Most pregnancies in Kenya end in live births, but a closer look at county-level data from the 2022 Kenya Demographic and Health Survey (KDHS) reveals a country where the safety of pregnancy depends heavily on where a woman lives. Geography, access to care and the strength of local health systems are shaping outcomes in ways that national averages cannot fully capture.

Nationally, 88.1 per cent of pregnancies result in live births. That figure, however, masks sharp differences across counties. Marsabit, Mandera and Wajir record the highest live birth proportions, while Kirinyaga, Uasin Gishu and Mombasa report lower rates. Those differences point to the quality and reach of health services, the timing of antenatal care, and the ability of women to reach care when complications arise.

Miscarriage: Marsabit, Mandera, West Pokot show far lower rates

The national miscarriage rate stands at 9.8 per cent, but Kirinyaga, Mombasa, Uasin Gishu and Bungoma report much higher figures. At the other end, Marsabit, Mandera and West Pokot show far lower rates, though those figures may also reflect under-reporting or limited access to diagnosis rather than genuinely lower risk.

The World Health Organisation (WHO) guidance notes that maternal age, previous pregnancy loss and environmental factors can raise miscarriage risk. In Kenya, those risks are compounded by delayed antenatal attendance and wider service gaps. The survey also shows that urban areas report higher miscarriage rates than rural areas, which may reflect better diagnosis and reporting, or later childbearing and other urban health pressures. Women with more than secondary education show higher miscarriage rates, but that is likely linked to delayed pregnancy rather than education itself. WHO evidence consistently identifies advanced maternal age as a major risk factor for pregnancy loss.

Stillbirths: Wajir, Uasin Gishu and Siaya stand out as higher-risk counties

Nationally, 1.5 per cent of pregnancies end in stillbirth, but Wajir, Uasin Gishu and Siaya stand out as higher-risk counties. A stillbirth rate of 5.0 per cent in Wajir signals serious gaps in emergency obstetric care, referral systems and skilled attendance at birth.

Stillbirth remains the most painful silent burden in the data. The Ministry of Health (MoH) and WHO both stress that many stillbirths are preventable when labour and delivery care is strong and timely. Where that care is absent or arrives too late, the consequences fall most heavily on women in counties already underserved by the health system.

Induced abortion: Busia, Murang’a and Uasin Gishu show higher reported figures

Induced abortion is the most difficult outcome to measure accurately. The survey records 0.6 per cent nationally, but stigma and legal sensitivity almost certainly suppress reporting. Counties such as Busia, Murang’a and Uasin Gishu show higher reported figures, while many others record none at all.

That does not mean abortion is absent in those counties. It more likely means many women do not disclose it, especially where services are unclear or socially risky. The true scale of induced abortion in Kenya remains hidden beneath a layer of silence that survey data alone cannot fully penetrate.

Uasin Gishu: Is in higher-risk group for miscarriage, stillbirth and induced abortion

Uasin Gishu is a notable outlier across the dataset. It appears in the higher-risk group for miscarriage, stillbirth and induced abortion, which may point to a genuine need for closer review. It may also reflect referral patterns, as major facilities attract complicated cases from surrounding counties. Either way, the pattern warrants targeted maternal health attention across the North Rift region.

What the data means for policy: Kenya’s progress is uneven and fragile

These findings matter because they show that pregnancy outcomes in Kenya are not evenly distributed. A pregnancy in Marsabit, Kirinyaga or Mombasa does not unfold under the same conditions as one in Wajir or Uasin Gishu. National averages are useful, but they hide local crises, and policy that ignores those differences will miss the women at greatest risk.

Kenya has made progress, but this dataset shows that progress is uneven and fragile. The country’s challenge is to reduce the gaps that make pregnancy safer for some women and far more dangerous for others.

Data analytics and visualisation: Stanley Njihia 

Text: Yvonne Kawira.