Doctors in limbo as abortion rules withdrawn


Kenya: The Ministry of Health has withdrawn the national guidelines on safe abortion, setting the stage for another battle over an issue that almost stalled the adoption of the new Constitution in 2010.

Abortion was among the key contentious issues during the 2010 referendum, with the pro-life groups including the church opposing a clause that allowed for abortion when the health of the woman is in danger.

The groups argued that the clause could be exploited to allow abortion to be easily carried out. Despite the church’s objection, the Constitution was voted in.

But now it has emerged that pro-lifers have regrouped and are putting pressure on the Government to enact policies that will make it hard for doctors to prescribe termination of pregnancy even when the life of the mother is in danger.

Following the enactment of the Constitution, which partially allowed for abortion, the Ministry of Health moved fast to put in place structures and policies to ensure the law is not abused by rogue doctors and women.

One such document was the Standards and Guidelines for Reducing Mobility and Mortality from Unsafe Abortions in Kenya, which was launched by the Director of Medical Services Francis Kimani in September 2012.

Deserving cases

Among other things, the document was to advise health workers on who, where, and how to perform an abortion, under what circumstances and to compel the workers to only offer the option to deserving cases as per the law.

Launching the guidelines on October 17, 2012, Dr Kimani said the intention was to reduce deaths and illnesses associated with unsafe abortion.

“These guidelines are now available and I call upon all caregivers to acquaint themselves with them and use them as working tools for the benefit of patients,” he had said.

However, in a surprise move on December 3 last year, Kimani wrote to the 47 County Directors of Health suspending the guidelines, arguing that there was need for wider stakeholder consultation on the contents of the document.

In the foreward to the guidelines, Kimani says it was prepared with the full participation of many groups representing legal, religious, gender, rights and public health interests.

Listed as signatories to the document are more than 25 groups including religious organisations, professional health groups, UN bodies, universities and civic groups.

“It took more than a year to agree on this document,” says Dr Joachim Osur, one of the principal authors, adding: “But all stakeholders agreed that it had to be scientific and lawful; we had to put emotions aside in what at times was a heated debate and just use facts.”

Contacted by The Standard, Kimani said he was not ready to discuss the matter. “I can’t comment on the issue at the moment because the document is being worked on. We shall be able to tell you what is going on at least by the first week of July,” he said.

‘Dark forces’

Kimani refused to disclose the person pushing for the changes but any drastic deviation from the current document could be seen as a move to undermine the constitutional guarantees through the back door.

Last year, the Ministry of Health launched a Patients Charter, which spells out what a patient can demand, including emergency care as guaranteed by the Constitution and the right to seek redress.

The charter, which was published last April, says the Constitution guarantees every person good health care services, maternal and reproductive health care and the right to emergency medical treatment.

Medical workers are required to offer a woman with an unwanted pregnancy all options open to her including abortion, where it is legally applicable.

During the launch, Kimani argued that it was important to adequately equip health providers with the requisite skills and knowledge to provide quality abortion-related care to women.

But by withdrawing the guidelines, says Saoyo Griffith, a Reproductive Health Rights Programmes Officer at the Federation of Women Lawyers (Fida), Dr Kimani may have just broken the spirit of the Constitution.

Ms Griffith says the guidelines were the only existing document for health professionals addressing the conditions needed in order to procure a safe abortion.

“Their withdrawal creates a gap, which is fuelling questions on how to safely terminate a pregnancy, who qualifies for safe termination, where safe procurement should be procured, and when a doctor can lodge a conscientious objection,” she argues out.

Although Kimani refused to explain where the pressure is coming from, sources within the Ministry indicate that US-based anti-abortion groups could be exploiting a legal gap to push USaid to arm-twist Kenya on abortion.

US groups

Following the adoption of the Constitution in 2010, some US Congressmen had accused President Obama’s administration of having illegally funded civil groups lobbying for legalising of abortion in Kenya.

The law called the Siljander Amendment states that: “None of the American foreign aid may be used to lobby for or against abortion.”

Following the complaints, the US Government Accountability Office (GAO) instituted investigations and in a 42-page document, advised USaid to prepare clear guidelines on how US funding can be used without breaking this particular law.