Unsafe abortions: Unscrupulous doctors' goldmine

The country is still grappling with the death of seven month pregnant Sharon Atieno who was gruesomely killed in what has come to be one of the tragic love stories of our time.

Atieno, who is said to have been hobnobbing with Migori Governor Okoth Obado is said to have been urged to terminate the pregnancy but refused. It is reported that her mother against getting an abortion because it could lead to serious health consequences including death.

At the time of her death Atieno was a student at the Rongo University. While her story is gruesome, it is not news that women of child-bearing age are seeking abortion services and falling into the hands of unscrupulous medics and quacks. They are subsequently left with tales of pain and wasted money.

Kenya joined in celebrating the World Contraceptive Day which is a global day whose significance cannot be gainsaid. Contraception prevents unwanted pregnancies, thus unsafe abortions.

On learning that she had conceived, 20-year old Carol opted to terminate the pregnancy. She missed her periods for two weeks and when she tested for pregnancy, it turned positive.

"The only option I had was to get rid of the pregnancy I am still waiting to join college and – I thought - nothing should stop me and my parents would be mad if they knew," Carol revealed.

A friend advised her to visit a private doctor within the precincts of Nairobi City Centre. Despite abortion being a muffled subject in Kenya, the Center for Reproductive Rights notes that unsafe abortions cause 5,000 deaths each year while more than half all admissions to gynecological wards across Kenya result from abortion-related complications.

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What Carol thought was going to be a simple process turned out to be a nightmare and a near financial rip-off by a respected medic who started his practice way back in 2000 according to records from the Kenya Medical Practitioners and Dentists Board (KMPDB). First of all, the doctor charged a consultation fee of Sh3,000.

Carol narrates, "I was then given options available for abortion. For pills, I would be charged Sh10,000 while for a theatre procedure to remove the pregnancy would cost Sh30,000."

She opted for the pill and paid; she was given four pills with instructions to swallow two and insert the remaining two into her vagina.

Carol was lucky but had to endure three days of excruciating pain which started with menses-like bleeding on the first two days and heavy bleeding with clots on the third day.

"On the fourth day the bleeding subsided but the pain became unbearable which forced me to call the doctor and he asked me to go and see him," she confides.

All the four days, she had to keep overdosing on pain-killers to help relieve the pain that she claims made her almost run out of her mind.

A 2018 report by the African population and Health Research Center (APHRC), states that nearly four out of five women who received post-abortion care in health facilities are treated for moderately severe and severe complications such as sepsis, shock, and organ failure.

The report which dwells on the cost of treating unsafe abortions in Kenya states that in 2012, Kenya had close to half a million induced abortions with a quarter of these women seeking treatment for complications arising from unsafe abortions.

Health experts argue that those who do not seek services after unsafe abortion could end up lucky and get well; choose to suffer in silence with untold damages; or die.

Bleeding is the single leading cause of maternal deaths according to the National Council for Population and Development; unsafe abortions are the leading cause of bleeding thus leading killers.

When Carol went to see the doctor, her expectation was that he would examine her and propose a way forward. He never did!

Carol narrates, "He just asked me if I was in pain and when I said yes, he said I needed to be cleaned in a theatre; he never examined me to find if there were any complications."

For the theatre session, the doctor was asking for Sh8,000 as his fee and an additional Sh30,000 for the theatre. And he wanted the money immediately making it look like an emergency.

Without the money, Carol Opted to go back home and the pain subsided and the bleeding lessened and finally disappeared over the days.

"I only came to realize that I could have actually walked into any chemist myself and bought the drug for just Sh200 per tablet and swallowed it instead of wasting all that money on a private doctor," she adds.

A spot check by the Nairobian found that the drug which is mainly intended to be used to stop excessive bleeding among women after they have given birth is readily available in most chemist shops. Some chemists however claim they only sell to those with prescription from gynaecologists.

Carol's story does not end there. About three days after leaving the doctor, he called her asking her to go back so that she can be cleaned or she would face untold complications. He called a month later asking if she had money.

Her story is almost similar to that of Stacy, a college student who sought abortion services from a man only known as Japolo in Mathare.

Stacy was lucky to have survived too but without the ability to bear children due to a messed up uterus in the hands of the quack – Japolo.

Japolo, a well-known abortionist is neither a doctor but has been of 'help' to women seeking services in Mathare Valley. He operates clandestinely in the name of religion but social workers who know him say that he is the face of abortion services in the slum.

"Any lady who needs to away with a pregnancy seeks Japolo and the work is done," a social worker who deals with young people in the area intimated.

She says that Japolo uses all manner of material to terminate a pregnancy, some of which involve instruments that unfortunately end up perforating the uterus thus leading to complications like those suffered by Stacy.
But Japolo is cheaper and gets the job done.

"The women who have sought his services say he charges Sh5,000," revealed the social worker.

Prof Joseph Karanja, a consultant gynaecologist says that abortions could end up in complications which have to be cleaned. He attributes this to the fact that abortion is criminalized in Kenya.

"Most of those who find themselves with complications, go for procedures to clean the mess, which would cost between Sh3,000 and Sh100,000 depending on where it is being undertaken," says Karanja.

He does not rule out the possibility of some doctors taking advantage to mint money out of their patients because of the desperation.

While some doctors ask for as high as Sh50,000, post-abortion care costs only a tenth of this in most public hospitals. A source at Marie Stopes in Eastleigh confided that post-abortion care in the clinic costs an average of Sh8,000.

Dr John Ongech, a leading gynaecologist says that post-abortion care is a feature that is common in public health facilities which mainly try to solve a problem created by rogue practitioners out there.

"After the damage has been done out there, public healthcare facilities end up with the burden of care which eventually adds to the cost to the women as it is not free," he says.

A report released in February this year by the Ministry of Health found that treating medical abortion costs an average Sh4,822 to treat. Medical vacuum aspiration costs about Sh4,488.

Prof Karanja however points out that in a circular by former director of medical services Dr Francis Kimani had directed that post-abortion care be included as a part of free maternity care – but it seems that was quietly ignored.

A research published in BMC Pregnancy and Childbirth in 2016 indicated that young women aged 10–24 years are at heightened risk for unsafe abortion due to their high vulnerability to unintended pregnancies.

"Comprehensive post-abortion care services targeting young women are needed. In particular, post-abortion care service providers must ensure that young clients receive contraceptive counselling and effective pregnancy prevention methods before discharge from the healthcare facility to prevent unintended pregnancies that may result in subsequent induced abortions," concludes the research," says Evelyn Opondo the executive director of CRR.

Treating an abortion complication requires about eight hours of a medical practitioner's time according to the report by APHRC.

The APHRC report notes: The estimated cost of treating complications of unsafe abortion in public facilities in Kenya in 2012 was Sh432.7 million, a conservative estimate based only on the caseload of 75,581 women who were treated in public health facilities in 2012.

Estimations are that in 2016, almost half a billion shillings was spent on treatment of complications from unsafe abortions in public health facilities.  

Level 4 facilities having seen an expenditure of Sh221 million followed by Level 3 at Sh83 million. Level Five facilities on the other hand spend Sh65 million.

The APHRC report states that Rift Valley had the greatest expenditure on complications of unsafe abortions at Sh112 followed by Western at Sh83 million with the two regions having the greatest number of women admitted for complications in 2012.

The report reiterates the need for improved family planning services including information that is relevant to avert the demand for unsafe backstreet abortion services.

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Nairobi City CentreMigori Governor Okoth Obadot Sharon AtienoRongo UniversityWorld Contraceptive DayCenter for Reproductive RightsKenya Medical Practitioners and Dentists BoardAfrican populatio