How Kenyan medics are abusing women with forced sterilisations and getting away with it
A woman who underwent tubal ligation without her consent shares her experience in Karen, Nairobi on February 7, 2023.
What you need to know:
- The report highlights that 94 per cent of Kenyan women in the counties did not report their obstetric violence
- The report further notes that 46 per cent of women who had experienced OBV were between 25 and 34 years of age.
- According to the researchers, psychological and emotional abuse cases were at 62 per cent.
Kenyan women seeking maternal health services are being subjected to non-consensual pelvic exams, forced sterilisation, and unnecessary caesarean sections without their consent, a new report has found.
They are also being restrained in health facilities if not being pressured and manipulated into accepting medical interventions or procedures they do not want or need.
This is according to a report by the Association for the Physically Disabled of Kenya (APDK), Center for Advocacy and Awareness on the Rights of Youth- Africa (CAARY-AFRICA), Nguvu Collective and partners.
The findings lift the lid on how medics in 27 counties deliver medical services without dignity and respect.
“68 per cent of the incidents were gross human rights violations that encompassed a range of egregious acts that deprived women of their rights to dignity, autonomy, and quality healthcare during pregnancy, childbirth, and the postpartum period,” the authors of the report concluded based on the data from their findings.
The report highlights that 94 per cent of Kenyan women in the counties did not report their obstetric violence (OBV/OV) experience because they did not know how to do so.
OBV or OV refers to various forms of mistreatment and abuse that women go through during pregnancy, childbirth, and the postpartum period, and is a prevalent issue that undermines these rights.
On who is subjecting Kenyan women to OBV, the report points out that multiple healthcare providers were reported to be involved in OBV.
“The most involved in subjecting women to OBV was found to be nurses (51 per cent), doctors/obstetricians/Gynecologists (25 per cent), and support / Non-clinical staff (19 per cent) such as receptionists, catering staff, maintenance and cleaning staff.”
This is why nine per cent of the OBV incidents resulted in infant death, while thirteen per cent had a long-term negative impact on the child's health and development.
Wrong medication
According to the researchers, of the 25 women in the focus group, three reported that they lost their child while two mentioned that their child now has a disability as a result of what happened during childbirth.
“Since that day, I wished they could show me the foetus in my womb but they never did. The treatment they gave me/I received did not please me at all! Until today, I have wished to get pregnant again but have not been able to, I have never had my monthly periods since then despite visiting a lot of hospitals and using all means,” one of the Kenyan women who took part in the study told the Nation.
The findings show that medical neglect, malpractice, and unnecessary interventions such as denial of care, unsanitary maternity settings, and unnecessary/wrong medication prescription and recommended usage was at 28 per cent.
83 percent of 189 women who participated in the study had experienced at least one form of OBV while 11 per cent were women with disabilities.
“Responses were from 27 counties across 7 provinces - Nairobi, Western, Central, Nyanza, Coast, Rift Valley, and Eastern,” the report highlights.
It stressed that maternal care is a fundamental aspect of public health, and ensuring that it is provided with dignity and respect is crucial.
The Kenyan Constitution enshrines every citizen's fundamental right to access high-quality healthcare, which encompasses the highest attainable standards of reproductive health.
The report further notes that 46 per cent of women who had experienced OBV were between 25 and 34 years of age while 51 per cent of women who participated in their study came from low-income and below-the-poverty-line households.
According to the researchers, psychological and emotional abuse cases were at 62 per cent and they include disregard of needs and pain, verbal abuse, humiliation, dehumanizing and rude treatment as well as discrimination.
But where did all these forms of abuse happen?
The researchers, however, did not give the names of hospitals they visited where patients told them of their painful encounters such as forced sterilizations.
The Kenyan High Court recently ruled that the forced sterilisation of a woman living with HIV was a violation of her human rights, in the first case of its kind.
In December 2022, after eight years of litigation, Hon Justice Anthony Mrima delivered a historic judgment when he declared that the tubal ligation of a woman living with HIV, without her consent, violated her rights to dignity, freedom from discrimination, right to health and her right to found a family.
The woman had since 2014 challenged the action of a health care provider in a private medical facility, who sterilised her without her knowledge or consent.
Physical injuries
“This win is not just for me but for each woman living with HIV who has been subjected to forced sterilization. I am happy that the violations against us have been acknowledged and hope my story will be a tool for the protection of the right to health for other women living with HIV, she said after the ruling.
“21 per cent of the OBV incidents affected both the mother and child’s health and development in the long term.
13 per cent of the women reported that they were harmed and had physical injuries during childbirth as a result of OBV,” they noted.
They further disclosed that 59 per cent of women respondents who experienced OBV received care at public hospitals, while 16 per cent sought care at private hospitals.
OBV incidents occurred in a variety of healthcare settings, including health centres four percent, maternity clinics two per cent and mission/faith-based hospitals
The researchers are of the view that their data suggests that OBV is not limited to any specific type of healthcare institution, indicating the need for further research with a larger and more diverse sample size to understand better which institutions may be more prone to OBV.
They explain that fear of retaliation or further mistreatment was also a significant deterrent, impacting 32 percent of survivors.
This, coupled with the lack of awareness of how and where to report (35 per cent) and lack of confidence in the reporting process (26 per cent) were other key factors contributing to underreporting.
Additionally, feelings of stigma or shame (17 per cent), concerns about confidentiality or privacy (18 per cent), and the perception that OB was a normal experience for women (13 per cent) also influenced survivors' decisions not to report incidents.
“No national policy currently exists in Kenya to address or prevent OBV, Githunguri MP Gathoni Wamuchomba (now Githunguri MP) tabled a proposal for developing a national policy on OBV in November 2023 but parliamentary discussion on the matter has since been delayed,” the researchers cited when the Nation sought to understand why this was happening.
“There is therefore a pressing need to prioritise documenting survivor experiences to develop a deeper understanding of the challenges and barriers that exist within the maternal care system.
Targeted interventions
This will guide policy reforms and the implementation of targeted interventions that are centred on the experiences,” the researchers assured while recommending the strengthening healthcare provider training on OBV prevention and compassionate care which is supported by 72 per cent of respondents as a key priority.
“73 per cent of survivors stressed the importance of implementing and enforcing policies and guidelines to protect women's rights during childbirth.”
The Kenya Medical and Dentist Practitioners Council (KMPDC) reminds that it is mandated to regulate health training, practice of medicine and dentistry as well as regulate healthcare standards in hospitals, medical centres and clinics through the Disciplinary and Ethics Committee. “The Disciplinary and Ethics Committee (D&EC) is established by the Medical Practitioners and Dentists Act, Chapter 253 of the Laws of Kenya, Section 4A (1) (b) which mandates the D&EC to conduct inquiries into complaints submitted to it.”
According to Eunice Muriithi, the Assistant Director, Discipline and Ethics, the determination of cases involves intense investigation based on medicine and is backed by a thorough analysis of the patient journey by critically evaluating the complainant and respondents’ statements, patient files and records to ensure a fair outcome for each complaint presented to the committee.
“In hearing and determining complaints of alleged medical negligence, the D & E Committee goes through several stages including receiving of a complaint, opening of a D&EC case file, expert review and committee stage all while allowing both the complainant and respondents have adequate time to file submissions to ensure an impartial process.”
