What you need to know:
- With the African culture, most gender-selective abortions carried out in Kenya are eliminating the female gender.
- Culture is riding on the availability and advancement of technology to eliminate the unwanted gender.
- A KNH study states that nearly two-thirds of women who seek post-abortion care services are married, 22 per cent single, divorced or separated (12 per cent) while 4.4 per cent are widowed.
By the time they exchanged vows in 2016, Makena and her husband had made a covenant to have only two children - a boy and a girl.
Three years into the marriage, Makena - who requested that we use only one of her names to protect her identity - says she trawled through the Internet day in day out to research on ways to have her second child as a son; as their first born was a girl.
“When I gave birth, I could tell my husband was not as fulfilled with the child being a daughter,” she says.
He had, during family gatherings and in between their talks, alluded - albeit jokingly, that he looked forward to having a son.
Two years after the birth of their first baby, her husband suggested that they get another baby. He wanted a boy.
“To me, he wanted to boost his ego among his friends and family. All his brothers apart from one, have given birth to daughters and I could tell from their conversations every time we went out, that they were competing to have a boy- Ndume. He always said he already had a name for the boy,” Ms Makena says.
And so just 10 weeks after the conception of their second baby, she hatched a plan; she would go for an ultrasound to establish the sex of the baby with a clear intention - abort if it was a girl.
“From my husband’s demeanour, I knew my marriage would hit the rocks if I had another girl. I was worried sick. When the ultrasound was conducted and the results showed I was carrying a girl, I secretly procured an abortion at a clinic in Pangani, Nairobi.
“That was not enough, the third pregnancy was a girl again and I did the same. Luckily, the fourth was a boy and I carried it to term,” she confesses.
Strange and sad as it may sound, Ms Makena is not the only woman who has conducted a gender selective abortion or sex-selective terminations.
Consulting gynaecologist and obstetrician, Clement Karanja, estimates that one in every five abortions procured by married women in Kenya are gender selective.
“Women are increasingly choosing to give life to a child of the gender they want. Sadly, with the African culture, most of the gender-selective abortions carried out in Kenya are eliminating the female gender,” Dr Karanja says.
An interagency statement by the United Nations’ agencies- the Office of the High Commissioner for Human Rights, (OHCHR), the Population Fund (UNFPA), United Nations International Children's Fund (Unicef), UN Women and the World Health Organisation (WHO) already expressed a common concern that the tradition of patrilineal inheritance in many societies, coupled with a reliance on boys to provide economic support, security in old age and to perform death rites, have placed greater value on sons than daughters.
“A general trend towards declining family size, occasionally fostered by stringent policies restricting the number of children people are allowed to have, is reinforcing a deeply rooted preference for male offspring. As a result, women are often under immense family and societal pressure to produce sons,” the report says.
It points out that in many societies, failure to do so may lead to consequences that include violence, rejection by the marital family or even death.
And even though the agencies raised the concern five years ago, Dr Karanja says culture is riding on the availability and advancement of technology to eliminate the unwanted gender.
“Elective abortion in Kenya is illegal, but still happens and so there is no data for that. Women just abort; they don’t specify that they are doing it because the foetus is a boy or a girl. And to make it worse, clinics which conduct these terminations are always after money,” he says.
Gynaecologists admit that most requests for ultrasound are based on the need to spot whether there are foetus abnormalities and also to know the sex of the child.
“Ultrasound uses high-frequency sound waves to produce an image on a screen of the baby in the mother's uterus. The sex organ of the baby can be spotted from between week 16 to 17 weeks,” obstetrician and gynaecologist John Ong’ech says.
Dr Ong’ech says that with the available technologies in the country and worldwide, it is almost accurate to establish the sex of the baby by sonography.
In most countries, a technology called the Non-Invasive Prenatal Test (NIPT) is being used as a safe method of detecting Down’s syndrome and other genetic conditions. The technology is also being widely used as a sex-determination test.
Dr John Nyamu, a consultant gynaecologist and executive director at Reproductive Health Services in Nairobi, notes that couples use many other methods to try and conceive their preferred gender but observes that the baby's gender is determined when the egg is fertilised.
“Whether a baby will be a boy or a girl is determined at the time of conception and there are people who use ovulation timing and In-Vitro-Fertilisation (IVF) to choose their preferred sex. But IVF is costly to some people. It can cost between Sh400,000 and Sh1million depending on where it is done,” Dr Nyamu says.
Although he says he was not aware of any cases of gender selective abortions, he notes that it is highly possible it is happening in Kenya.
“Abortion is illegal. I personally don’t support on-demand-abortion. There are many reasons women demand for abortion and gender selection could be one of them,” he says.
The egg from the mother and the sperm from the father, which carry sex chromosomes meet to fertilise. The egg always contributes an X chromosome, and the sperm can contribute either an X or a Y chromosome, depending on the sperm cell. The sex of the baby is determined by the sperm cell that fertilises the egg first.
Section 159 of the Penal Code provides that any woman who procures an abortion outside the boundaries stipulated by the law commits a felony and is liable to imprisonment for seven years upon conviction by a court of law.
The African Population and Health Research Centre (APHRC) estimates that in Kenya, about 470,000 abortions are procured every year.
A Kenyatta National Hospital (KNH) study, titled Acceptability of Rapid HIV Test Screening among Patients Presenting with Incomplete Abortion at Kenyatta National Hospital, states that nearly two-thirds of women who seek post-abortion care services are married, 22 per cent single, divorced or separated (12 per cent) while 4.4 per cent are widowed.
Another study by reproductive health clinic- Marie Stopes published in the journal Plos One in November 2019, shows that almost 23 per cent of women in Nairobi who procure abortions are married, partnered or cohabiting.
The Medical Practitioners and Dentists’ Council says gender-selection abortion does not fall in the category of medical reasons for termination of pregnancy.
The regulator of the medical professionals maintains abortion is not permitted as stipulated by section 26 (4) of the Constitution, which states that abortion is not permitted unless, 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.
“At this time, the council is not in receipt of any complaint from any persons regarding gender selection abortion. Further, no such complaint has been filed at the council involving an individual practitioner or health institution,” council chairperson Daniel Yumbya says.
Mr Yumbya notes that in the event such a complaint is filed, the council shall investigate and make a determination based on the findings, the necessary disciplinary measures and recommendations shall then be taken in line with the Medical Practitioners and Dentists Act.