Health experts warn restrictive policy will drive more women toward unsafe abortions

A few hours after leaving a herbalist's house, Mercy* started experiencing strong abdominal pains. A sudden, hot rush of a warm liquid running down Mercy's inner thighs startled her. To her shock, she noticed blood flow.

The 16-year-old felt a little relieved. Hours earlier, she had been a guest of the herbalist, and she knew for certain these were after-effects of the unsafe abortion procedure she had undergone in the company of a friend at her rural home in Bungoma.

Her visit to procure unsafe abortion had been successful, so she had thought. "You will spot light blood, nothing much to worry about," the medicine woman had assured her. Mercy immediately put on a sanitary towel and retired to bed hoping to wake up feeling much better the following day.

“I was carrying my step-father’s child. Allowing my mother to know about it would have subjected me to the trauma of being an outcast. The only solution was to terminate the pregnancy,” Mercy told Healthy Nation.

The teenager also shared that the misconceptions about seeking safe abortion services in hospitals, including being arrested for ending life, did not allow her to visit a health facility.

Also read: Haunted by unsafe abortion, failed by policymakers

During the interview, Mercy tearfully recalled the horrifying ordeal of being defiled by her stepfather while her mother was away attending a night vigil. She spoke with pain and sorrow, recounting the events of the fateful day that changed her life forever.

On that fateful day in June last year, Mercy, 16, had just put her younger brother to bed and stepped out of the house to buy milk at a nearby kiosk. When she returned, her stepfather, who was visibly tipsy, had transferred her sleeping brother to his own bedroom. He then asked Mercy to check on the boy.

"When I entered his bedroom, my stepfather, who had been following me, locked the door and defiled me,” Mercy said, her voice shaking with emotion. She added that he had threatened to kill her if she ever told anyone about what had happened.

Though terrified and deeply traumatised, Mercy decided to keep the events of that night a secret. However, anxiety began to creep in when her periods failed to come. Overwhelmed with fear, she took a pregnancy test, which confirmed her worst fears—she was pregnant. 

Mercy could not come to terms with the reality of carrying her stepfather’s child. Desperate and confused, she confided in one of her close friends, a neighbour, who suggested they could seek help from a village herbalist. The herbalist, her friend said, would charge Sh800 for her services.

The following day, Mercy visited the herbalist. The elderly woman asked about the gestation stage and then proceeded to prepare a concoction. “I was made to drink one cup of the concoction. The woman then asked me to lie on a mat facing up and inserted two small pieces of leaves into my cervix with her bare hands,” Mercy recalled. The herbalist assured her that the leaves would exit her body once she started bleeding.

Initially, the bleeding was light, but it became heavier over time. That same night, one of the leaves came out mid-flow, but the other remained lodged inside her cervix. Mercy grew increasingly worried. 

To make matters worse, her vagina became extremely itchy. The next morning, she returned to the herbalist, who dismissed her concerns, claiming that the remaining leaf would eventually be discharged by the blood flow.

Two weeks later, the leaf was still stuck inside her cervix, and Mercy’s condition had worsened. She experienced severe lower abdominal pain, persistent bleeding, and other worrying symptoms. 

"The bleeding did not stop. Instead, my skin and eyes turned pale. I would also experience frequent headaches and dizziness,” Mercy said. Fearing for her life, she approached a trainer affiliated with the Kisumu Medical and Education Trust, a non-governmental organisation running reproductive health interventions in several counties, which immediately referred her to their health facility for treatment.

At the facility, doctors performed a scan that revealed the remaining leaf had caused a serious infection. “The scan also revealed that the abortion procedure was not complete,” Mercy said. She was immediately placed on medication to complete the procedure.

After the procedure, Mercy continued to bleed for a few more days, during which a decayed piece of the leaf was discharged. However, this time, the bleeding was accompanied by pus with a foul odour. “The doctors informed me that I had developed an infection,” Mercy said. She is still undergoing treatment and remains on medication to address the complications.

Mercy’s case is among the 73 million induced abortions that occur globally every year, according to a World Health Organization (WHO) report.

WHO describes abortion as a common health intervention, stating that the procedure is safe when carried out using its recommended methods appropriate to the pregnancy duration and performed by a qualified provider.

The agency estimates that six out of 10 unintended pregnancies end in induced abortions, with 45 per cent of these being unsafe.

In Kenya, recent statistics from the Kenya Obstetrical and Gynecological Society (KOGS) reveal that 465,000 abortions occur annually, with the majority being unsafe. Further estimates indicate that at least 2,600 women die each year due to complications from unsafe abortions, translating to eight women losing their lives daily.

“Another 21,000 women are hospitalised annually due to complications arising from unsafe abortions,” says KOGS, a national advocate for sexual and reproductive health rights.

Dr Dennis Miskellah, a Nairobi-based gynecologist, warns that these numbers could rise following the decision by US President Donald Trump to reinstate the anti-abortion policy.

On January 24, 2025, just days after his inauguration, Trump reinstated the Republican anti-abortion policy, known as the Mexico City Rule or the “global gag rule.” This policy bars non-governmental organisations that promote or perform abortions from receiving US aid.

Additionally, Trump signed an order reaffirming the long-standing US policy prohibiting federally funded NGOs from using government funds to provide abortion services overseas.

The Mexico City Policy, first introduced in 1984 by then-US President Ronald Reagan, blocks foreign aid to NGOs that support abortion as part of family planning services or advocate for abortion rights.

Trump's decision has sparked global outrage, with individuals and organisations protesting against the policy.

Last month, over 100 international civil society organisations (CSOs) joined forces to call for an end to what they described as a ‘harmful policy’.

In a press release, the 107 CSOs argued that the policy restricts US assistance for critical global health initiatives if the recipient organisations provide, counsel, refer, or advocate for legal abortion.

“Since 1984, the policy has come and gone with changes in the US presidency, leaving the health and lives of millions vulnerable to political whims,” the statement read.

They further argued that the policy has dismantled life-saving health services in communities already facing systemic barriers to care.

It has also forced the closure of numerous clinics, cut off outreach programmes to underserved populations, and created barriers to accessing contraception.

The organisations called for a permanent repeal of the policy, emphasising that past implementations have led to increased unintended pregnancies, unsafe abortions, and preventable deaths.

Martin Onyango, associate director for Legal Strategies Africa at the Center for Reproductive Rights, explained that the Mexico City Policy prohibits any organisation receiving US government funding from using its own funds or any US aid to provide, promote, or discuss abortion services.

He noted that like many African countries, Kenya does not have standalone facilities dedicated solely to abortion services.

This is despite WHO statistics showing that 97 per cent of unsafe abortions worldwide occur in developing regions such as Africa, Asia and Latin America.

According to Mr Onyango, the policy threatens healthcare service delivery, which in many cases is heavily dependent on US grants.

“What this means is that all organisations and health facilities receiving US government funding must stop providing abortion-related information or services, or they risk losing their funding,” says Mr Onyango.

Dr Miskellah warns that the Mexico City Policy will disproportionately impact women and girls in informal settlements and low- to middle-income groups.

He cautions that safe abortion services will soon become inaccessible for individuals from underprivileged backgrounds.

If the policy remains in place, he says, many women and girls will be forced to pay more to access safe abortion services.

“I cry for the women of Africa, Kenya, and across the global south. Their backs are against the wall. For a long time, organisations have helped women access safe abortions despite the legal challenges, saving countless lives. I can only imagine the suffering they will now endure,” he says.

He adds: “Women will be knocking on doors, but the services may no longer be free. Their next resort will be unsafe procedures.”

The gynecologist explains that regardless of location or economic status, data indicates that many women still seek abortion services, whether safe or unsafe.

These abortions often result from unmet family planning needs, inadequate sexual and reproductive health education, and other factors.

The 2022 Kenya Demographic Health Survey estimates that 14 per cent of married Kenyan women have unmet family planning needs.

“Unsafe abortion is one of the leading causes of maternal deaths worldwide. When restrictive laws and policies hinder access to safe services, we open the door to unsafe methods,” Dr Miskellah says.

He warns that unsafe abortions expose women and girls to severe health risks, including uterine rupture, internal bleeding, infections and death.

Other complications include kidney failure, infertility, mental health issues, and financial burdens from medical treatments.

“Unsafe abortion can also cause severe hemorrhage, leading to anemia and, in extreme cases, death,” he adds.

Sharon Amendi, policy and advocacy lead at KMET, explains that Article 26 of the Kenyan Constitution guarantees the right to life and recognises that life begins at conception.

However, she notes that Section Four of the article allows abortion if a medical expert determines that the mother's life or health is at risk, in emergencies, or if permitted by other laws.

“The Sexual Offences Act also provides an exception for abortion in cases of rape, defilement, or incest,” says Ms Amendi.

Kenya’s Constitution grants citizens the right to the highest standard of healthcare, including reproductive health, under Article 43.

The WHO defines health as a state of complete physical, mental, and social well-being, not merely the absence of disease, Ms Amendi explains.

“Abortion is restricted in Kenya, but it is not completely illegal as many assume,” she clarifies.

She highlights progress in access to safe abortion services, including favourable court rulings affirming reproductive rights.

“A notable example is the Malindi case, where police arrested an underage girl for seeking safe abortion services. The court ruled that safe abortion is a fundamental reproductive health right in Kenya,” says Ms Amendi.

Despite legal provisions, many women still struggle to access safe abortion services due to misconceptions about its legality.

Other barriers include the requirement for parental consent for girls under 18 and widespread stigma.

Dr Miskellah cites inadequate funding as another major challenge, noting that Kenya and many African nations rely on US donor support.

He argues that the Mexico City Policy does not prevent abortions but forces women to seek unsafe procedures.

“Women do not die because they seek safe abortion services; they die due to complications from unsafe procedures performed by unqualified providers,” he says.

Kelly Blanchard, president of Ibis Reproductive Health, states that decades of evidence confirm that access to safe abortion is a human rights issue that saves lives.

Evelyne Opondo, a board member of the organisation, warns that the policy will cause harm and violate the rights of women, girls and marginalised communities worldwide.

She argues that prohibiting organisations from advocating for or providing safe abortion services infringes on free speech.

“It is crucial to raise awareness about the devastating impact of this policy on sexual and reproductive rights worldwide,” says Blanchard.

Ms Amendi echoes these concerns, noting that changes in US leadership often disrupt global health programmes.

“The Mexico City Policy forces organisations to choose between providing abortion-related services or forfeiting US funding,” she says.

She warns that the policy threatens maternal health programmes, forcing many to shut down.

While Kenya has legal frameworks for safe abortion, Ms Amendi notes that lack of funding makes implementation difficult.

“We have made progress, but this policy pushes us backward. It will take years to recover,” she says.

The policy, she warns, could cripple government services, reduce access to reproductive healthcare and increase maternal deaths.

She also urges African nations to invest in their reproductive health programmes instead of relying on foreign aid.

Mr Onyango calls on the Kenyan government to bridge the funding gap to prevent a collapse of healthcare services.

“Health is a fundamental right, and the government must prioritise funding through public healthcare systems,” he says.

Ms Amendi concludes by urging countries to seek alternative funding sources and partnerships beyond the US.

“We hope that philanthropic organisations like the Gates Foundation and the Open Society Foundation will step in to fill the gap,” says Dr Miskellah.

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