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Allow abortion in public hospitals, say medics

Poor women seeking safe abortion could soon get the services in public health facilities if developed reproductive health guidelines and policies are ratified. The death of a woman from a botched abortion at a backstreet joint angered former chairman of the Kenya Medical Association, Dr Stephen Ochiel.

“The law banning abortion is the greatest killer of women because it does not criminalise sex. It criminalise abortions,” he said. The victim, a hawker visited a quack to terminate her 28-week pregnancy.

But Florence Wambui, instead, landed in hospital. When her condition deteriorated, doctors decided to perform an operation to restore her uterus. They were shocked to discover an instrument embedded her abdomen. The mother of two admitted she had sought the services of a quack to terminate the pregnancy.

“I was not in a position to provide for another child,” she was quoted before she passed on after ten days. Wambui said the quack induced the abortion, then told her to go to a public hospital for treatment . However, public hospitals lack facilities to provide post-abortion related services.

Similar deaths are set to be minimised if Director of Medical Services Dr Nicholas Muraguri releases rules and guidelines as promised. The move will allow women access abortion services at public health facilities across the country.

“Currently, poor women, youth and marginalised communities cannot access safe abortion in government facilities as the services are not available,” says gynaecologist and Reproductive Health Services boss Dr John Nyamu.

“In the absence of policies to guide the process of accessing safe abortion services, women resort to unsafe abortion services offered by quacks, which leads to complications and deaths,” says Dr Nyamu. Safe abortion is available to financially able women who arrange with doctors to have it done in private hospitals.

Majority of the women who resort to unsafe abortions in backstreet clinics are the vulnerable and poor who cannot afford better services,” he says. Wambui is among 266 per 100,00 women who die from unsafe abortion complications.

According to a study by the Health ministry and African Population and Health Research (APHRC), there were 465,000 induced abortions in Kenya in 2012. This translates to 1,200 induced abortions daily. On complications, 157,762 were treated on – induced and spontaneous abortions.

Gynecologist Prof Joseph Karanja and also University of Nairobi don, during celebrations to mark the Global Day of Action for Access to Safe and Legal Abortion on September 28 said: “The myth that abortion in Kenya is illegal must be demolished. Abortion is legal and within the law.

What we require are policies to enable women access the services.” Article 43(a) guarantees a right to the highest attainable standards of health including reproductive healthcare.

Samson Mwita of Mwera Medical Centre says though legal, the process has certain restrictions that makes those seeking safe abortion services be turned away from health facilities.

“We are fighting for the policies to ensure women seek for abortion services at public health facilities, and not quacks,” says Mwita. In Kenya, abortion is permitted only to save the life of the woman.

“By denying women the right to reproductive health, the Constitution would have ended up criminalising and stigmatising innocent women,” says Prof Karanja. He says the scenario is bound to worsen as more women will troop to quacks’ dens for cheap services. “Every one has a right to life.

We need to prevent women from landing into such dangerous clinics,” he says. Winfred Lichuma, Chair Kenya National Human Rights Commission argues that women lack the right to access quality reproductive healthcare services.

“Most laws inherited from colonial masters have been amended to allow for abortion on request,” she said, adding that consequently, countries spent huge resources to treat women from unsafe abortion complications.

A study carried out by – Ipas, (an organisation that protects women’s health and reproductive rights) Health ministry, Kenya Medical Association (KMA) and the Federation of Women Lawyers FIDA-K) gives a global picture of the problem.

Worldwide, about 20 million unsafe abortions or the procedure to terminate an unwanted pregnancy is often performed by unskilled persons, performed in a situation without minimal medical standards or both, are performed annually. Kenya uses about Sh18.4 million to treat incomplete abortions, says the study done in public hospitals. The study also indicates women seek abortion for several reasons.

Married women are often reluctant to conceive because of the age of a young child. Unmarried women fear being stigmatised by family and peers. Other reasons include uncertainty of the partner’ future intentions, insistence by a partner or husband that the woman was not ready, and objection by a partner or husband to the use of contraceptives.

Content producer at Kenya Health User Generator ( K-HUG0, Rose Odengo, says Kenya adopted a new constitution that permits abortion when there is need, in the opinion of a trained health professional, for emergency treatment; if the life or health of the woman is in danger; or if it is permitted under any other written law.

“Previously, abortion was only permitted to protect a woman’s life. To date, it is unclear how widely the new legal status of abortion is understood or being implemented,” says Odengo.

She further says sections of the penal code have not been revised to reflect the language in the new Constitution; thus, many medical providers may be reluctant to perform abortions for fear of legal consequences.”

She regrets that despite legal restrictions and the medical risks associated with clandestine procedures, Kenyan women obtain abortions from a wide range of providers, including doctors at private clinics, midwives, traditional herbalists and other untrained providers. Besides, some women induce abortion themselves.

Unsafe abortion methods include inserting foreign objects into the cervix or uterus, overdosing on various drugs, ingesting harmful substances, engaging in extreme physical exertion and roughly applying pressure to the abdomen.

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