Let's talk about abortion: Who really needs it?

Discussions on abortion often draw a fierce debate between pro-life and pro-choice followers.

The Kenyan government is, however, aware of the huge burden of treating complications arising from unsafe abortions.

In 2018, the Ministry of Health partnered with African Population and Health Research Centre (APHRC) and Ipas, an international organisation that works to increase access to safe abortion and contraception to study the same.

They found that on average to treat a woman for complications from an unsafe abortion requires 7.4 hours of healthcare personnel time. This time ranged from 5.5 hours for mild complications to 6.7 hours for moderate complications, and up to 12.4 hours for the treatment of severe complications, involving procedures such as pelvis abscess drainage or cervical or vaginal tear repair.

And most of these were time spent by nurses and medical officers. Additionally, the average cost of a typical treatment stood at Sh4,943. This cost varied from Sh3,264 for mild complications, Sh4,362 for moderate complications and Sh9,133 for severe complications.

For a better understanding of the burden of abortion and its lack of access, I speak with Kenneth Juma, a researcher at APHRC who extensively studies maternal health issues such as abortion and its associated complications across Africa.

What is the economic and emotional cost of lack of access to safe abortion for a survivor of sexual violence?

The law in Kenya restricts abortion and only provides for it on a limited set of conditions, including when the life and health of a woman is at risk.

But in the High Court ruling in 2019 on JMM case, the High Court provided additional grounds including, if there is rape.

***************

The case filed by Federation of Women Lawyers-Kenya and three others in 2015 involved a 14-year-old girl (JMM) who died from complications that resulted from an unsafe abortion. After becoming pregnant as a result of rape, JMM was unable to access safe abortion services. She had her pregnancy terminated by an unqualified provider and did not receive the post-abortion care she needed. 

****************

There are, however, challenges with access to abortion. This is because it is heavily stigmatised at the community and health facility level. And because of that, many people do not want to identify themselves with abortion whether it is the providers or the communities the women come from.

Often, a victim of rape suffers from blaming. It is assumed there is something wrong they did. That they were in the wrong place; they would be dressed badly or that they would have subjected themselves to the risk of rape

It is a twin burden of stigma for a woman who has been raped and who is trying to seek a safe abortion. Then, the context of seeking abortion creates an additional barrier.

The law can only be supportive once someone has declared that they have been raped and declared in sufficient time.

When it comes to seeking abortion in the context of rape, the big question is how you prove that it was rape when it wasn’t reported.

Also read: Men, too, have a story to tell on the abortion debate

It happened and you did not report and then one month later, you realise you are pregnant and then you begin to seek an abortion, claiming you were raped, and the providers do not have sufficient proof that the pregnancy is a result of rape.

That journey becomes very torturous. The potential fear that ultimately they may not get that abortion and the days are passing by and the pregnancy is maturing, affects them mentally and psychologically.

When is it safe to procure an abortion?

Abortion is most safe when the pregnancy is below eight weeks. At 12 weeks, it becomes more technical.

Safe abortion entails a woman being given the right dosage of medicine when the pregnancy is eight weeks old. At 12 weeks, it is done surgically by a midwife, nurse, clinician, or physician.

There haven’t been empirical studies to estimate the burden of mental and psychological stress such women suffer but from anecdotal evidence, it is known to be heavy. Sometimes they are unable to recover from this trauma.

Because of complications associated with accessing safe abortion, they end up going for unsafe abortion.

What worries you the most about the current state of access to abortion and post-abortion care in Kenya?

We put the lives of women and girls at risk when they can’t access safe abortion and post-abortion care.

Already, we know from data that close to 13 per cent of maternal deaths are linked to unsafe abortion.

When we don’t address the deaths by addressing the challenges associated with access to safe abortion and post-abortion care, it means you don’t care about the health and well-being of women and girls.

Apart from survivors of sexual violence, what categories of women and girls seek abortion?

It is a diverse group of women and girls. It is adolescents who constitute close to 50 per cent and married women. And they are from all religions; Muslims, Christians and other religions.  They are also a mixture of the educated and the non-educated.

What drives them to abortion?

Abortion happens when a woman feels I had a child last year and I can’t have another one this year. Or she’s in school and doesn’t want to have the child. Or I’m too old; I’ve had enough babies, I can’t have another one. Or maybe it is not with the right partner.

Unintended pregnancies happen because of limited access to effective family planning. You cannot prevent unintended pregnancy by counting days or using beads or using withdrawal methods.

In Kenya, there is a huge gap in unmet family planning needs; which means a huge number of women who end up with unintended pregnancies seek an abortion. It worries me that while we are not reducing the proportion of women having unintended pregnancies, we are limiting abortion. And the result of this is that abortions will most often be unsafe.

***************

Kenya has a 14 million population of women and girls of reproductive age, an increase by three million in a span of eight years, according to the Family Planning 2020 (FP2020) report. In 2012, there were 11 million women and girls aged 15-49 against the 14 million in 2020.And in 2020, only 5.97 million women and girls of the reproductive age were using contraceptives which is nevertheless an increase from 5.82 million in 2019.

*****************

From our studies, we’ve found that in the Kenyan context sex begins early at the age of 12 or 13, and since we are opposing comprehensive sexuality education in schools, sex is then happening within a setting of very limited information.

Girls don’t know when they can get pregnant or ‘how do I know I’m pregnant?’

And because of lack of access to information, you end up with a pool of adolescents and young women who carry a pregnancy but want to terminate it. And though there is a restrictive law on abortion, they will still have it. Only that it will be unsafe.

Will opening up the window for abortion increase the rates?

When the law is made liberal or improved, it does not necessarily increase the rates of abortion. What it does is that it makes abortion safer.

When the law is relatively tight as it is today, what it does is that it does not prevent abortion. What it does is that it makes abortion more and more unsafe. And an unsafe abortion leads to very severe complications.

What complications arise from an unsafe abortion?

Unsafe abortions lead to complications that then require post- abortion care. And when they don’t have access to comprehensive access to post-abortion care then it means these women will suffer complications that will lead to death. If they don’t die, they end up with permanent disabilities where one’s uterus has to be removed or have acupuncture on the uterine wall.

So then, what is the solution to these challenges?

Let there be legislative and policy reforms to expand the abortion space once that happens, we educate the community on what is legal, and what is not legal including the opportunities to access post-abortion care. A few women know that even though I’ve had this abortion outside the hospital, now that I have complications, I can rush to the hospital for post-abortion care.

The other strategy is to address the drivers of unintended pregnancy and how do we do that? There is definitely a need to improve access to family planning services.

In our context, since sex begins early, then you have to ensure that those who are doing it have information and access to contraceptives.

Some of these early sexual activities emerge from sexual violence; a girl was defiled at 13 or 14 years. So, then we have to address the issues around sexual violence.

They also emerge from child marriages. The reality is that child marriages are happening despite the fact that they are illegal. But since they are happening, we have to ensure that these communities have access to family planning services while we address the challenge of child marriages.

Also address issues around return-to-school policy. When a girl in school gets pregnant, the desperation to terminate the pregnancy is so high. To address the desperation, we need to improve the policy so that when a girl gets pregnant she has access to sufficient support to complete her studies.

The current policy is not supportive enough. It does address issues such as, who will take care of her child when she’s at school or what are the socio-economic incentives for the institutions supporting her.

There is also a need to train healthcare providers to deliver services that are patient-centred. Such that when women come for post-abortion care, they need to know that the service is legal and they don’t need to harass them.

[email protected]