Unsafe Abortion: Is Kenya Brave Enough to Take A Stand?
By Bertha Rinjeu on 29th May 2014 for the May Gender Forum
Large brown eyes scan the broad room. In a buttercup yellow dress, green sweater and flip-flops on her feet, Jane Vike Alfayo sits; the shy smile creeping to her lips belaying the nervousness with which she faces the day.
A great crowd has gathered at the Nairobi venue for the Heinrich Böll Stiftung Gender Forum, a monthly discussion focusing on gender dimensions of topical issues. Abortion being a personal and emotive subject, the room is laden with sentiment. Tables are filled with papers teeming with reports, research findings and prepared statements.
Incognito bouncers survey the crowd vigilantly hoping to sniff out unruly activists. If ever there was a conversation that could deteriorate in seconds, this is it. Still, the multitude purs in: some to hear a story, some with judgments ready, several to express and defend ideology, others brought here by sheer curiosity – others still, like Jane, with tales to tell. Patiently, she awaits her turn.
“When I got pregnant I was in Class 8,” begins Jane in a loud and clear voice that reachesevery corner. “I was under a lot of pressure from my friends to abort. My Mum chased me from our home so I had no option but to join the other girls.”
In breaking English, Jane tells of an immediate commencement of life on the street. With little education and sudden displacement from her home, Jane, like many others across the world, at 14, stared down an unplanned pregnancy with ever increasing desperation.
“Some of the girls from our group (on the streets) dropped off to get married, and others died attempting abortion…my own son was born with a wound on his back because I tried to have an abortion.”
Her tongue snitches on how unaccustomed she is to an English speaking environment. Growing up in Mukuru-Lunga Lunga, one of Nairobi’s poorer neighbourhoods, perching precariously off the city’s main industrial area,and where she still makes her abode, Jane’s life makes for the sort of worthy news story most likely to fill acres of space.
“What makes people so willing to go through with it?” the forum moderator asks her.
“It’s circumstances,” Jane replies, and continues. “A fourteen years old girl, gets pregnant. In the low income settlements, girls as young as twelve years are sexually active. You tell the boy to use a condom. He refuses but you still agree. When you get pregnant, the boy runs away, what are you to do?”
Her story depicts the pathetic disempowerment of poor girls. Jane is a beacon of psychological strength to them. Due to an ambiguous legal framework in Kenya, Jane and others like her are left no choice but to share information from the internet on how to do a complete self-abortion.
The conversation moves away from Jane and back to the experts - the well dressed specialists and researchers, the articulate doctors with what must be a hundred years of obstetric and gynecological experience between them. To this room she is an oddity and to this panel the necessary human addition to lists and charts of almost absurd statistics all of which should represent one woman and one child, but do they really?
In 2012, in Kenya, 464,690 induced abortions were recorded. According to the African Population and Health Research Centre (APHRC) in a study conducted in partnership with the Ministry of Health in 2012, women between the ages of 15 and 49 were most likely to procure an abortion. Whether married, never married, widowed or divorced, religious, in employment or not, women continue to seek out induced terminations for unplanned or mistimed pregnancies.
Dr. Carol Odula-Obonyo, an obstetric gynecologist sheds light on the statistics. “These roughly 460,000 you are seeing here are only the ones with complications. Those that can afford it will never feature because they got complete abortions.” She continues. “It is common knowledge that you can force an abortion even with the simplest item that we all have here: a pen. Just poke yourself somewhere. It can be unsafe but if it is complete, it will never show up in statistics.”
Professor Boaz Otieno-Nyunya of the Kenya Medical Association carries on stressing that counseling works for woman still in the process of deciding on keeping or terminating her pregnancy. “Let us not confuse a woman who can be counseled with one who has already decided. If you deny her services the next thing you know she comes back to the emergency room with a stomach full of pus. Let us not mix issues. If a woman has decided she wants that abortion there is nothing she will not do to get it, including going to heaven.” he concludes.
Dr. Odula-Obonyo and Prof. Otieno-Nyunya raise important questions on the difficulties of accessing abortion services within the mainstream healthcare system.
The Constitution of Kenya 2010 in Article 26 (4) explicitly outlines circumstances in which abortion services may be provided to women and girls.
A. 26 Right to Life….
(4) 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.
The medical code identifies those trained and equipped in abortion care – that is medical doctors, clinical officers or nurses – as trained health professionals for purposes of this section.
The Maputo Protocol to the African Charter of Human and People’s Rights at Article 14 requires State Parties to provide safe abortion services to victims of rape or incest. Though Kenya has ratified the Charter and the Protocol, it has expressed an official reservation of its Article 14. Since September 2012, medical practitioners have been guided by the Ministry of Health Standard Guidelines to Reduce Maternal Morbidity and Mortality from Unsafe Abortion but these were suspended in December 2013. This suspensionraises serious questions.
Millennium Development Goal 5 on maternal health seeks to ensure that no woman suffers any dire situation in the child bearing process. It requires a comprehensive and streamlined outlook to reproductive health from family planning to post natal care.
Yet, in Kenya, birth control, condoms and contraceptives, provided through the government mainly depend upon donor funding. Early and child marriages, though outlawed even by law, continue to be a cultural norm. Female Genital Mutilation and Infibulations which greatly inhibit the birth process still practiced despite its illegality.
Kenya is unlikely to attain MDG 5 by 2015. Meanwhile unsafe abortion contributes in excess of 13% of all maternal deaths. Moreover, records and reports do not capture all abortion related deaths.
In a country that struggles with HIV/AIDS, Malaria, Tuberculosis, Cancer and other chronic diseases, handling what seems to be a pandemic of cases of post abortive care, a preventable issue, seems like an incredible failure.
What options does a woman or girl who finds herself unexpectedly pregnant truly have? Cornered by the law, most women in crisis opt for hurried and hushed and often unsafe procedures. Even when the abortion is complete, such procedures always leave an indelible mark on the psychological health of the individual.
The forum was curious to unpack Kenya’s stand. Will enforcement of abortion criminalization translate to a decrease in incidence of incomplete, unsafe termination or will it merely increase the numbers of women that die silently? What is the economic loss of all this?
The forum was quick to call out men who are often bystanders or in some instances, inciters when they are not ready drop down their social strata by being prematurely called dad. Through the discussion, it dawned on the audiences that policy is almost unenforceable hence gravely disconnected with reality. A gaping hole in policy exists that could provide a comprehensive guideline to reduce unsafe illegal abortions, including to provision of supportive care for mothers willing to carry ill timed or unwanted pregnancies to full term.
Dr. Jean Kagia, an OB/GYN in private practice, has seen it all, from quack doctors who pull out patient’s intestines in mistaken belief that it is the foetus’s placenta, to women who suffer psychological distress years after their complete abortions.
In the comfort of her medical practice in Hurlingham, on a cloudy afternoon, a cheery Kagia tells of a life dedicated to the salvaging of young girls in crisis pregnancy.
“My becoming an advocate for this anti-abortion thing is because of what I have seen especially while at Kenyatta (National Hospital).” she begins.
Her infectious laugh and good-humoured manner could be a shield to the weight of the matter, the thousands upon thousands dead of preventable causes. She is confident in her wealth of knowledge that is forty years of gynecological and obstetric practice. To Kagia, we have been looking at it wrong.
“These girls are not sick; they’re pregnant! We need affordable, acceptable, community-based, replicable solutions” to help them carry their pregnancies to term.
To her, crisis pregnancy is a social, not medical concern. “This (pregnant) girl is in a crisis not only from the pregnancy. She is already in guilt. She does not have the resources to look after this child. The man has already run away. Where are you telling her to go?” She adds, “Let us give a social solution to a social problem. An unplanned pregnancy is a social problem. It must be given a social solution and it is everybody’s responsibility.”
At the end of the day it does not matter on which side of the divide one chooses to stand. It is no longer a question of the morality or ideology of abortion. Abortion is rife in Kenya. Education on sex and sexuality, could stem unplanned pregnancy which remains the chief cause of abortion, safe or unsafe.
Jane Vike Alfayo is one of millions. She survived her homemade abortion but not without complications. To this day she suffers health consequences.
Without education and without goodwill a cohesive solution may never be found and women like Jane Vike will continue to suffer the long consequences of preventable lifelong problems. It is not enough to proclaim something. Constitutional pronouncements must be backed up by legislation and comprehensive action framework to respond to ground realities. Kenya can and should take a stand regardless of the ideological stances taken by advocacy groups.
As one participant aptly put it, “Every public health crises has been solved through a comprehensive, concerted and cohesive approach. Unsafe abortion cannot be handled unilaterally.”
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