Haunted by unsafe abortion, failed by policymakers

As we drive along the backstreets of Kibra slums in Nairobi, there are shoes dangling on power lines every few metres. Everyone has their theory as to what that signifies; one of those being that the shoes are mementos for people who died along those streets. The further we drive, the more we encounter them.

While the crammed houses and uninviting narrow alleys between them exude gloomy conditions, there is a visible sense of vibrancy in the people when they are outside.

When the sun goes down and all doors are locked from inside, the fleeting joy of daylight is over and now every household lives in their reality. In some households, the anguish of losing their unborn babies hits most when they are lonely, at night. Unlike the men whose shoes sag on the power lines, babies lost through unsafe abortion did not live to have a shoe, and so there is no memory of them. At night, their mothers are occasionally drowned in thoughts of what life could have been.

As the world marked International Safe Abortion Day last week, Healthy Nation spoke to women who have undergone unsafe abortion, highlighting the need for implementation of sexual and reproductive health policies and getting rid of the quacks to save the lives of Kenyan women.

We find Beryl in her mother’s house. At 26, she is a mother of one. When she got pregnant with her second baby, her first was slightly over a year old. At the time, her mother was sick, and her first child needed attention as well. Her first child was born with complications. She tells Healthy Nation that she could not bear the burden of having another child successively.

When she told her boyfriend about the pregnancy, he told her that he was not the father and that she should find the real father.

“My first instinct was to terminate the pregnancy, but I didn’t want my mother to know. Since then, I have hated men, and I don’t want anything to do with them,” she tells Healthy Nation.

She went out to look for menial jobs to raise money to procure an abortion. After a few weeks of working, she raised the required amount.

But, there was one problem. “I found the drugs at the chemist to be expensive, so I opted for a local herbalist who needed just a few coins,” she says.

“When I went to the herbalist, he told me that the drug was effective, but I shouldn’t go back to him should a complication arise. He also insisted that I should pay him in cash,” she adds.

She was given some herbs to drink and since then, her life has never been the same.

She was alone in the house when she took the herbs. The impact was instantaneous.

“It felt as though a baby was running in my stomach, moving from one side to the next. That came with intense pain, but I kept it to myself,” she recalls.

On the first day, she did not bleed as she had anticipated. The bleeding started a day after and it came in full throttle.

“My mother was concerned with the bleeding, so she called my sister asking her to take me to Mbagathi Hospital. At the hospital, I was only given an injection to stop the bleeding. I did not get any other treatment because I didn’t have the money they were asking for,” Beryl tells Healthy Nation.

“To this date, I cannot do house chores that involve bending, the pain has never waned. I occasionally experience dizziness, and just the other day, I was taken to hospital when I became unconscious,” she adds.

Later, when her sister went to look for the herbalist, he was not stationed at the place that Beryl directed her. He moved, and they do not know where to.

Beryl now lives alone at her parents’ house. 

“If God wills, one day I will get married and get a child, but only with a serious man,” she says.

A few metres from Beryl’s home, we find Elizabeth. She is a mother of four. When she got married to her husband, she had two children from a previous relationship. The husband accepted all of them and became a foster father to Elizabeth’s children. Last year, when her first born daughter was on the verge of completing her high school studies, she was impregnated by a boda boda rider. Elizabeth was also pregnant. 

After realising the twin pregnancies for mother and daughter, Elizabeth tells us that living in their one-room tin house in Kibra became hell. The husband was upset with her daughter, and by extension, she too, vexed him. Because of her pregnancy, Elizabeth stopped being a fishmonger and did not have any source of income. She was at the mercy of her husband’s income.

“He wanted us to move out of his house. I am an orphan, and I have nowhere to go. I didn’t know what to do. My daughter was also stressed and she contemplated suicide. The father of my daughter’s child was nowhere to be found, we hear that he was arrested,” she narrates.

“I thought about the situation and even though my daughter did not want to procure an abortion, we finally agreed to do it,” Elizabeth adds.

After reaching that consensus, she asked around and found a herbalist who sold her a herbal drink for Sh1, 500. 

She gave it to her daughter that evening and the foetus of her grandchild came out. 

“She is not okay now, but I had no option,” says Elizabeth.

On the flipside, Elizabeth carried her baby to term. When we visited their home, the little girl was already teething, and she smiled at us like a spirited angel.

Elizabeth’s daughter still remembers the night that she lost her baby.

“I didn’t sleep that night. I remember taking the herbs at 7pm. At around 10 that night, my stomach started aching, and then, shortly, I started bleeding,” she tells us.

“I struggled to breathe. It is then that my mother took me to hospital but she did not mention anything about the abortion. She told the nurses that I had a miscarriage,” she adds.

The 21-year old has never stopped bleeding since then –October 2023, and her back aches every day. 

Even though she went back to school and completed her studies, her life has never been the same.

“I regret it. I sometimes wish that I gave birth to my baby. I believe I could still get a chance to study. What if I died? I could have left my studies anyway,” she says.

After the termination of the pregnancy, Elizabeth’s husband became more cordial and rarely speaks about that event. Once in a while, when her daughter makes a mistake, he stabs her with hurtful words –reminding her that she is a mannerless child because she got pregnant young.

In a different neighbourhood in the same slum, Eunice is now the custodian of her parent’s house. They left for the village. We find her watching a movie from their cathode ray tube TV. She is shy, but we assure her that we will protect her identity, so she opens up. 

When Eunice met her boyfriend in 2019, she knew that he was going to be her life partner. They were in a relationship for three years. At the time, she was young and naïve. She had just completed her studies and was working as a waiter at a local hotel in Nairobi.

“He seemed believable. I fell for it. While I was serious with our relationship, he was in for fun and took it superficially,” she tells us.

The two got intimate and that resulted in a pregnancy. When she told her partner, he ghosted him and said he was not the father to the unborn child. She was only 21.

“When my mother learnt about the pregnancy, she was so upset. She told me that I brought shame to the family and that really affected me.”

Unfortunately, the altercation with her family resulted in her being chased away from home. She didn’t have a place to stay, so a friend accommodated her briefly.

“I went to the streets. I could stay up with fuel attendants at the different gas stations. Other times I slept in dingy places. During the day, I used to sit alone in an open field and it is then that I contemplated suicide,” she says.

An old friend chanced on her one time, and she advised her to just get rid of the baby.

“That scared me. I didn’t have the money, but she offered to help. She took me to a lady in Kawangware and my heart was not at peace.”

The lady was cordial when Eunice and her friend arrived. She even offered them tea.

“I remember her mentioning that I was visibly scared. But my friend told me not to worry, that everything would be okay. However, she left me and to this day I have never seen her,” she says.

After feeling comfortable in the stranger’s house, she opted to stay there and finish the business that brought her there. 

The lady gave her three cups of herbal drinks of different types.

“Immediately after the last gulp, I felt like I was losing my mind. My stomach felt as though someone had stabbed me. I started screaming and she immediately shushed me. She told me that if I let out any sound she would kick me out or say that I was a thief in her house.”

Eunice writhed in pain, puling while holding her stomach, taking in all the pain and not letting it out. The lady started mocking her, asking her why she engaged in sex before getting married.

“I was defeated. She pressed my stomach with her hands. This time I started bleeding profusely. She put a gunny bag where I had squatted to get hold of the flowing blood. After that, she gave me another drink, which she said would stop the bleeding, but that did not work,” says Eunice.

The lady offered Eunice a sanitary towel and asked her to get out of her house. Eunice was still in pain and had nowhere to go. She begged the lady to allow her to stay with her, but that was bad for her business. In the three days that Eunice stayed there, another client came but when she saw her in that pain, she changed her mind. 

On the third day, she left Kawangware in a trembling gait and fainted a few metres from the lady’s house. Next thing, she was in hospital courtesy of a Good Samaritan.

“I told the nurses in the hospital what had happened. There’s a nurse who gave me two hot slaps but eventually, they cleaned my stomach and I decided that I was going back home,” she says.

When she got home, her mother was still angry at her, but she forgave her and told her she was now ready to take care of her unborn grandchild. Eunice did not mention what had happened until the next day. When her mother learnt of the abortion, she did not talk to her daughter for a week. 

“I just prayed and asked God to forgive me. My mother softened and we had a long talk. I vowed never to encourage any girl to go to a quack for abortion. It was a lesson that only experience can teach,” she says.

“I cheated death, and now I am not ready to be in a relationship until I get someone serious.”

What reproductive health experts say

In an interview with Prof Joachim Osur, a reproductive health expert, he says that based on his studies, the decision to have an abortion is mostly a group resolution.

A mother has to convince her daughter, a friend, brother or even a boyfriend.

He says that abortion comes at the end of a chain of things but the baseline is that it is from a point of not receiving sexuality education.

This, he says, is the making of a doomed generation, failed by policy makers.

“Sexuality education is a big problem among young people. In our system, people have rejected it every time it comes up. There is a section of society that thinks that if you educate people about their sexuality, they will become promiscuous,” he says.

“Previously what used to happen, if you grew up in a community, they had a system of passing that knowledge. But that system has also now kind of collapsed. When you're living in a city, you don't have aunties talking to you about your sexuality,” he adds.

Prof Osur says that once someone has conceived, there are many options that they could get, including counselling.

“The question is where do you go, where are those counsellors?” He quips.

He explains that some of the options during counselling could either be to keep the baby to term and give it up for adoption, or raise it and if the mother is still not convinced, they can seek abortion services but it has to be medically and legally viable.

He says that unsafe abortion comes with its own challenges and risks –including death.

“Some may never conceive after that. Others could have chronic pelvic pain because of the damage. What causes death is the bleeding and infection. When unsafe abortion is done, people are exposed to unhygienic conditions. Then they get infected,” he explains.

“In the longer term, the chronic damage, the infection may damage not just the uterus, but it goes even to the tubes and the whole pelvis. So some people end up with chronic pelvic infection or Pelvic Inflammatory Disease which is the commonest cause of infertility in Kenya,” he adds.

He says that the stage of pregnancy and method determine the risks that someone is exposed to.

Nelly Munyasia, the executive director for the Reproductive Health Network in Kenya echoes the need for sexuality education as a way of reducing cases of unsafe abortion in Kenya.

“Most young girls don’t have access to information, and those that have access get the wrong information, that is why they go to quacks or unskilled healthcare providers to help them terminate the pregnancy,” she says.

She mentions that young girls still don’t have free access to contraceptives, which could ideally help them prevent getting pregnant. The facilities in Kenya are not youth-friendly and that comes with stigma; dissuading the girls from getting that access.

“There’s also a lot of disinformation online where girls get ideas on how to terminate their pregnancies,” she explains.

Nelly worries that while we have great policies at the national level, the implementation has remained a stumbling block to ensure young girls access quality healthcare.

“We see a lot of misalignment of policies and what is supposed to be implemented. Abortion is still a value-based issue, and we see a lot of religious and gender groups fighting access to safe abortion. They do not just fight abortion, but anything that is reproductive health,” she says.

Nelly is fuelled to continue advocating for reproductive health rights because she wants girls to live a quality life. 

What does the law say?

Martin Onyango, associate director Legal Strategies Africa for the Centre for Reproductive Rights, tells Healthy Nation that abortion in Kenya is regulated in law, in policy and health guidelines to service providers.

He says that while we made great strides in the 2010 Constitution, there exist moral, philosophical, religious, cultural beliefs, arguments and perceptions that influence how we view the subject of abortion.

The Constitution of Kenya under Article 43 (1a) protects the right to health including reproductive healthcare services.

“These are all the services you need from puberty to menopause for women and puberty to andropause for the men,” he says.

In the Constitution, abortion is addressed under Article 26, which talks about the right to life. He explains that abortion is prohibited unless in the opinion of a trained healthcare professional, if there is an emergency, or if the life of the woman is in danger, or if allowed by any other written law.
The Health Act elucidates the definition of abortion, emergency, health and threat to life.

“Abortion is defined in section two of the Health Act of 2017 as the termination of a pregnancy before the foetus is viable to survive independently outside the womb,” he explains. 

“Post viability it is now not an abortion allowed in law, it is something else that then will be treated as a criminal offense,” he adds.

He explains that when we talk about health in the context of abortion, it denotes one's physical health, mental health and their social well-being.

Before the 2010 Constitution, the only other law that allowed abortion was the Sexual Offences Act of 2006, which mostly recommended it for survivors of sexual violence. The new Constitution opens it for any other woman as is in the confines of the law.

In 2012 after the Constitution was promulgated, the Health ministry came up with guidelines for reducing maternal mortality and morbidity from unsafe abortion. This was specifically for healthcare providers, which then led to the development of a curriculum to train them on providing safe abortion services.

A snag came up when religious leaders were against the guidelines, leading to its quashing. The annulment was later challenged in court and the guidelines and the training curriculum were reinstated in 2019.

However, there is an existing penal code which criminalises abortion and could lead to imprisonment ranging from three years to seven years. 

“Even after enacting the Sexual offences Act and promulgating the new Constitution, the penal code has not been changed to date,” explains Martin.

“Parliament has not revised the penal code to align with the new Constitution, and even the Health Act,” he adds.

In 2022, Kenya came up with the National Reproductive Health Policy, which is not clear on some issues such as the issuance of contraceptives to adolescents.

A new World Health Organization report warns that restrictive age of consent policies are limiting young people’s access to sexually transmitted infection and HIV services. 

“Such measures can marginalise young people, reduce health-seeking behaviour and lead to lasting negative health impacts,” shows the WHO report on Adolescents’ Health.

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