Quality assessment of sexual and reproductive health services for young women in Nairobi Kenya: results of a mystery client survey.

Young people aged 10-24 years represent a significant proportion (40-70%) of women in low and middle income regions who undergo unsafe abortion. They are more likely than older women to delay seeking appropriate post-abortion care. These delays often result from a lack of knowledge fear of negative provider attitudes and lack of confidentiality an inability to pay lack of transportation fear of the medical procedure and feelings of shame or embarrassment. Young women constituted almost half of patients (49%) treated for severe complications from the estimated 500000 induced abortions performed in Kenya in 2012. More than a quarter of these young patients (26%) received poor quality post-abortion care. Worse 30% of those receiving post-abortion treatment were not offered contraceptives upon discharge; thus increasing their vulnerability to repeat unintended pregnancy. Comprehensive post-abortion care (PAC) is a critical intervention to address complications arising from unsafe abortion – induced pregnancy termination carried out by unskilled personnel or in an environment that does not meet minimal medical standards or both. Comprehensive PAC not only ensures that women receive appropriate treatment for existing complications but also provides an opportunity to prevent future unintended pregnancies through linkages to contraceptive and other reproductive health services. In this briefing paper we summarize key findings from a mystery client survey conducted in 12 public and private health facilities in Nairobi County (Kenya) between April and May 2016 to understand young people’s perceptions of the quality of sexual and reproductive health services provided in these facilities including emergency contraception sexually transmitted infections and medical abortion.