Orals East Africa>Unsafe Abortion, the Silent Maternal Crisis At the hut of the story

Written by Emmanuel Oyier

In the vast expanse of Kenya's maternal health landscape, much like the iconic Big Five animals on an African game drive, there are five critical causes of women dying during pregnancy, childbirth, or shortly after giving birth that demand our collective attention.

These are heavy bleeding after childbirth, severe infection, high blood pressure complications, obstructed labor where the baby can't come out naturally, and the fifth is, unsafe abortion which is an attempt to end a pregnancy without proper medical care.

While concerted efforts are made to address the first four, there exists a disconcerting hush surrounding unsafe abortion. The mere mention of the term ‘abortion’ often induces silence and heads turn discreetly, as if discussing a forbidden subject.

As this taboo persists, unsafe abortion claims lives.

Seven deaths every day

In ongoing work, that Kisumu Medical and Education Trust KMET, an indigenous Kisumu-based non governmental organization established to promote quality in health and education services, have been engaged in Kisumu’s Nyakach Sub-County, we encountered Domnic, a grieving widower in Katito village whose wife, Mercy, died attempting to terminate a three-month pregnancy.

Similarly, in Nyabondo Center, Sylvia, a 13-year-old girl, passed away from complications related to a secret seven-month pregnancy, leaving behind a newborn in her mother's care. Yet in another tragic case, Achieng, a 19-year-old who was six months pregnant and a form one student who was already a mother of one child, died attempting to terminate her second pregnancy.

These stories highlight the dire consequences of unsafe abortions and a broken system that fails young girls and women. Countrywide, approximately 2,600 women and girls which translates to seven deaths every day are reported as dying every year due to unsafe abortion. Many more cases remain unrecorded.

Social norms and stigma

These deaths are preventable, and the apparent lack of action by communities and healthcare providers can be attributed to deeply rooted social norms, misinformation, and unimplemented health policies that contribute to abortion stigma. This stigma, in turn, exacerbates the toll of deaths and injuries, as girls and women face reproach for seeking medical services related to their sexual and reproductive health.

The women are left at the mercy of unscrupulous health workers who extort them for clandestine services by making it look like they are doing them an ‘illegal favour’. Consequently, termination of pregnancy remains a privilege for the rich, while the poor bear the fatal consequences of unsafe abortion in the hands of herbalists and unqualified drug vendors due to limited access to the health system.

Dispelling prevalent myths and half-truths

Contrary to the belief that abortion is illegal in Kenya, it is permissible by law and protected by the constitution if a health provider deems it necessary for the individual's health. It is this false premise of illegality that has fuelled Kenya’s problem of increasing back-alley termination of pregnancy, and police harassment of legitimate health providers that offer the services.

The fact is it is restricted to the opinion of a qualified health provider, that is one that is trained and has the requisite licenses and qualifications.

Moreover, the narrative that all abortions are inherently unsafe and lead to dire consequences is not true. When conducted by a qualified professional, it is a safe procedure with no lasting health impacts. One can live a normal and healthy life afterward and can continue to have children if one wishes to. On the contrary unsafe abortions cause long life injury, may cause infertility, and lead to death as we have witnessed.

An additional lie perpetuated by anti-rights movements is the claim that abortion is a Western agenda imposed on Africans. Various indigenous cultures and traditions have historically incorporated family planning, termination of pregnancy, and other reproductive practices. Varied herbs and traditional medicine have been documented to have been used in addition to other child spacing practices like observing the calendar of ovulation, abstinence, and withdrawal albeit with relatively lower efficacy compared to the modern methods.

Global issue

Maternal deaths and the need for family planning are global issues, transcending Western societies. Governments worldwide, including in Kenya, have instituted reproductive health policies and programs reflecting our unique cultural contexts. In fact, in 2023, Kenya’s Ministry of Health released a Clinical Handbook on Prevention and Management of the BIG five direct causes of death and injury among women, unsafe abortion included as a best-practice reference for health professionals.

As a society, we may hold differing opinions on the termination of pregnancy, but we also have shared values that compel us to address the dangers of unsafe abortion

Kenyans agree that we must protect mothers and children from harm and preventable deaths and that everyone should have equal access to comprehensive healthcare and accurate reproductive health information, regardless of how much money they have.

So, what would it mean to act on these shared values?

Firstly, it is imperative to maintain an ongoing conversation about reproduction at all stages of life, from puberty to menopause. This dialogue should cover contraception, childcare, termination of pregnancy, and other reproductive needs. Doing so would enhance public knowledge and guide individuals on where to access information and services safely.

Next, we know that women will continue seeking to end pregnancies. Healthcare providers have to make legal and safe abortion more accessible so they can do so safely. Offering information on safe options tailored to individual circumstances minimizes the risks associated with seeking help from unskilled providers or resorting to unsafe methods.

Finally, the government is implementing myriad interventions toward achieving universal health coverage. Family planning and sexual and reproductive health education are pivotal preventive measures for unplanned pregnancies and abortions. Investments in these areas must be expanded and improved, particularly in regions of Kenya burdened by the highest maternal mortality rates.

By taking these three actions, we can collectively eradicate the crisis of unsafe abortion, saving the lives of thousands of girls and women and thereby ensuring their well-being and that of their families.