Before the new Constitution of Kenya was adopted in 2010, abortion there was illegal except to save a woman’s life. Article 26 of the 2010 Constitution, while specifying that life begins at conception, allows abortion when, “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 new Constitution also asserts that every person “has the right to the highest attainable standard of health, which includes the right to health care services, including reproductive health care.”
Despite these greater legal rights, women in Kenya are still forced to resort to unsafe methods. As in many countries where abortion is or has been highly restricted, there is a dearth of access to and information about safe abortion in Kenya. Women continue to ingest herbs or other drugs or seek out untrained “quacks” who perform surgical procedures using unsterilized equipment in unsanitary conditions.
On average, 1,200 Kenyan women still die every year from complications following an unsafe abortion, and many more suffer grave injuries. A 2012 Kenya Ministry of Health study found there are approximately 465,000 induced abortions every year, most of them unsafe. In 2012, one-quarter of the women and girls who underwent an unsafe abortion had to be hospitalized as a result of serious complications such as uterine perforation, cervical damage, and septic shock.
The implementation of the new constitutional provisions should have saved thousands of lives already and made it possible for all women in need of an abortion to attain one legally and safely through the public health system. Unfortunately, three years on, knowledge and training among health care workers at public health facilities has not caught up. Much of the general public, and even many medical professionals, are still unaware of the new constitutional provisions. Misinformation has created an environment of fear and uncertainty around what should now be, in most cases, a legal procedure.
The International Women’s Health Coalition is supporting Reproductive Health Services (RHS), a women’s health clinic and reproductive health advocacy group based in Nairobi, to improve access to comprehensive abortion care services by educating and training health care workers at public health facilities.
Unsafe abortion remains “a problem of the poor,” says Professor Joseph Karanja, an obstetrician/gynecologist who teaches at the University of Nairobi’s School of Medicine and chairs the Kenyan Obstetrics and Gynecology Society (KOGS) as well as RHS’s Board. Because the poor can only afford health care at public hospitals, and few doctors or health professionals working there have the training and equipment needed to provide safe abortion services, poor women continue to resort to other means. “So they go to the quacks, they get injured. Some of them die,” Karanja says. “Those who survive, survive with complications and long-term disabilities.”
“As a gynecologist working in this area, I realized that unsafe abortion is an area that has not been tackled very well because most people are not willing to touch it,” says Dr. John Nyamu, RHS executive director.
In 2004, Nyamu and two RHS clinic nurses, Marion Kibathi and Mercy Mathai, were arrested and charged with providing illegal abortions. After more than a year in pre-trial detention, Nyamu, Kibathi, and Mathai were acquitted. The media attention that surrounded their arrests and trial galvanized the community of doctors, lawyers, and activists working on reproductive health issues to come together and launch a campaign that led to the provisions on abortion and reproductive health in the 2010 Constitution.
IWHC President Françoise Girard recently interviewed Karanja and Nyamu while in Nairobi.
Professor Joseph Karanja:
Dr. John Nyamu:
The 2010 Constitution marked a victory for reproductive rights in Kenya, but those rights must extend to all women, not just those who can afford it. Training health care providers at public hospitals is only one piece of the equation. RHS will also spearhead a public education campaign through local media, churches, and women’s groups to ensure women know they have the right to an abortion to safeguard their health and wellbeing.
The dedication of champions like Karanja and Nyamu is critical in ensuring the Kenyan government delivers on its promise of providing all Kenyan women with the highest quality reproductive health care.