Back street abortions on the increase even as debate rages on

Rose Otieno was seated behind her desk at the clinic flipping through a newspaper when a familiar face on the obituary section caught her attention. As she read through the orbiyuary, details of the familiar face became clearer.

“The picture on the obituary wasn’t anything close to the face she wore the last time I saw Elizabeth,” recounted Otieno.

Otieno, a healthcare service provider, said Elizabeth (second name withheld to to save family members from embarrassment) had walked into her clinic two weeks earlier, explaining that she wanted to terminate her eight-week pregnancy. The 16-year-old said she was a student at a high school in Kisumu and would not risk keeping the baby.

The healthcare provider counselled Elizabeth and even offered to help her break the news to her parents the following day, which she agreed to. But that was the last she ever saw of her.

 “I attended her funeral and established that she had died after procuring an abortion. She had an incomplete termination, but by the time she sought help, it was too late,” she recalled.

Complications

Otieno said Elizabeth was on March 13, last year found by her mother lying in the corridor of her home in Kisumu County, vomiting and bleeding profusely from complications of an unsafe abortion.

She was taken to hospital and eventually received emergency treatment. But it was too late. Her uterus had to be removed because an infection had damaged it completely.

She later died in the hospital while undergoing treatment.

The controversy surrounding abortion has returned, after two civil society organisations went to court to compel the Government to put in place guidelines for safe abortion.

The case is ongoing before a five-judge bench. Although the Constitution provides that life begins at conception, a doctor told the court last week that it starts the moment one is born.

Joseph Karanja, an obstetrician and gynaecologist, said between 10 and 15 abortions are procured at Kenyatta National Hospital on referral everyday.

Halima had just joined a college in Nairobi when she missed her monthly periods. She knew she was pregnant and immediately panicked.

“I was still new in the school and could not share with anyone except my friends back in the village in Butere. My friend referred me to a traditional birth attendant, who charges Sh2,000 for the service,” Halima narrated.

But the end of one trouble marked the beginning of many others for the 19-year-old woman from a staunch Muslim family.

“She inserted a blunt object in me and pricked life out of the developing foetus, leaving me bleeding seriously. For more than 24 hours, I lay in her house bleeding, as she fed me on painkillers and traditional herbs to replace what was lost,” she said.

Deadly aftermath

Halima was discharged when she felt better, but was still unable to travel back to the city, as she had not stopped bleeding. She began suffering episodes of extreme stomach and back pains and was slowly losing weight.

“I could not tell my parents, but the school fees for the next semester went to my treatment. The doctor told me my uterus was beginning to rot. I was washed and put on drugs. Today, I can only hope that there was not much damage,” she narrated.

In another case, the proprietor of a clinic in Kayole, Nairobi County, was arrested after a woman died in his facility, the Faith Medical Clinic, on 16 March last year.

The woman is alleged to have gone there on March 14, last year, to terminate her pregnancy. She was found lying dead on one of the clinic’s benches the next morning.

She was 30-years-old and mother of four children.

Sadly, cases of clandestine abortion are not rare. In fact, recent statistics on backstreet abortion indicate that at least 360 women in Kenya procure abortions daily, 77 per cent of which are unsafe.

Stigma around abortion

According to civil society organisations, a combination of social stigma around abortion and lack of awareness of legality due to poor guidance lead to the pushing of abortions underground.

“The prevailing stigma around abortion and the lack of service delivery policies and guidelines from national Government have left health professionals afraid of attending to women asking for abortion services,” said Dr Joachim Osur, a reproductive health specialist.

It is against this background that Centre for Reproductive Health and other actors filed a petition that specifically represented a 15-year-old girl known as JMM, who became pregnant after being defiled and sought an unsafe abortion.

In December 2014, JMM’s guardian PKM received a call from a relative informing her that the former was vomiting and bleeding heavily at a local clinic where she had gone to seek treatment. JMM had admitted to clinic staff that she had procured an unsafe abortion and that she had been sent to various hospitals for post-abortion care.

Devastatingly, JMM now has a chronic kidney disease and will have to receive dialysis regularly until she can get a transplant.

Following this case, Trust for Indigenous Culture and Health, a local organisation, started a petition for the reinstatement of the Standards and Guidelines.

Medical complications arising from unsafe abortions are expensive.

A report by African Population and Health Research Centre launched this year indicates that the total average cost of treating a typical patient with unsafe abortion complications in public health facilities is Sh4,943.

“The treatment and care of a typical patient with complications of unsafe abortion in public facilities in Kenya required at least 7.4 hours of health care personnel time at a cost of Sh2,848. The cost for mild complications was Sh1,930; moderate complications was Sh2,353 while severe complications cost Sh5,653,” reads a section of the report.

The petition claims that although rape is one of the legal grounds for termination of pregnancy as per the Ministry of Health National Guidelines on the Management of Sexual Violence, rape survivors are still unable to access legal abortion services.