One is too many women to lose to unsafe abortion


Activists celebrate after the High Court ruled that the Ministry of Health was wrong to withdraw safe abortion standards and guidelines in Milimani, Nairobi, on June 12, 2019. 

Photo credit: File | Nation Media Group

Lack of access to safe abortion due to known barriers remains unacceptably high. Unsafe abortion is a public health concern, and according to the Ministry of Health's 2013 Magnitude and Incidences of Unsafe Abortion in Kenya study, unsafe abortion in the country is among the highest in Africa. Maternal mortality is high at approximately 6,000 deaths per year, 17 per cent of which are due to complications from unsafe abortion.

The study, conducted by the African Population and Health Research Centre in collaboration with the Ministry of Health, Ipas, the Guttmacher Institute and other partners, estimated that 464,690 induced abortions were conducted in Kenya in 2012, resulting in an induced abortion rate of 48 abortions per 1,000 women of reproductive age (15-49 years) and an induced abortion ratio of 30 abortions per 100 live births in 2012.

Some of these statistics represent the untold misery of young girls, some of whom are breadwinners living in squalid conditions. The study also estimates that 157,762 women were treated for complications from induced and spontaneous abortions in health facilities in the same year. Of these, 119,912 had complications from induced abortions.

The World Health Organization (WHO) defines unsafe abortion as a procedure to terminate a pregnancy that is performed either by persons who lack the necessary skills or in an environment that does not meet minimum medical standards, or both.

The situation is further exacerbated by people of different beliefs who insist on imposing their misinterpretation of the right to safe abortion on other members of the community. While all this is happening, the number of admissions for post-abortion care in public facilities is increasing, while a large number of children remain orphaned because their mothers could not access safe abortion services.

Despite this glaring challenge, attempts by human rights organisations and women's groups to compel the government to provide access to safe abortion services have often fallen on deaf ears.

Article 26(4) of the Constitution allows abortion in certain circumstances, such as in the opinion of a trained health professional, when emergency treatment is required, when the life or health of the mother is in danger, or when otherwise permitted by written law.

Women's rights organisations such as TICAH have campaigned for safe abortion as a means of reducing maternal deaths caused by the high number of unsafe abortions. However, there have been attempts to frustrate efforts to reduce maternal mortality by failing to operationalise progressive guidelines such as the Standards and Guidelines for Reducing Maternal Mortality developed by the Ministry of Health, which have been left to gather dust on the shelves of the Ministry of Health.

This can also be said of laws that are slow to be implemented when they are found to be expanding the range of sexual and reproductive health services to the smallest extent possible, and we can only wait to see if the proposed clinical manual on the prevention and management of the five leading causes of maternal morbidity and mortality in Kenya is implemented.

A High Court ruling in Malindi on March 25, 2022, affirmed that abortion care is a fundamental right under the Constitution and that arbitrary arrest and prosecution of patients and health care providers for seeking or providing abortion services is illegal.

The Court also directed Parliament to enact an abortion law and public policy framework in line with the Constitution. However, unintended pregnancies and unsafe abortions remain high due to low contraceptive prevalence.

The clarion call on this International Safe Abortion Day, celebrated annually on September 28 is for the Ministry of Health and related government institutions to rise above any bias that may stand in the way of providing safe abortion and instead adhere to scientific evidence in formulating policies and guidelines, and while doing so, boldly reclaim their position in ending the pandemic of unsafe abortion.

The author is Programme Manager at TICAH.