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Kenya’s 2010 abortion law impacts contraceptive use and fertility rates

Reproductive Health volume 22, Article number: 52 (2025) Cite this article

Abstract

Introduction

Prior research suggested that liberation of abortion laws in Sub-Saharan Africa (SSA) was associated with fewer abortion complications and deaths. However, few studies have examined the association of abortion law liberalization with modern contraceptive use and fertility rates  among women in SSA. In this study, we assessed the impact of Kenya’s 2010 abortion law liberalization on modern contraceptive use and number of recent births (births in the past 5 years ) among women of reproductive age in Kenya.

Methods

Data from three rounds of the Demographic and Health Surveys (2003–2016) for Kenya, Tanzania and Uganda were used for the analysis. We used the differences-in-differences estimator to assess the impact of the policy change in Kenya using Tanzania and Uganda as the control group. We performed multivariable logistic and Poisson regressions to estimate the adjusted odds ratios (aOR) and adjusted prevalence rate ratios (aPRR) with 95% confidence interval (CI) for modern contraceptive use and number of recent births respectively.

Results

A weighted sample of 117,163 women aged 15–49 years was used for the analyses. Modern contraceptive use increased from 25.4% and 19.4% to 39.1% and 27.2% for the intervention and control groups, respectively, in the post-intervention period. In contrast, the mean number of recent births declined from 0.71 and 0.88 to 0.63 and 0.80 for the intervention and control group, respectively in the post-intervention period. We found that Kenya’s 2010 abortion law liberalization was associated with more people using modern contraception (aOR, 1.22; 95% CI 1.11, 1.34) and fewer recent births (aPRR, 0.95; 95% CI 0.91, 0.98).

Conclusion

Our findings suggest that Kenya’s 2010 abortion law was surprisingly associated with higher use of modern contraceptives. Reforming restrictive abortion laws may indirectly improve use of contraceptives in Sub Saharan African countries.

Plain Language Summary

Many countries in Sub Saharan Africa (SSA) have laws that prohibit legal termination of pregnancy (abortion) except when the pregnancy poses danger to the life of the woman. These laws, known as abortion laws, are often associated with high level of unsafe abortion practices and its related complications. Our study sought to examine the impact of Kenya’s 2010 abortion law on modern contraceptive uptake and number of recent births (births in the past 5 years). We used three rounds of cross sectional data from the Demographic and Health Surveys (DHS) in Kenya, Tanzania, and Uganda for the analysis. DHS data are mostly collected every five years with standard questionnaire across implementing countries. To assess the impact of Kenya’s abortion 2010 law, we used Tanzania and Uganda as the control group. We found that the change of the abortion law (from highly restrictive to moderately restrictive) was associated with an increase in the uptake of modern contraceptive methods among women in Kenya. Furthermore, change of the law was also associated with women in Kenya having fewer births (births that occurred five years prior to the surveys). Our study suggest that changes in laws that permit legal termination of pregnancy on broader grounds without restrictions in SSA countries, may help improve the use of reproductive health services such as modern contraceptives.

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Introduction

The impact of restrictive abortion laws on the reproductive health of women in Sub-Sharan Africa (SSA) cannot be overestimated [1, 2]. Unfortunately, many countries in SSA still have highly restrictive abortion laws which prohibit abortion altogether or only to save the life of the woman [3]. Furthermore, abortion laws in several other countries in SSA do not guarantee access to legal abortion on grounds of the mental health of women [1]. Evidence indicates that legally restricting abortion does not lead to reduction in the number of abortions; restrictions only increase the number of unsafe abortions and their complications [4]. A report by the United Nations (UN) suggested that the average unsafe abortion rate is about four times higher in countries with restrictive abortion laws than in countries with liberal abortion laws [2]. Moreover, the maternal mortality ratio is three times as high in countries with restrictive abortion laws than those with liberal abortion laws [2]. SSA has the highest abortion case fatality in the world—185 maternal deaths per 100,000 abortions as of 2019 [1].

In response to the Maputo Protocol, an international treaty that aimed to improve access to legal abortion services for women in Africa [5], several countries in SSA have reformed their abortion laws to broadly improve access. For example, in 2005, Ethiopia liberalized their abortion law to allow legal abortion in cases of rape, incest, or fetal impairment. In addition, a woman is legally allowed to terminate a pregnancy if her life or physical health is in danger, if she has physical or mental disabilities, or is a minor who is physically or mentally unprepared for a childbirth [6]. Other countries including Rwanda, Mozambique, Sao Tome and Principe, Democratic Republic of Congo, and Angola recently reformed their abortion laws to expand access to abortion care [3].

Furthermore, Kenya moderately liberalized their abortion law in 2010 from abortion is allowed only to save a woman’s life to abortion is allowed on health grounds [7]. Kenya’s 2010 abortion law implied that legal abortion was not only permitted to save a woman’s life (i.e., a woman could lose her life without an abortion care) but also, legal abortion could be performed to protect a woman’s health [8]. The Wealth Health Organization (WHO) advises that all countries permitting abortion on health grounds should interpret “health” to mean “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity [9].” Physical health entails laws that may permit abortion on health grounds that has serious or permanent health injury. Interpretation of mental health may vary across countries but may include, for instance, the psychological distress suffered by a woman who is raped or incest [1].

Despite the recent liberalization of abortion laws in some SSA countries, studies on the impact of this liberalizations on the reproductive health of women in SSA are limited. A comprehensive report by the Guttmacher Institute suggested that the liberalization of the abortion law in Ethiopia was associated with fewer unsafe abortions [1]. Furthermore, a panel analysis found that changes in Ghana’s abortion law from total ban to abortion allowed on health grounds (physical and mental health) in 1985 was associated with lower total fertility [10]. However, few studies have examined the impact of liberalization of abortion laws on modern contraceptive use. For example, prior research suggested that abortion would be used as a substitute for contraceptives, especially when access to modern contraceptive methods was limited [11,12,13]. This assumption implicitly assumed that liberalization of abortion laws could lead to lower use of modern contraceptives especially in SSA where access is limited.

The liberalization of Kenya’s 2010 abortion law presented a unique case to examine the association of abortion law liberalization with lower use of contraceptives. For several decades, Kenya, Tanzania, and Uganda practiced similar abortion laws (i.e., legal abortion was permitted only to save a woman’s life) [3]. However, Kenya moderately liberalized their abortion law in 2010 while Tanzania and Uganda still have the same abortion laws. This presented an opportunity to assess the role of Kenya’s 2010 abortion law change using Tanzania and Uganda as control group. Furthermore, it was appropriate to use Tanzania and Uganda as control group because they share several similarities with Kenya. For example, the three countries share geographical boundaries and have some similarity in their cultures, e.g., Swahili is spoken in all three countries [14], their abortion laws were inherited from the Great Britain and had similar provisions, [15] and they all practice democracy. They also have similarity in their healthcare system (regulations, financing and delivery of care) with public sector dominating [16,17,18]. In addition, prior health research have compared these three countries [19,20,21].

The objective of the study was to assess the impact of Kenya’s 2010 abortion law on modern contraceptive use and number of recent births among women in Kenya. We hypothesized that the liberalization of Kenya’s abortion law would not be associated with a decrease modern contraceptive use but with a decrease in the number of recent births among Kenyan women.

Materials and methods

Data sources and study population

We performed secondary data analysis using data from three rounds of the Demographic and Health Surveys (DHS) from Kenya, Tanzania, and Uganda. The intervention group was Kenya whereas the control group comprised of women from Tanzania and Uganda. Of the three rounds of data, the first two rounds were used for the pre-intervention period and the last round for the post-intervention period. For Kenya, data for 2003 and 2008/09 were used for the pre-intervention period, whereas 2014 was used for the post-intervention period. For Tanzania 2004/05 and 2010 were used for the pre-intervention period while 2015/16 was used for the post-intervention period. For Uganda 2006 and 2011 were used for the pre-intervention period while 2016 data were used for the post-intervention period (supplementary Table 1).

DHS surveys are typically conducted every five years in many low-and middle-income countries using a standard questionnaire across countries. DHS sample design uses two-stage probability samples mostly drawn from a recent census frame. In the first stage of selection, the primary sampling units (PSU) are selected with the probability proportional to size within each stratum. The PSU forms the survey cluster. In the second stage, a complete listing of households is created in each selected cluster. A systematic probability sampling technique is then used to select households for participation. Details of DHS sample designs, stratification, and sample weights is publicly available [22]. This study used the standard DHS women’s questionnaires for each country. The study population were women of reproductive age: 15–49 years.

Variables

Dependent variables

The dependent variables were modern contraceptive use and number of recent births among women of reproductive age. Modern contraceptive use was a binary outcome and referred to women who were using any modern contraceptives to delay or limit birth at the time of the survey. Modern contraceptive methods included male and female sterilizations, intra-uterine devices, subdermal implants, hormonal pills, injectables, male and female condoms, emergency contraceptive pills, patches, rings, diaphragms, and vaginal spermicides. Standard days methods and lactational amenorrhea were also classified as modern contraceptive methods. This classification was adopted from the 2015 WHO Department of Reproductive Health and Research, and the United States Agency for International Development technical consultation team [23].

Number of recent births was defined as the number of births (live and stillbirths) per woman, five years prior to the DHS survey and was measured as a count variable. This definition is consistent with Kenya’s abortion policy change in 2010 and the first DHS data collection after the policy in 2014. The definition of number of recent births is also consistent with data collection periods for Tanzania and Uganda.

Primary independent variable

Kenya’s 2010 abortion law was our primary independent variable. To estimate the effect of the policy change, we created two dummy variables. First, we created a group dummy (1 for participants in Kenya and 0 for participants in Tanzania and Uganda). We created another dummy for time period—1 for all women in the post-intervention period (Kenya = 2014; Tanzania = 2015/16; Uganda = 2016) and 0 for those in the pre-intervention period (Kenya = 2003 and 2008/09; Tanzania = 2005/05 and 2010; Uganda = 2006 and 2011). We then created an interaction (group*time period) to estimate the coefficient of interest. The interaction coefficients capture the average change in in the dependent variables attributable to change of the abortion law.

Covariates

The covariates were age, marital status, place of residence, education level, wealth index, health insurance coverage, religion, visited by family planning (FP) workers, and access to FP information in the media. Age was measured as a continuous variable and defined as; age in years of the women. The remaining variables were measured as follows; marital status (married/cohabiting, never in a union, separated/divorced/widowed); education level (no formal education, primary education, secondary education, higher education); and religion (Christianity, Islamic, Others). Those who were also visited by FP workers in the past 12 months were considered to have been visited by an FP worker. Women were considered to have access to FP information if they heard of any FP products from the media in the past few months. Health insurance coverage was measured as yes for women who had valid health insurance at the time of the survey.

DHS generated a wealth index using principal component analysis on household ownership of selected assets, such as television and bicycles; materials used for housing construction; types of water access; and sanitation facilities [24]. These data were then categorized into household wealth quintiles (poorest, poor, middle, rich, and richest). The place of residence was classified into urban and rural areas. The variable selections for this study were based on prior studies [25,26,27].

We also included year and country’s region fixed effects to control for time shocks, and time invariant region level characteristics. Regions for each country was coded consistently with DHS surveys but modified for Tanzania and Uganda to be consistent over time because new regions were created (supplementary Table 5).

Analyses

We used difference-in-differences (DiD) to estimate the impact of Kenya’s abortion law liberalization on modern contraceptive use and number of recent births among women of reproductive age in Kenya. The DiD estimator is typically used to estimate the effect of an intervention (such as a new policy) by comparing the changes in outcomes over time between the population affected by the policy (intervention group) and those not affected by the policy (control group) [28].

The DiD models were performed using multivariable logistic and Poisson regressions to estimate the odds ratios and prevalence rate ratios with 95% confidence interval (CI) for modern contraceptive use and number of recent births, respectively. We ran two separate models for each of the outcomes. For modern contraceptive use, model one did not include religion, visited by FP workers, access to FP information in the media, and health insurance coverage; whereas model two included imputed data of these variables. Similarly for number of recent births, model one did not include religion, whereas model two included imputed religion data. We chose this approach of analyses because the four imputed variables had either no data at all or missing more than 50% data for some of the countries in the pre-intervention period. Multivariable imputation by chained equations (MICE) was used for the imputed analysis. We specified 20 imputations for each model. Sampling weights, clustering and stratification were taken into account due to the complex sampling design employed by the DHS surveys. All analyses were conducted using STATA 17.0 (StataCorp, College Station, Texas, USA) with the SVY command.

Test of parallel trends assumption

We conducted virtual inspections to ascertain validity of the parallel trends assumption. The DiD estimator relies on the validity of the parallel trend assumption (i.e., in the absence of the intervention, the unobserved differences between the intervention and control group are the same over time). The data suggested similar trends of the outcomes between the intervention and control groups in the two pre-intervention periods (Supplementary Figs. 1 and 2). This implied that the change in use of modern contraceptives and number of recent births over time were similar between Kenya and the control group during the pre-intervention period—an indication that any change in the trends of the two outcomes after 2010 would be attributable to Kenya’s abortion law.

We also performed falsification analyses by restricting the data to the pre-intervention period. We found no statistically significant differences in the use of modern contraceptives and number of recent births between Kenya and the control group in the pre-intervention period (supplementary Table 2). The falsification test further supported the validity of parallel trends assumption—implying that any statistically significant changes in the outcomes after the post-intervention period would be attributed to Kenya’s 2010 abortion law.

We further used the Granger’s causality test to assess the validity of the parallel trends assumption. Granger’s causality test is a post estimation test using the “didregress” command in STATA. The null hypothesis for this test is that there is no effect in anticipation of treatment [29]. This test also supported the validity of parallel trends assumption.

Sensitivity analysis

We specified linear probability model (LPM) model for modern contraceptive use and linear regression model for number of recent births to test robustness of the results. The LPM and linear regression models estimated modern contraceptive use and number of recent births respectively using the ordinary least square estimator—the probability of an event is a linear function of a set of independent variables.

Results

Characteristics of the study participants

The total weighted sample size was 117,163 women aged 15–49 years. The sample size for intervention group (Kenya) was 47,718 (16,639 in the pre-intervention and 31,079 in the post-intervention period). The sample size for the control group (Tanzania and Uganda) was 69,445 (comprising 37,673 and 31,772 in the pre and post-intervention periods respectively). In the pre-intervention period, modern contraceptive use was 25.4% and 19.4% for the intervention and control groups, respectively. This increased to 39.1% and 27.2% in the post-intervention period for the intervention and control groups respectively. The mean number of recent births declined from 0.71 per woman in the pre-intervention period to 0.63 in the post-intervention period for the intervention group and from 0.88 to 0.80 for the control group (Table 1).

Table 1 Characteristics of women of reproductive age (15–49 years) in the intervention and control groups during the pre and post-intervention periods
Full size table

The mean age of the study participants increased from 28.3 in the pre-intervention period to 28.9 in the post-intervention period for the intervention group but remained the same (28.2) for the control group in both periods. Both the intervention and control groups had slight increase in the number of women living in urban areas in the post intervention period. Similarly, women with secondary and higher education increased for both groups in the post-intervention period whereas women with no education declined. Wealth index and marital status of the women remained fairly the same for both groups in the two time periods (Table 1).

Impact of Kenya’s 2010 abortion law liberalization on modern contraceptive use

The findings from the logistic regression model one with no imputation and those from model two with imputed variables are presented in Table 2. In model one, we found that Kenya’s abortion law liberalization was associated with 22% increase in modern contraceptive use (adjusted odds ratio (aOR) 1.22, 95% CI 1.11, 1.34) among women in Kenya. Furthermore, increase in the number of living children, higher educational level, and increase in the wealth index were all associated with higher odds of using modern contraceptives whereas increase in age and living in rural areas were associated with lower odds of using modern contraceptives. Women who were never in a union or were widowed/divorced/separated also had lower odds of using modern contraceptives compared to married women. The results in model two were similar to those in model one. The imputed variables in model two indicated that women affiliated with Islam or other religions had lower use of modern contraceptives than Christian women. Furthermore, women who were visited by FP workers and those who heard of FP in the media had higher odds of using modern contraceptives (Table 2).

Table 2 Multivariable logistic regression models of modern contraceptive use among women aged 15–49 years after Kenya’s 2010 abortion law liberalization
Full size table

Results from the sensitivity analysis (linear probability model) were consistent with the main findings (supplementary Table 6).

Impact of Kenya’s 2010 abortion law liberalization on number of recent births

The results in Table 3 for model one indicated that Kenya’s abortion law liberalization was associated with decreased number of recent births by 5% among women of reproductive age in Kenya (adjusted prevalence rate ratio (aPRR) 0.95; 95% CI 0.91, 0.98). Furthermore, women who were currently using contraceptives and those who ever used contraceptive had increased number of recent births than those who never used contraceptives. Living in rural areas was also associated with increased number of recent births compared to living in urban areas. In addition, increases in age, wealth, and educational level were all associated with lower odds of number recent of births among women of reproductive age. We also found that women who were never in a union or widowed/divorced/separated had lower number of recent births compared to those who were married/living with partner. Results for model two (imputed) were similar to those in model one. Also in model two, women affiliated with Islam or other religions had higher number of recent births than Christian women (Table 3).

Table 3 Multivariable Poisson regression models of number of recent births among women aged 15–49 years after Kenya’s 2010 abortion law liberalization
Full size table

Results from the sensitivity analysis (linear regression model) were also consistent with the main findings (supplementary Table 6).

Discussion

This study examined the impact of the 2010 abortion law liberalization in Kenya on modern contraceptive use and number of recent births among women of reproductive age. We found no association of Kenya’s 2010 abortion law with lower use of modern contraceptives. In contrast, the liberalized law was associated with an increased use of modern contraceptives and reduced number of recent births among women in Kenya. We also found that educational level, wealth index, age of women, place of residence, marital status, and religion were all associated with modern contraceptive use and number of recent births. In addition, visits by FP workers and access to FP information were positively associated with modern contraceptive use.

Our finding of increased use of modern contraceptives following liberalization of Kenya’s abortion law is positive and somewhat unexpected. Prior research suggested that abortion would be used as a substitute for contraceptives, especially when access to contraceptive methods are limited [11,12,13]. This assumption implicitly assumed that liberalization of abortion laws could lead to lower use of contraceptives, especially in SSA where contraceptive use is lower compared to other regions of the world. It is important to note, however, that contraceptives are not designed to terminate a pregnancy but rather prevent an unintended pregnancy, whereas abortion is used to terminate an existing pregnancy. Thus contraception and abortion complement rather than substitute for each other. Furthermore, prior evidence suggests that women would prefer to use contraception and prevent a pregnancy rather than have an abortion [30,31,32]. These data indicate that an effective strategy for reducing expensive and potentially unsafe abortions may be to expand the supply of modern contraception.

That said, access to legal abortion care would still be necessary in cases of contraceptive failures. It is also critical to highlight the clinical importance of legal abortion access. For example, abortion care is most often necessary for certain pregnancy complications such as ectopic pregnancy, intrauterine death, preeclampsia and eclampsia cases. Given these important reasons, liberalized abortion laws in SSA could significantly improve reproductive health service use and health outcomes of women without being counterproductive to modern contraceptive use.

We believe that Kenya’s abortion law liberalization created the avenue not only for legal abortion access but also for modern contraceptive uptake. Prior evidence suggested that access to legal abortion care was also associated with postabortion contraceptive use because of postabortion contraceptive counselling [33,34,35]. Postabortion contraceptive use has been shown to reduce future unintended pregnancies [36, 37]. However, in countries with restrictive abortion laws, women may be resorting to unsafe abortion practices without having access to postabortion contraceptive methods, and that may often result in another unintended pregnancy and a need for abortion care. Our finding suggest that abortion law liberalization is not only associated with improved access to abortion care, reduced unsafe abortion practices, and reduced maternal mortalities [1, 38, 39], but it also increases the uptake of modern contraceptive methods. Therefore, the combination of liberal abortion laws and contraceptive access gives women a range of resources to control their fertility and improve their reproductive health outcomes.

The finding highlights Kenya’s commitment to improving access to and use of reproductive health services [26]. In addition to the abortion law liberalization, Kenya is one of the countries in SSA that has improved access and use of modern contraceptive methods [26, 40,41,42]. For example, Kenya’s National Family Planning program has implemented new strategies to improve community-based distribution of modern contraceptive methods [42, 43]. Importantly, the supply and use of effective contraceptive methods is crucial for preventing unintended pregnancy and subsequently eliminating the need for an abortion [11, 13, 44]. The importance of access and use of contraception underscores the critical role of policy makers in SSA to simultaneously ensure access to contraceptives and liberalize abortion laws.

Our findings also suggested that Kenya’s abortion law liberalization was associated with decreased number of recent births among women in Kenya, though the magnitude of effect was relatively small. It is unclear why the magnitude of effect was small, however, a prior panel analysis also found that Ghana’s abortion law liberalization from total ban to abortion allowed on health grounds (physical and mental health) in 1985 was associated with 1.5% lower odds of a woman having a child in a given year [10]. Our finding is also corroborated by prior studies in low-and-middle income countries. For example, in Nepal, Mexico and Uruguay, multiple studies suggested that abortion laws liberalization were associated with decline in fertility among women [45,46,47,48,49]. Although the dynamics for fertility preference in these countries may differ, the overwhelming evidence indicates that liberalization of abortion laws is associated with fertility decline. Abortion has long been recognized as one of the proximate determinants of fertility [50]. The impact of abortion liberalization could therefore have a direct and indirect influence on the fertility of a population. For example, we would expect the number of unplanned births to reduce in countries that women have legal access to abortion care. Also, legal abortion access promotes postabortion contraceptive use which reduces the incidence of unintended pregnancy and indirectly impacts the number of births. The combination of these two factors is known to contribute to the decline of population fertility.

Consistent with prior nationally representative studies in Kenya [25, 27, 51], higher education and higher wealth index were associated with higher use of modern contraceptives and fewer births. Higher education and wealth empower women with knowledge and material resources to access modern contraceptives. Furthermore, women in rural areas had lower use of modern contraceptives but higher number of recent births compared to those in urban areas [27]. This finding may be because women in rural areas tend to be poor, lack adequate health infrastructure, personnel, and commodities [52]. Women who were affiliated with Islam or other religions were found to have lower use of modern contraceptives but higher number of recent births than Christian women. This finding is collaborated by previous research [25, 27]. We also found that women who were visited by FP workers and had access to FP information were more likely to use modern contraceptives than those who were not visited by FP workers or had no access to FP information. This finding aligns with prior research [25, 27] and suggests important programmatic implications that could increase use of contraception. Visits by FP workers and access to FP information in the media provide relevant knowledge of the type and availability of contraceptive methods to women and likely increase their chances of using a contraceptive method.

Strengths and limitations

The first strength of this study is the use of the quasi-experimental study design. In particular, the parallel trends assumption of DiD was met—an indication that the findings are strengthened. The rigorous methods ensured that the results were internally valid for conclusions to be drawn. Furthermore, to the best of our knowledge this is the first study to assess the impact of abortion law liberalization on modern contraceptive use in SSA. The study, therefore, contributes new findings to existing literature and would help shape future research in this area especially in SSA.

The study has, however, several limitations. First, the data for the pre and post periods for the three countries do not match exactly although they were collected every five years in each country. This inconsistency could have influenced the findings. However, because the DHS data is one of the very few nationally representative data sets available, it was the most ideal data for this analysis. Furthermore, the study controlled for time trend which could have mitigated any differences. Second, although the study included several covariates including region level fixed effects in each country, another important limitation is that we were unable to control for other important variables such as women’s knowledge of abortion laws, country level contraceptive policy, supply of contraceptive and abortion care access. Finally, the outcome variables were self-reported and recall bias could have been introduced. However, recall bias was expected to be minimal because the events measured were current (i.e., currently using modern contraceptives and number of recent births), and easily recalled.

Policy implications

Kenya is one of the few countries in SSA to reform their abortion law in recent years. Their liberalization of the law was modest—moving from highly restrictive category (abortion permitted only to save a woman’s life) to moderately restrictive (abortion permitted on health grounds). Even with this modest liberalization, the finding sheds light on the reform’s impact on increased modern contraceptive use and fewer births among women in Kenya. One of the important policy implications from this study is that liberalizing abortion laws in SSA would not only reduce unsafe abortion and its complications, but could also increase the use of modern contraceptives. Therefore, liberalizing abortion laws and increasing reproductive health services such as supply of contraceptive methods and services are successful measures for preventing unplanned pregnancy and reducing the need for abortion. Expansion of this health reform could play a key role in reducing unsafe abortion and its complications, improving maternal and child health, and lowering the persistently high fertility rates in SSA.

Future research

This current study focused on the impact of Kenya’s 2010 abortion law on modern contraceptive use and number recent births. Future studies should examine the impact of Kenya’s abortion law reform on other factors such as abortion access, prevalence of unsafe abortions, maternal mortality, as well as birth outcomes. Future studies should also be designed to measure whether the impacts of the abortion law liberalization are heterogenous, and whether they affect social inequalities in access and utilization. Furthermore, the study in Kenya was limited to only one post intervention period. It is therefore important for future research to examine the long-term impact of Kenya’s abortion liberalization on reproductive health services and health outcomes. With the increasing number of countries in SSA reforming their abortion laws, it is important for researchers to design rigorous quasi-experimental studies to examine the impact of restrictive abortion laws and abortion law reforms on access to abortion services, prevalence of unsafe abortions, birth outcomes, and maternal and infant mortalities.

We also recommend the inclusion of data collection on abortion access and use of abortion services by large surveillance surveys, like the Demographic and Health Survey and the Multiple Indicator Cluster Survey. This inclusion would enhance future research on the impact of abortion restriction and abortion law liberalization on women’s reproductive health.

Conclusion

We found that modern contraceptive use increased, and number of recent births reduced following Kenya’s abortion law liberalization in 2010. The findings highlight that abortion law liberalization could potentially increase contraceptive use among women in SSA. We recommend that policy makers of SSA countries with restrictive abortion laws consider reforming their laws while building effective contraceptive programs. These changes could potentially improve reproductive health service utilization and health outcomes of women.

Availability of data and materials

The data that support the finding of this study are available from DHS upon request.

Abbreviations

DHS:

Demographic and health survey

SSA:

Sub Saharan Africa

PSU:

Primary sampling unit

FP:

Family planning

DiD:

Difference-in-differences

MICE:

Multivariable imputation by chained equations (MICE)

LPM:

Linear probability model

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Acknowledgements

We thank Dr. Chunhuei Chi of Oregon State University for his contribution to this paper.

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Authors and Affiliations

  1. School of Nutrition and Public Health, College of Health, Oregon State University, Corvallis, USA

    Maxwell Tii Kumbeni, Marit L. Bovbjerg, S. Marie Harvey & Jeff Luck

  2. Ghana Health Service, Nabdam District Health Directorate, Nangodi, Ghana

    Maxwell Tii Kumbeni

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Contributions

M.T.K. and S.M.H contributed to the conception of the work. M.T.K. contributed to data collection, data analyses, and interpretation. M.L.B. and J.L. contributed to supervising the analyses. M.T.K. contributed to drafting the article. M.T.K., M.L.B., S.M.H. and J.L. contributed to critical revision of the article. All the authors read and approved the final version of the article.

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Correspondence to Maxwell Tii Kumbeni.

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Kumbeni, M.T., Bovbjerg, M.L., Harvey, S.M. et al. Kenya’s 2010 abortion law impacts contraceptive use and fertility rates. Reprod Health 22, 52 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12978-025-02002-4

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Keywords

Reproductive Health

ISSN: 1742-4755