or victims of defilement. Financial constraints and high failure rates weighed heavily on their confidence, and law enforcement harassment created an additional barrier, leaving them fearful of performing even the most basic procedures.
- In Bungoma and Kakamega, providers lacked basic knowledge about gestation ages, proper dosages, and how to counsel clients. Many relied on hearsay from friends, performing risky procedures without proper examinations or client consent. The stigma of being labeled an “abortionist” was a heavy burden, and providers feared imprisonment. Girls were left with no choice but to seek unsafe options, further perpetuating the cycle of harm. The community viewed abortion services as a crime, leaving providers isolated and powerless to offer the help they knew was desperately needed.
Then came the MASU project
The MASU project has strengthened reproductive health services by training 137 providers across 10 counties, resulting in a significant rise in post-MA contraception uptake to over 80%. Between 2021 and 2023, 137 pharmacies were strategically onboarded (34 in FY21, 66 in FY22, and 37 in FY23) establishing a robust network for safe MA service delivery. Over 7,000 clients have been reached and as a result, utilization of MA services has grown substantially across the 10 target counties.
providers trained across 10 counties
%
post-MA contraception uptake
pharmacies strategically onboarded
over 7,000 clients reached
They learned how to confidently administer medical abortion services using combi packs, significantly reducing complications and improving outcomes. Access to medical abortion drugs was no longer a distant dream but a reality, with stronger supply chains and more affordable options now available.
“By improving our documentation processes and following set guidelines, I’ve been able to establish strong relationships with my clients. Their trust in the care they receive has grown significantly.” — Beatrice Mwangi*, Kiambu
Kisumu saw an equally dramatic transformation. The MASU project introduced providers to new methods and technologies, like the WHO app, which keeps them informed about the latest guidelines. What was once a community plagued by hearsay is now a hub of knowledge, where providers confidently administer combi packs and counsel their clients with empathy and precision.
“We have realized that girls are living better lives now that they can access safe and affordable medical abortion services. As I provide the services, the fear of legal repercussions has shifted to a strong awareness of the laws that safeguard both of us as providers and the clients.” Peter Opiyo* – Kisumu
In Trans-Nzoia, the once-isolated providers now benefit from a robust network of professionals who support each other through difficult cases. Providers have been economically empowered as client flow has increased, offering not only health services but also hope and empowerment to their communities.
“Through the MASU project, we’ve been able to establish referral systems that ensure clients get the care they need on time, while the standardization of services has significantly reduced failure rates. Law enforcement has transitioned from being a threat to becoming a partner in delivering safe, dependable care to our community.” Jackson Kitoto* – Trans-Nzoia
In Bungoma and Kakamega, where fear and stigma once ruled, providers now stand tall as champions of safe medical abortion. The Nurse Nisa app, introduced through the MASU project, has equipped them with the tools they need to offer accurate, compassionate care. VCAT training shifted mindsets, helping providers understand the importance of the services they offer and instilling in them a deep commitment to protecting girls from unsafe methods.
“With additional funding, the MASU project can expand its reach, ensuring more providers are trained, and more girls are able to access safe abortion outside the formal health system. We have the opportunity to build a future where safe, accessible reproductive health services are the norm, not the exception,” concludes Edward Ngoga, Ipas’s Quality of Care Manager
**Names have been changed to protect the identities of the people involved in the MASU project.