To terminate or not to terminate… these are the words that linger in most women minds when faced with an unplanned pregnancy. Currently, Kenya’s national abortion rate, at 48 abortions for every 1,000 women, is higher than almost every other country in Africa.According to a report released last week by the Ministry of Health, 465,000 women had abortions last year, the vast majority in unsafe conditions. As a result, some 120,000 women sought medical treatment for complications from abortions.
This loosely translates to a high of 1274 abortions per day and 53 every hour, with Rift Valley and Western and Nyanza combined accounting for 64 and 63 incidences per 1,000 cases respectively.
Rift Valley had the highest prevalence at 46,912, followed by Nyanza and Western’s 45,027. Central and Nairobi had 20,676 cases, North Eastern and Coast 16,649 incidences, while Eastern recorded the least at 12,169.
Of those who procured the abortions,64.4 per cent of them were married women or those living with their partners, 27.8 per cent of them had never been married and 7.5 per cent were divorced. Another report released last year by the Kenya National Commission on Human Rights found unsafe abortions caused up to 50 percent of maternal deaths in Kenya.
Speaking during the report launch in Nairobi, Kimani reiterated the need to increase contraceptives to address the unmet needs. Kenya has a 4.6 fertility rate, which loosely translates to five children per woman; a number population experts warn is too high in comparison to resource availability.
According to the report, nearly 50 per cent of births that were reported by the 2008-09 Kenya Demographic and Health Survey were “unwanted” or “mistimed; a figure that exposes cracks that continue to define the slow uptake of FP methods.
It further says that more than 70 per cent of women seeking post abortion services are not using contraceptives. Although most government facilities provide subsidised or free family planning services, the centres usually suffer a shortage of operations and inadequate qualified healthcare givers.
Common FP methods for women include female condoms, pills, coils and injectibles, while men can either use male condoms or undergo vasectomy, with the latter being snubbed by most men, due to its permanent status.
The ever contentious debate on slow uptake of FP has for long been riddled with myths that range from side effects, cost implications and biological malfunctioning for those using them.
In efforts aimed at reversing trends and regaining public confidence, Kimani says the government will put measures in place to enhance accountability by health providers. He says enforced citizen charters and a motivated workforce can turn around the skyrocketing numbers that are behind complications that bedevil operations.
“Unsafe abortion has been recognised as a leading cause of maternal morbidity and mortality,” Kimani says, as he cites a recent study that ranked unsafe sex as the leading contributor to disease.
“Stigma, inadequate information on sexuality and cultural pressure also hinder contraceptive use among women and girls,” the DMS says, and calls for strengthening of the ongoing demand-side financing of reproductive health services.
The current report reveals that abortions must be done only in accordance with the constitution, with the latest statistics revealing a high fatality rate of 266 deaths per 100,000 unsafe abortion procedures, which experts say are preventable.
Now medics are worried about the public’s casual approach to sex, devoid of the dangers they are exposing themselves to, which include HIV/Aids and infertility as a result of using crude methods to secure an abortion.
“Abortion is a very personal decision, and whether it is deemed legal or illegal, moral or immoral, no opinion on whether to legalise it or not will stop a woman who is determined to procure it from doing it,” said Nelly Bosire a Kenyatta National Hospital gynecologist.
KNH receives most of the complicated cases after backstreet operations. “We basically clean up the mess, which is a big burden to the health sector. There is need for us to come up with a holistic approach that will be applied to address this problem, instead of pointing fingers and engaging in blame game,” she says.
In a largely male dominated society, where women are censured for any botched reproductive health, existing male family planning options, which include the permanent vasectomy, are almost a taboo, with numerous misconceptions affecting their uptake.
“Vasectomy is extreme, as it is permanent. It is like being sterilised, and yet you may still want to have children in future,” a Public Health officer based in Homa Bay,” Patrick Emisiko says, adding that he would instead advocate for other cheap, yet effective methods such as condoms.
“My inability to father will translate to my being deemed not man enough, as the society expects me to bring forth children.” The unmarried practitioner says he would instead advocate for his wife to go for tubal ligation, “as the society accepts such practices on women, but not men”.
According to 2011 African Population and Health Research Center findings, Kenya has managed to conduct 3,652 vasectomies, compared to 246 recorded between 1987 and 1991.
“I have attended many FP trainings with local NGOs, and some of the methods being fronted are very good and effective, but due to lack of knowledge, some women choose to ignore these methods and engage in unsafe sex.”
Emisiko regrets the level of societal ignorance and blatant refusal by public to abide by rules, saying, a change in attitude must be embraced to realise positive outcomes from strategies.
One of the methods being advocated for is the use of coil, which Emisiko hails as one of the best. If installed properly, he says, it functions effectively, and can be removed anytime a woman feels prepared to conceive and bring forth children.
Bosire, who believes that the statistics could even be higher than what was captured by government research that was commissioned by the APHRC, is calling on all sectors of the country to teamwork and formulate practical mechanisms that should be enforced to bring to an end the neo-culture that is causing more harm, known and unknown, to would-be mothers.
The emotive subject continues to attract varied opinions from all professionals, with some attributing stringent laws that outlaw the practice, to increased cases of backstreet operations that mostly backfire.
Abortion is illegal in Kenya, unless instructed by a qualified doctor, with the intent of saving the mother’s life that may be at risk. A section of medics have attributed the rising deaths and complications from unsafe procedures to quarks operating in disguise of the law.
An estimated 3,000 women die annually from unsafe procurements, while public hospitals attend to over 20,000 cases of post abortion complications from gory operations that include rupturing of the uterus, abdomen and intestines.
In the sprawling Mathare slums, the operation is normally conducted by special quarks that are referred as Japolo [a luo title for a saint, waiting to go to heaven]. The “men of god” normally use wire-like crotchet long needles that are used for knitting sweaters.
“They prick the unborn foetus using the needle and then prescribe herbs, aimed at stopping excessive bleeding,” a resident at the slum that is notorious for unlicensed health facilities, Joyce Mandela says.
Rose Odhiambo from Naivasha wants the Kenya Medical Practitioners and Dentist Board to take a different approach and rent in on rogue doctors who have been accused of disseminating the vice. “These are greedy people who want to make money at the expense of desperate victims.”
“The government is sleeping on its mandate; why haven’t we witnessed raids on these mushrooming kiosks that are doubling up as hospitals? They are contributing to continued cases that are denying children a chance to live.”
While comparing Kenyan laws to some countries where abortion has been legalised, Bosire says liberalisation may not necessarily lead to an increase in the number of cases: “Just like alcohol that is legal and locally available in the market, its presence does not make everyone a drunkard.” She further says that in countries where the practice is legalized, cases have not necessarily skyrocketed.
“When we address abortion from a legal or moral standpoint, we only serve to delineate some crucial sectors from working towards addressing this problem,” Bosire says, adding that factors leading to the choice of abortion must be explored to ensure that they are addressed and resolved.
Her counterpart from the Kenya Medical Practitioners, Pharmacists and Dentist Union chairman, Victor Ng’ani however is of a different opinion. He says that stringent measures need to be put in place to prevent unwanted pregnancies, especially amongst teenagers.
While clarifying that his stand on the subject is personal, Ng’ani differs with the medical jargon of safe or unsafe abortion, citing risks even in those operations normally procured by specialists: “This is a question of life, as the unborn child is 50 per cent alive, and we cannot accept 50 per cent mortality.”
“It is important for people to be responsible for their actions and not resort to abortions,” Ng’ani says, as he sends out an appeal for the up scaling of FP methods and services.
Both he and Bosire are rooting for enhanced education, especially amongst youth, as the latest statistics revealed girls aged 10-19 years and students accounted for 45 and 47 per cent of the population that experienced severe complications.
While advocating for a pro-life position, Ng’ani is calling on pregnant women to persevere the task of carrying the unborn babies for nine months, and later give them up for adoption, “if they don’t want to raise them up, as many people are willing to have children, but cannot, due to various circumstances beyond their control”.
Abortion is rampant among married women at 64 per cent, with 90 per cent of all interviewed reporting to possess some basic education, with Christians leading the park of a practice that is highly regarded as sin, as it deprives one the right to life. It is more common in the rural areas at 59 per cent, compared to urban’s 41.
Bosire is calling on the health sector to revamp the provision of FP methods to the public to enable women prevent unwanted pregnancies: “Offering contraceptives could be part of the solution, as most abortions are being done as of form of contraceptive use.”
Medics want the family structure to be strengthened to ensure morals are upheld. They want the government to incorporate safe sex themes in the education curriculum to ensure early grooming for the learners.
“This will enable youth to be more proactive, as they will be empowered to make informed decisions from an early stage. This is because most of the later repercussions for their actions may be unknown to them as they access the backstreet services, mostly as a result of fear,” Bosire says.
“Let us detach our religious biases and embrace a secular approach, similar to the one taken when HIV/Aids was claiming many lives. It was declared a national disaster that later led to an all-inclusive campaign to fight it,” she says.
Experts warn that if the situation is not managed, attaining Millennium Development Goals on preventing infant and maternal deaths will be a tall order, as blame game ranging from legality, morals and religion continues to be played out in the public arena.