A lot has, and is being done about maternal health in Kenya, a most notable initiative being the Beyond Zero campaign which was spearheaded by the first lady Margaret Kenyatta last year. But we cannot begin to address the worryingly high numbers of maternal deaths and morbidity without addressing one of the key courses of the same – unsafe abortions which are killing approximately 266 out of 100,000 women every year. This is aside from rendering many more women unable to bear children in future as the severe effects of unsafe and incomplete abortions take hold of their reproductive and family lives. We’re looking at problems like excessive bleeding, punctured reproductive organs, post abortion sepsis and uterine perforations among other horrific side effects. These complications and deaths are totally unnecessary because performed by skilled professionals and in a good medical facility and within the law, termination of pregnancy is a safe medical procedure.
In 2012, the Ministry of Medical Services released a document detailing standards and guidelines for reducing morbidity and mortality from unsafe abortions in Kenya. The document in which the Ministry of Medical Services acknowledged unsafe abortion as a key cause of maternal deaths was arrived at with participation at different stages and in different capacities by various organizations namely:
• Kenya Medical Practitioners & Dentists Board
• Nursing Council of Kenya
• Clinical Officers Council
• Provincial Directors of Health
• Provincial Reproductive Health Coordinators
• Kenya National Commission of Human Rights
• World Health Organization (WHO)
• Kenya Obstetrical and Gynecology Society
• National Nurses Society of Kenya
• Clinical Officers Association
• Ipas Africa Alliance
• Marie Stopes Kenya
The ministry further acknowledged the importance of these policies and guidelines because there was a glaring absence of clear guidelines among the medical fraternity for management of abortions in the context of the Kenyan Law. It was therefore a crucial document both in terms of guiding medical personnel on how to go about reproductive health issues, as well as shielding them from possible prosecution for legal abortions. It also played into protecting and preserving the rights of women to the full spectrum of reproductive health services.
In December 2013 however, the guidelines were withdrawn without any consultation or explanation to the stakeholders who had participated in bringing it forth. A few months later in February 2014, the Ministry issued a memo to all public and private health workers stating that the Constitution of Kenya 2010 is clear that abortion on demand is illegal and that all trainings of health workers on safe abortions cease, lest legal measures be applied. The memo however did not clarify when abortion IS legal, and this is where the problem lies.
This directive threw the medical professionals into confusion and in obvious fear for their livelihoods if they went ahead and performed abortions. This blanket directive took effect even for women who needed termination of pregnancy due to danger to the mother. Such cases include ectopic pregnancies or pregnancies in women diagnosed with cancer, and whose pregnancies cannot withstand the rigors of treatment for the same. It also flew right into the face of women’s reproductive rights which the Government has the power and obligation to protect.
Other than crippling medical professionals to legally do what belongs in their field, this back and forth by the Ministry brings with it the risk of sending even more women to the backstreets to attempt clandestine abortions in the hands of quarks. Without training of medical staff, especially middle level ones who these women can access, where do they run to? Unlike doctors who learn about safe abortion practices in medical school, nurses and clinical officers who often work in rural and informal settlement areas rely on these trainings led by medical associations and private institutions.
It is here that we come full circle into the problem of increased maternal deaths due to unsafe abortions. It is the poor and rural women who bear the brunt of this government recklessness because their richer counterparts can always procure discreet abortions which they can afford to pay top dollar for. Someone has to stand for these women.