Why lack of abortion guidelines in Kenya will cause women more suffering

The Kenya Obstetrical and Gynaecological Society (Kogs) issued a positional paper on abortion recently. Kogs President Kireki Omanwa explains why a woman would need legal abortion.

Q: In medical terms, what's abortion?

Abortion is the process that puts an end to a developing pregnancy. Abortion could be spontaneous (miscarriage) or initiated.

Q: Why do you think the word evokes lots of emotion?

Because we live in a society where people's views are influenced by belief systems; be it traditions, religion, or just ideology. A lot of it is determined by the environment we grow up in.

Q: Let's talk about KOGS' positional paper: what was the important takeaway?

KOGS's position is anchored on our constitution and our laws. What we were saying, in a nutshell, is that no woman in Kenya should hide away or go backstreet when the law already envisages the possibility that a woman may need medical attention for abortion-related services.

Q: Medically speaking, who qualifies for an abortion?

Let me first say that our laws, in no way, suggest that any pregnant woman can just walk into a health facility and ask for an abortion. That said, a woman who is in the process of a miscarriage, may need a doctor's services to make sure no more conception material is left in the womb because it could lead to an infection.

In some situations, the pregnancy may threaten a woman's health and life. For instance, a woman may develop a condition known as pre-eclampsia, which causes high blood pressure, and is threatening to a mother's life. In some situations, pregnancy might be developing in the fallopian tube as opposed to the womb. That is deadly.

Also, imagine a pregnant woman who becomes diagnosed with a terminal illness, like stage 4 cancer, and is in urgent need of chemotherapy (which would kill the foetus), what do you do?bThe law says abortion becomes a medical procedure when the life, health or wellness of a mother is in danger.

Q: Then there is the question on whether it is a right of a woman, or girl, who has been raped... is that correct?

The needs and rights of women who become pregnant from rape or defilement should not be ignored. Survivors of these crimes may need counselling. If they are of sound mind and ask for termination of the pregnancy they should be able to access the service at a medical facility where their safety and wellbeing are guaranteed.

Q: Do all doctors have the same view on abortion.

Of course not! Doctors are part of the society. Society is divided on the issue and so are doctors. There are doctors who would not attend to a lady who has come to hospital with an abortion that is already in progress.

Q: Does that mean they would let the woman suffer possible consequences?

In an ideal world we would be guided by facts; we would follow the science. But, doctors, like all humans, also grew up in an environment where they took up certain beliefs and cultural systems. It is therefore possible that some doctors may chose not to touch such a patient. KOGS's recommendation is that when that happens, the doctor should refer the patient, within good time, to another practitioner who would not have a problem attending to the patient.

Q: Would you know if doctors, today, are giving legal abortion services without fear?

The legal situation in Kenya is still not clear. Yes, the law permits abortion as a medical service. However, the government withdrew guidelines on abortion in 2013 and has never reinstated them despite orders from the High Court. So, at the moment, you would say that doctors are operating in an environment of fear; no one wants to be arrested by the government.

Q: What should happen for the guidelines to be reinstated?

I don't know. Perhaps we get guidance from the Judiciary - now that the courts have already pronounced their voice on the matter.

Q: What message would you like to pass to women on this issue?

First, they should understand that going backstreet is not safe: they will likely die or survive with debilitating injuries. I would also implore them to have an increased awareness on their bodies, as well as arm themselves with information on human sexuality. Lastly, if something has happened already, please go to a hospital. Do not die 'hiding'. Doctors took an oath to save lives. Let a qualified doctor attend to you.