Unsafe abortion: The problem nobody wants to talk about

The images still sneak up to her when she least expects. They come unannounced, and they torture her. Eve never imagined that the process of trying to get rid of an unplanned baby could leave her with physical and emotional scars that have refused to go away.

When she speaks of abortion, she whispers. The shame she feels lingers in every word she utters.

“I get bad dreams and I am haunted by the act,” she says.

It all started when she was duped into a sexual relationship with a 30-year-old police officer. She was 14. The officer’s wife had just given birth, and would not have sex with her husband. She brought her to the house and handed her to the officer. The officer would later coerce her to procure an abortion. Life changed for the teenager from Maisaben village, in Kuresoi, Nakuru County.

After terminating a 16-week pregnancy on July 4, 2020, she suffered excessive bleeding, constant body swelling, dizziness, acute abdominal pains and general body weakness.

She is still under treatment at a health facility in Molo.

“I am tormented. Why did my best friend betray me?” she asks.

Her story represents everything that is wrong with Kenya’s policies on sex education and reproductive health. Hers is a road that has been traveled by so many others.

Most teenagers who have procured abortions say they did not know that they could easily get pregnant and were unaware of the dangers of unsafe abortion.

A study by the Ministry of Health and the African Population and Health Research Centre (APHRC) found that 500,000 abortions are procured annually in Kenya. Since abortion is still illegal in Kenya, most of these are procured in unsafe backstreet clinics. Most of them end up with complications.

On August 10, another teenager from Musuro village in Baringo, walked approximately 15 kilometres to Marigat Hospital to procure an abortion.

Afraid that her mother will kick her out, the 14-year-old Second Former says she cried uncontrollably, pleading with medics to help her terminate her six-week-old pregnancy. 

The medics at Marigat Hospital were not moved by her cries for an abortion. They put her through counselling and enrolled her in antenatal clinic.

But the stigma of being pregnant at such a tender age would not set her free. She was determined to get rid of her pregnancy. Encouraged by her peers, she opted to use herbs and concentrated drinks to terminate it.

The rising number of unsafe abortions continues to spark uproar across the country.

Despite abortion being illegal in Kenya, over the years, counterfeit drugs, quacks, pesticides and other unconventional means have become the go-to options for women who want to terminate their pregnancies.

So many suggestions, no clear solution

Efforts to develop laws that govern abortions have been futile, even as unsafe procedures leave painful stories of deaths and near-death experiences.

To avert unsafe abortions, several Bills have been formulated by Kenya’s lawmakers, but none has successfully gone through the legislative process to become law.

The latest among these Bills was the Reproductive Healthcare Bill 2019 that seeks to address reproductive health challenges. But as soon as it was made public, several pro-life activists and the clergy rallied to oppose it.

The Bill, sponsored by Nakuru Senator Susan Kihika, sought to address issues that surround abortion in cases of emergency, mentally ill persons and minors.

“A trained health professional shall not, where the circumstances arise under Section 26 for the termination of pregnancy, terminate the pregnancy unless the health professional has — (a) obtained the written consent of the pregnant woman; or in the case of a pregnant minor, has consulted with the minor’s guardian and determined that the it is in the best interests of the minor,” reads the Bill in part.

It also seeks to address how adolescent-friendly reproductive health services are provided, including mentorship, spiritual and moral guidance, counselling on abstinence, consequences of unsafe abortions, STI’s and HIV and Aids among other services.

Also covered are FGM-related issues and registration of births.

Religious leaders claim that the Bill, which is at third reading stage at the Senate, will encourage immorality and want it shelved.

Kepha Omae, the presiding bishop of Redeemed Gospel Church said the Bill seeks to introduce the Comprehensive Sexuality Education (CSE) which will teach that sexual pleasure is a right.

“Teaching that sexual pleasure is a right would automatically create perverts who will engage in masturbation, same sex relationships, rape, bestiality, incest and teenage sex,” he said.

Muslim clerics say the Bill provides room for misuse of the right to life by allowing pregnancies to be terminated at will.

“This severe abnormality that is incompatible with life outside the womb is not defined and opens the door for abuse. Unless you are a prophet, how would one tell that this physical abnormality is incompatible with life?” reads part of a statement by Muslim clerics.

Aborted guidelines

Other Bills and guidelines that sought to address the issue of abortions faced similar fate, most of them never saw the light of day.

Key among these was the Post Abortion Care (PAC) guidebook, which was meant to complement the existing PAC reference manual, PAC curriculum and other training packages offered by the Ministry of Health.

However, in 2013, the Director of Medical Services withdrew the guidelines on claims that they had been misused. This was followed in February 2014 by the suspension of training of health workers on safe abortion care and the use of the drug Medabon for medical abortion.

The ministry threatened health providers with dire legal and professional consequences if they participated in any training on abortion.

As a result, one of the petitioners — an adolescent known only as JMM — died after suffering complications from an unsafe abortion.

What doctors say

Fredrick Kairithia, a consultant obstetrician and gynecologist, says Kenya is in dire need of a law that governs termination of pregnancy for the safety of women.

“Talking about abortion is a taboo, but again, its demand is an indication of a deeper problem that requires solutions,” he said. 

Primary risks of unsafe abortions include bleeding, infections, genital injuries during the procedure and fatalities.

Teenagers who procure abortions may develop fistula, psycho-trauma and difficulties in conception in the long run. In botched abortions, surgeries have been carried out where reproductive organs like the uterus are removed.

“Abortions result in deaths from injuries and complications, because they are mostly done in hidden places due to its illegality. In some instances, we have suicide cases among teenagers due to stigma,” he said.

Use of herbs and concentrated drinks are prohibited, as they result in septic abortions that lead to infections that cause death.

“People who use concentrated drinks like juices may have in effect introduced infections and caused chemical injuries in a reproductive system that is not fully developed,” he said. 

Post-abortion trauma

Susan Gitau, a counselling psychologist, warns that post-abortion emotional dangers may last a lifetime for some women who terminated pregnancies in their teenage years.

Gitau, who is also the chair of the Department of Counselling Psychology at African Nazarene University, says that before, during and after, most teenagers get nightmares and bad dreams.

Most women who procure abortion in their teenage-hood tend to avoid sex later in life, keep off hospital visits, and are haunted by voices of children. 

Recurrent negative emotions post-abortion are characterised by anger, fear, guilty, hurt and anxiety.

“Abortion should never be forced because it brings social and psychological disturbance. For some, it might be social and for others spiritual. Those who are Christians think that God will never forgive them for terminating the pregnancy,” Gitau said.

Trauma may result in suicidal tendencies, she said.

To manage post-abortion trauma, psychological counseling is key and should be done within 48 hours.

But because abortion is illegal in Kenya, most girls do not undergo counselling. They are haunted by the ordeal for a lifetime.

So what next?

In 2018, the Federation of Women Lawyers filed a petition on behalf of JMM, claiming that authorities failed to provide her with proper post-abortion care.

On June 12, the court ruled that withdrawing the 2012 Standards and Guidelines for Reducing Morbidity and Mortality from Unsafe Abortion in Kenya had violated both the right to comprehensive and accurate health information and the right to the highest attainable standards of health for women and girls.

The court further ruled that since the Guidelines and the Training Curriculum are policy documents that had been developed through public participation, there should have been a similar procedure around their withdrawal.

In June, Fida Kenya director Wanjiru Kamanda said inaccurate or misleading information on sexual and reproductive health is to blame for the rise in cases of teenage pregnancies.

“The Reproductive Health Bill goes beyond pregnancy and abortion. It also has other issues that affect adolescents. We ask the government to include age-appropriate information in the school syllabus,” she said.