Without a doubt, abortion is a controversial subject in this country. It evokes a lot of emotion and receives opposition from religious leaders, conservative pockets of society and anti-choice groups.
Yet no matter how much we may try to moralise abortion, women and girls’ lives remain at risk. An estimated 2,600 Kenyan women die from unsafe abortions annually (approximately seven every day), according to a joint 2016 report by the Ministry of Health and the African Population and Health Research Centre (APHRC).
The report further revealed that only 23 per cent of women who survive unsafe abortion go to the hospital for post-abortion care (PAC), with 37 per cent of them showing severe complications (such as high fever, sepsis, shock or organ failure).
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Since the onset of Covid-19, the Health Ministry has not made enough effort to document unsafe abortion cases in our communities as all efforts have been directed at fighting the pandemic. Yet we continue to hear news of women barely surviving back-alley abortions.
With increasing rates of unintended pregnancies mostly among teenagers, unsafe abortions are happening everywhere in the country; women are dying and we are somehow bent on blinding ourselves to this reality.
It should, therefore, not surprise us that unsafe abortions account for 35 per cent of maternal deaths in Kenya (2014 Kenya Demographic Health Survey); the global average is 13 per cent. Study after study continues to show that the best means of reducing abortion is to expand health coverage so that every woman can consult with her doctor about her medical needs.
And for those more compelled by economic arguments, in 2017, complications arising from unsafe abortion in public facilities cost the Kenyan taxpayer Sh432.7 million, according to a 2018 study by APHRC and the Health ministry. That’s almost half a billion shillings spent dealing with consequences of malpractices that should have been avoided.
This is further complicated by the fact that many women who need and seek abortion services come from poor and underprivileged communities who are already deprived of the information and commodities (contraception) necessary to make abortion unnecessary in the first place.
The reasons for seeking abortion are also revealing in their bias towards the poorest amongst us. Young girls seek unsafe abortion due to the stigma of childbirth outside marriage, poor financial status leading to inability to provide for a child, fear of dropping out of school, societal discrimination and lack of pregnancy or child support from boyfriends or sex partners.
Even though Article 26 (4) of the Constitution is clear on the when and whether of terminating a pregnancy (abortion is not permitted unless in the opinion of a trained health professional; there is need for emergency treatment; or when the life or health of the mother is in danger), many women and girls resort to unsafe methods due to stigma, misinformation and fear of violence. Covid-19 has led to an increase in sexual violence and transactional sex, thus doubling the number of unintended pregnancies among young people aged 15-19.
We cannot ignore the unsafe abortion crisis anymore. We must hold leaders and the government to account to ensure effective implementation of the Constitution to reduce maternal deaths. Implementing Article 26 (4) will ensure access to safe abortion services and reduce complications resulting from unsafe abortion, thus aligning the country’s health agenda to international commitments and promises like last year’s ICPD25 summit on zero maternal deaths worldwide.
Health CS Mutahi Kagwe also needs to help women with unmet contraceptive needs and ensure those in hard to reach areas have access to post-abortion care as per the 2012 Ministry of Health standards and guidelines. The ministry is also yet to roll out a curriculum and guidelines on the training of health care providers on the provision of post-abortion care.
Kenyan women represent more than half the people who voted for the current constitution. Their voice, lives and health matter. We can only dance around the debate for so long; we must begin to make systemic changes to our healthcare system that will ensure no woman’s life is lost to unsafe abortion.
-Ms Odhiambo is Youth Coordinator, Reproductive Health Network Kenya