Never ending abortion debate heads for homestretch as Ministry promises new guidelines

NAIROBI, KENYA: The debate on abortion has refused to come to an amicable conclusion with the hope of new guidelines expected by June this year according to acting director of medical services Dr Jackson Kioko.

To make the supreme law on abortion implementable, the Ministry of Health in September 2012 came up with a document, Standards and Guidelines for reducing morbidity and mortality from unsafe abortion in Kenya to guide the health sector on the thorny topic. But a push and pull led the ministry to withdraw the guidelines unceremoniously.

The first part of the suspended guidelines looked into prevention of pregnancy by focusing on adolescent and youth reproductive health; family planning and contraception; relationship counseling to prevent unwanted pregnancy; sexual and gender based violence; rape defilement and incest; and drug abuse.

Basically, it looked at ways of preventing unintended pregnancies which is a precursor to the desire to procure an abortion. The National Adolescent Sexual and Reproductive Health Policy 2015 notes that 12 out of 25 girls have had their first sexual encounter by 15 years. This increases the chances of teenage pregnancies which calls for proper reproductive health education including use of contraception.

The second part of the document focused on management of unintended risky and unplanned pregnancies. First it offered an implementation guide for psycho-social and economic support as well as adoption services in case of pregnancy. Disagreements arose from this section.

In an interview with the Standard, then Cabinet Secretary for Health, James Macharia, defended the withdrawal saying that they were not watertight to prevent abuse.

The first section of part two focused on the law and implementation guides for termination of pregnancy. The last section looks into policies, standards and guidelines for care in termination of pregnancy. The final part of the document looks at post abortion care.

In December 2013, the guidelines were withdrawn unceremoniously by then director of medical services Francis Kimani setting off a conflict between the pro-life and pro-choice groups.

For the third year, Kenya is not only operating without guidelines thus making the field a free-for-all conflict-laden mess but also witnessing horrific tales of abortions gone awry.

Mercy's grave is about a year old not far from Chwele shopping centre, Bungoma County; she was in Form Two at a local secondary school last year when she got pregnant; the family decided that she had to terminate the pregnancy since her father is a church pastor and this would bring shame to his name.

"They used sticks to disturb the pregnancy but when it refused to terminate they got to hospital too late – the battle was lost," says Sarah Munoko a community reproductive health activist in Chwele Town.

In a similar incident, a student in Form Four in a nearby girls' school also lost her life when she sought abortion services from a quack. She was the daughter of the late chief in the area. Yet in another case a primary school pupil's life was saved at the Chwele health facility after a botched attempt.

Munoko says, "If a girl has a baby outside wedlock there is stigma yet when people realise the girl has aborted, the stigma is compounded with shame."

Less than a month ago, a final trimester foetus was dumped at the Chwele market and indications are that the foetus was still alive but was beaten to death by a blunt object. The perpetrators, who are known to the locals, fled from the town.

The battle is now in the corridors of justice as the Centre for Reproductive Rights (CRR) moved to court in June last year arguing that a memo by the Ministry of Health to health workers did not specify that abortion was allowed under certain circumstances.

Evelyn Opondo, CRR's regional director states that the Kenyan government is allowing thousands of women in Kenya to needlessly die or suffer severe complications every year due to unsafe abortion, and it must be held accountable because these deaths and injuries can be prevented.

"Medical professionals in Kenya must be trained and given clear standards and guidelines on providing women who qualify for services and need to end a pregnancy with safe, legal care," says Opondo.

The World Health Organisation (WHO) in 2013 documented that one in every seven maternal deaths were due to abortion. Collating figures in Kenya is an uphill task as the information gap increases with no other official figures since the release of Incidence and Complications of Unsafe Abortion in Kenya by the Ministry of Health in 2013.

The report looked at the ability of health facilities to offer services related to post abortion complications; the number of women treated for post abortion complications; number of women treated for induced abortion and number of cases of induced abortions.

It indicated that 48 out of 1,000 women aged between 15 and 49 had an induced abortion in Kenya in 2012. The same year, 157,762 received care for complications arising from induced and spontaneous abortions. The same report notes that 76 per cent of these cases were induced.

Article 26(4) of the Constitution states that abortion is not permitted unless, in the opinion of a trained health professional, there is need for emergency treatment, or the life or health of the mother is in danger, or if permitted by any other written law.

But the bone of contention between the proponents of either side is when life starts and who can end it; the definition of a trained health professional has remained a bone of contention.

CRR is in court on behalf of FIDA and a girl who was raped at 14, could not get abortion services from public health facilities but ended up seeking the services from a quack leading to complications including kidney problems.

Dr Kioko insists that there is a taskforce to come up with new guidelines and it is expected to present its report in June of this year. The taskforce was constituted in 2014.

He agrees that the trend of complications and deaths from abortions is worrying but the task force has until June to come up with new guidelines.

"There was delay in constituting the taskforce fully because it needed more stakeholders for comprehensive guidelines and we are fast-tracking its operations so that the missing link can be plugged," says Dr Kioko.

With school age girls seemingly being the most affected by sexual and reproductive health matters, the Ministry of Health came up with the Kenya National Adolescent Sexual Reproductive Health Policy last year to guide the process of dealing with young people.

The document indicated that pregnancy and delivery complications, including unsafe abortion, are the second leading causes of death for girls below 20 years.

Begging the question whether the guidelines would change anything

Kioko says that the most important thing will not even be having the guidelines but getting the information about the guidelines to the public and how they will be implemented is key even as he says the Kenya is yet to take a study on the cost implication of abortions in the period no guidelines existed.

The Roman Catholic Church, particularly, opposes the use of contraception and the church generally argues that according life is sacred from contraception. It is a conviction that still holds.

Bishop Joel Waweru of the Anglican Church of Kenya Diocese of Nairobi says that the same Constitution states in Article 26 (1) that every person has a right to life and in (2) that life begins at conception, hence nobody has a right under any circumstance to take life – except God.

"Only God has the authority to decide when life is to be taken away from person; doctors can speculate on whether the life of the mother is in danger but this does not mean they should take the life of the unborn," says Bishop Waweru.

The primate argues that abortion is a social more than health issue. He takes a case that is used commonly of children conceived from rape and says that while abortion may sound as an easier option, it must be remember that it was the rapist who is evil, not the baby.

With school age girls seemingly being the most affected, the Kenya National Adolescent Sexual Reproductive Health Policy 2015, seeks to guide the process of dealing with young people.

The document notes that estimates from developing countries indicate that pregnancy and delivery complications, including unsafe abortion, are the second leading causes of death for girls below 20 years.

Evelyne Opondo of CRR says that no guidelines likely increased cases of backstreet abortion since health practitioners lack a platform on which to operate.

"As it stands now, only the rich can access abortion services because they have money while the poor women cannot since they cannot pay for it," argues Opondo.

She explains that most Kenyan women get health services from mid-level practitioners like clinical officers and nurses.

Lucy Minayo of IPAS Kenya – an organization that works to end preventable deaths from unsafe abortions – says that the suspension of the laws has created a notion that abortion is illegal.

"We have seen health practitioners arrested and charged with aiding abortion and this has led to stigmatization despite there being provisions in the Constitution," says Minayo.

The question now is: Will the new guidelines change the trends?