Unsurprisingly, abortion is back in the news again. It remains one of the most controversial and divisive topics of conversations in the country.

While this may be true, the fact remains that each day, women and girls are dying because we are unable to have an honest, open conversation without fear of retaliation.

Recently, the story of activist Caroline Mwatha came into the spotlight after she was found dead from complications caused by a botched abortion. Whether it was forced or not remains to be determined.

Mwatha, who campaigned against police brutality experienced by those in custody, was discovered in a city morgue. Post-mortem results found that she had died of excess bleeding and a ruptured uterus. Six people have been arrested in relation to her death.

Unfortunately, Mwatha’s story is neither unique, nor will it be the last. For as long as Kenya, its government and its people continue to have the same restricted beliefs towards abortions, girls will continue to die.

Evelyne Opondo, the Africa director of the Centre for Reproductive Health, said, “Caroline did not have to die. Her death was preventable. She is just one of so many women who are killed needlessly due to unsafe abortion in clinics run by ‘quacks’.”

Every year, 2,600 women die from unsafe abortions. That’s seven women dying daily, accounting for 35 per cent of maternal mortality. The global rate is 13 per cent.

It was found that among the nearly 500,000 induced abortions, over 120,000 women were hospitalised for complications from unsafe abortions each year. Some 45 per cent of those who had severe complications were under the age of 19.

“This is a moment for the country to reflect. Our Constitution provides limited access to abortion, but we are not responding to the realities for many women, and neither is our law. It’s a conversation we need to start in Kenya.”

1893049 - Foetuses collected from dustbins in varsities as stigma, illegality propel unsafe abortions

Joshua Ochieng, the husband of activist Caroline Mwatha, with his mother-in-law Anna Kathathi at Dandora police station on February 1, 2019. /ENOS TECHE

LAW VS REALITY

According to Kenya’s 2010 Constitution, abortions are not permitted, unless in the opinion of a trained health professional, there is a need for emergency treatment, or the life or health of the mother is in danger, or if permitted by any other written law.

To conduct an abortion, the doctor or nurse must be specially trained. Not all health care professionals are qualified to provide them, but nevertheless, the service is available for those who fall into the requirements made by the current law.

Despite this, the World Health Organisation has found that Middle and Eastern Africa have the highest global rate of unsafe abortions at 36 per 1,000 women. In Kenya, unsafe abortions are one of the major causes of maternal deaths.

“An unsafe abortion is defined as a procedure for terminating an unwanted pregnancy, either by persons lacking the necessary skills or in an environment lacking minimal medical standards or both,” says Dr Caroline Tatua, a senior health systems adviser.

A study by the Kenya National Commission on Human Rights found that unsafe abortions are particularly affecting younger girls, especially those in universities and technical colleges.

These are areas where girls are the most vulnerable to the stigmas of unwanted pregnancies and would perhaps feel the greatest need to seek unsafe options. This may be because they are unaware of the help that is available or that they are unable to go.

One University of Nairobi student said, “Foetuses are collected from dustbins in universities. Most girls do not seek safe abortion services, including post-abortion care, as they fear being known to have aborted.”

And while unsafe abortions can lead to a number of complications and even death, this is not acting as an adequate deterrent for the thousands of desperate girls.

DISTRESSING EFFECTS

Take Sophie*, who lost her sister to an unsafe abortion after she bled to death in her home. Despite that, when she became pregnant at 16, she found herself pondering the same difficult decision as her sister.

“I was scared and I didn’t know what to do. I thought they would cut me and I would die. But I didn’t know who to talk to or where to go,” she said.

Death is not the only consequence of unsafe abortions that women and girls may face. For those who survive, they are susceptible to a myriad of health complications, from excessive bleeding, scar tissue build-up, and in some cases, infertility.

One victim who was raped found herself in this situation after seeking help from a quack doctor.

“I confided in a friend and we found someone who gave me three pills. Two I swallowed and one I inserted in my vagina,” she said.

“Unfortunately this did not work, so I went to another woman who inserted something inside me. I think it was a hanger. I remember the pain, I was bleeding so much, they had to take me to hospital.”

Luckily, she survived. However, due to the manner in which she was treated, she contracted an infection and had to have her entire uterus removed. Today, she is unable to have her own children.

The psychological effects of abortions are important to take into consideration. While the procedure is largely a physical one, the choice to have an abortion is a deeply personal and emotional one for many women and girls.

Depression, withdrawal from relationships, loss of self-esteem, as well as feelings of guilt and shame are often emotions that those who abort may experience.

The procedure is one that has the power to permanently affect the mental health of an individual. Through the proper and legal route, post-abortion care is always provided. This does not only include the physical health of the woman but their emotional and psychological health, too.

PSYCHOLOGICAL DISORDERS

Women and girls who have unsafe abortions are not afforded the same services. Because of the danger faced by those who conduct abortions under the table, they are unwilling to have any extended contact with their customers, leaving the girls to deal with the after-effects themselves.

Prof Phillip Ney, a Canadian psychiatrist and pioneer in the research on psychological disorders following abortion and child abuse, studied the link between abuse and abortion.

He found that having an abortion could reduce the instinctive inhibition on the expression of wild rage at a child one is responsible for. He also found that not only can the guilt and loss of self-esteem be transferred to the next child, but that the abortion of the first child can in fact curtail the development of a mother-child bond, blocking the normal expression of mothering functions.

Without the proper after-care provided by trained health professionals, without properly addressing their experience, women and girls who undergo unsafe abortions may feel its effects far into their lives and the lives of any future children they have.

Women and girls in Kenya are having abortions. That much is a fact. However, what is unnecessary is that they are dying from them. The moral or religious arguments raised will not change this, and by restricting the services and by making it harder for Kenyans to talk about it, they will continue to die.

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