By Joyce Chimbi, The Star Online
When the Kenya Certificate of Secondary Education results were released in 2013, Teresa Ngure had secured direct admission to one of the public universities.
“I was born and raised in Mathare slums, going to the university was a big achievement, everyone was talking about me,” she says.
But what Ngure would soon find out is that getting into the university was one thing and staying in it, an entirely different story.
“Only six months after admission, I was fighting for my life. I got pregnant and went to a quack who tried to remove the feotus with sharp objects,” she says.
Having bled excessively and requiring urgent blood transfusion, it is nothing short of a miracle that Ngure escaped with her life.
Unfortunately her case is not unique. It is one of many young and older women who get to the hospital starring death in the face.
Dr John Ong’ech, a leading reproductive health specialist in Nairobi says, “not all induced abortions end up in hospitals, only those with extreme complications.”
Perforated uteruses and intestines, bleeding to shock, anemia requiring blood transfusion as well as renal, heart and kidney failure are just a few of the health complications arising from an abortion gone wrong.
The senior obstetrician and gynecologist says that unsafe abortion complications are not just about “removing the products of conception that were not completely removed. You can evacuate but the perforated uterus has to be repaired, or you remove the uterus and it is rotten.”
Like Ngure, post abortion care cases become statistics, while the survivors do what they can to put together the broken pieces of shattered lives, hopes and dreams.
According to a 2012 national survey by the African Population and Health Research Center in collaboration with the Ministry of Health on incidences and complications of unsafe abortions, an estimated 465,000 abortions are induced yearly.
Of these, at least 120,000 women receive post abortion care and as the cases of unsafe abortion increase, so is the controversy around the abortion discourse, diving the country in the middle.
“We are seeing the impact of unsafe abortion and though post abortion care is accessible in nearly all health facilities, it is the extreme cases that are difficult to manage,” Dr Ong’ech explains.
He says that unsafe abortion complications leading to heart, renal or kidney failure can only be managed at Kenyatta National Hospital or the Moi Teaching and Referral Hospital in Eldoret.
“There are no other county hospitals with a dialysis machine or with the capacity to dialyse kidneys so this is how serious the situation is,” he says.
The Constitution states that abortion is not permitted unless in the opinion of a trained health professional, there is need for emergency treatment, or the life or health of the mother is in danger, or if permitted by any other written law.
Many women and young girls confronted with an unwanted pregnancy, in the face of a law that prohibits abortion on demand, put their lives in the hands of abortionists who use crude and unsterilised weapons.
As a result, at least 2,600 deaths occur annually from botched abortions.
Evelyne Opondo of the Center for Reproductive Rights says that among women aged 19 or younger who came to a health facility for post-abortion care, 45 per cent experienced severe complications.
“The country has a national abortion rate of 48 abortions per 1,000 women of reproductive age which is 15 to 49 years,” she says.
Against this backdrop, Jedidah Maina, a reproductive health expert at Trust for Indigenous Culture and Health says there is need for safe abortion when it is necessary and within the law.
But Opondo says there is still a lack of awareness on the legal provisions on abortion among women.
Maina says that while there is, and rightly so, too much focus on safe motherhood “as can be seen through the free maternity and the First Lady’s beyond zero initiatives there is not enough on unsafe abortion, and the cases are on the rise.”
The pro-choice camp which has been pushing for the legalisation of safe abortion claims that this will not only reduce maternal deaths significantly, but slash the governmnet budget for abortion care, by half.
Government statistics show that in every 100,000 live births, 488 women will die giving birth.
Opondo says the absence of guidelines and standards for reducing maternal morbidity and mortality from unsafe abortion is part of the problem.
Dr Ong’ech says while unsafe abortion is a significant contributor to maternal deaths, there is need to think through the abortion debate.
“There is too much focus on medical intervention which can only provide about 20 per cent of the solution, we need to address the root causes of unsafe abortion such as access to contraceptives,” he says.
Dr Ong’ech decries the casualness around sex among young people “it is risky sexual behaviour that we need to address. An unwanted pregnancy is just one outcome, there is HIV, or one could catch Human papilloma virus which can lead to cervical cancer.”
He says as a medical practitioner, “I see many infertility cases, blocked tubes due to sexually transmitted infections.”
“Young people must realise that sex comes with consequences. This way, sex will become synonymous to condoms or family planning,” he says.
Dr Ong’ech says there are significant reproductive health implications of unsafe sex that legalising abortion will not address.
“While unwanted pregnancy can be a crisis, there is no need for young people to have unsafe sex so that they can have an abortion later,” he says.
Dr Ong’ech says there is also need for social support systems for girls with an unwanted pregnancy which they do not want to terminate and this could involve creating services such as rescue homes.
“Empowerment of girls is also key as is poverty reduction to prevent girls from having unsafe sex for money,” he says.
Progress on guidelines:
1. September 2010 – Ministry of Health releases National Guidelines on the Medical Management of Rape/Sexual Violence. The guidelines allow for termination of pregnancy as an option in case of conception. It however requires psychiatric evaluation and recommendation.
2. 2012 – In collaboration with Ministry of Health, African Population and Health Research undertakes the first national survey on incidences and complications of unsafe abortions. The report was released in 2013.
3. In September 2012 -Ministry of Health releases Standard and Guidelines on unsafe abortion.This was towards prevention and management of unsafe abortions to the extent allowed by the Kenyan law.
4. December 3, 2013 – Ministry of Health sends letter withdrawing the standards and guidelines on abortion under unclear circumstances.
5. February 24, 2014 – Ministry of Health issues directive instructing all health workers (public/private/faith-based org) not to participate in any training on safe abortion practices and on the use of the medication abortion.
6. September, 2014 -Jackson Namunya Tali, a nurse, is sentenced to death after he was found guilty of killing Christine Atieno and her unborn baby in a botched abortion.
7. February 6, 2015 – Ministry of health confirms to the Star Newspaper that consultations on withdrawn guidelines are still ongoing with various stakeholders.