Wealth inequalities and a growing conservative backlash are combining to put lives at risk.
Beryl Mueni. PHOTO by J Kubania
When Beryl Mueni first sought an abortion, the supposed doctor she visited gave her two pills for which she paid Kes 500 (3.75 US dollars). It was only after she got home and checked the leaflet that she realised she’d been conned. The pills were Clomid, which ironically is used to stimulate ovulation so women can conceive more easily.
Mueni, only 17 years old at the time, was determined to terminate the five-month pregnancy so she could continue her education. “I went back to him and demanded proper abortion medication,” she recalled. “It was then that he gave me a single dose of misoprostol to place under my tongue. A few hours later, I felt my stomach begin to cramp but that was it. Nothing came out. I resigned myself to my failed abortion and made peace with the fact that I would become a mother.”
Each day, seven women and girls in Kenya die from complications associated with unsafe abortions. Most lack the knowledge and resources to access proper health care, pushed to the margins by a health system that prioritises those with money. Data from the African Population and Health Research Centre (APHRC) states that unsafe abortion is one of the leading contributors to maternal morbidity in Kenya, which currently stands at 362 per 100,000.
A big part of the problem is that the legality of abortion in Kenya remains misunderstood, leaving the health care landscape riddled with inconsistencies.
“Abortion in Kenya is restricted, not illegal,” said Jolly Mukangu, who runs a youth-friendly clinic called Usawa Reproductive Health Centre in Nairobi. Kenya’s constitution has certain provisions under which abortion is allowed, including if the pregnancy is deemed to be a risk to the physical or mental health of the pregnant woman.
“Unfortunately, only rich women can get abortions safely because only they have the resources to follow the correct procedures and get clearance from a psychiatrist attesting to their mental vulnerability, for example. In addition, they can pay for the abortion in reputable clinics,” said Jolly.
Abortion stigma is entrenched not just societally but also in government policy. Despite the constitution making abortion legal in 2010, the government of Kenya withdrew its guidelines in 2013. The high court compelled the government to reinstate these guidelines in 2019, but implementation is still low and uncertainty prevails in hospitals over how to handle abortion cases.
In 2004, Dr John Nyamu was arrested and charged with murder for offering abortion services in Nairobi. He served a year on remand before being acquitted of all charges. While there have not been other high profile arrests since then, reports of intimidation and harassment of healthcare providers by police are common.
“There is pushback towards healthcare providers like myself who offer comprehensive sexual and reproductive health services, including safe abortions, post abortion care and family planning,” Jolly said. “We face lots of criticism from anti-choice campaigners and religious zealots. However, I am a big believer in bodily autonomy.”
In recent years, foreign pressure groups have also attempted to restrict reproduction rights in Kenya. A 2022 investigation by the Bureau of Investigative Journalism (TBIJ) found that fundamentalist groups from the US and Russia were lobbying to limit reproductive and sexual health care in Kenya, with some success. TBIJ named Citizen Go, which claims to defend lives, family and freedom, as one of the entities actively using digital tools, political lobbying and physical protests to agitate against abortions.
Kenya’s murky abortion environment leaves even organisations such as Marie Stopes vulnerable to attacks and undue censure. In 2018 the government stopped the organisation from offering abortions to its patients after complaints that it was promoting terminations on radio. The ban was lifted a month later after campaigns by activists who warned that it was unconstitutional and would lead to increased deaths.
Cindy Manyasa could not afford to go to Marie Stopes, and said it was only for “rich people”. She is Mueni’s neighbour in Mathare and was 16 years old when she found out she was pregnant. She was too scared to tell her mother until she was about four months along and it became too difficult to hide.
Determined to not let an unplanned pregnancy interrupt her daughter’s life, Manyasa’s mother brought home a pill and instructed Manyasa to put it under her tongue. “My stomach started hurting that night, intense cramps that made it impossible to sleep. Eventually, I went to the bathroom and the foetus came out. I thought that was the end of it but I bled non-stop for two weeks, passing massive clots. They had to take me to hospital and flush out my uterus to complete the abortion,” Manyasa said. She was just one of many casualties of an unfair health system that has guaranteed a level of safety and comfort for the middle class while leaving poor women and girls in the hands of backstreet abortion providers with no medical training.
According to the APHRC, “more than 75 per cent of women with induced unsafe abortion experience moderate to severe and near miss complications (such as sepsis, haemorrhage, shock, and multiple organ failure) that require medical attention in health facilities, including admission into intensive care units”.
“Quacks commonly use crochet needles or sticks to pierce the uterus, which leads to heavy bleeding but ultimately rarely completes the abortion,” Jolly said. “Some administer medications but they do not have the knowledge to advise their patients on correct usage, which also leads to failed abortions.”
So dire is the issue, Jolly continued, that 40 to 60 per cent of all patients she treats at her clinic come in for post-abortion care treatment. Many of these patients are young and poor.
[The article continues to show that young women have little or no access to contraceptives either…]
SOURCE: Institute for War & Peace Reporting, by Jacqueline Kubania, 21 November 2024