Despite myriad targets and 17 inter-related goals, the 2030 Sustainable Development agenda has, at its core, a single prevailing ambition: to invest wisely in ensuring that no one is left behind in the race to achieve growth. And central to this ambition is keeping people of all backgrounds, ages and creeds, healthy, alive and able to contribute productively to their homes, their communities and their societies as a whole.
So it makes sense that keeping women healthy and empowered and ultimately productive is an essential driver of what constitutes success in the Sustainable Development Goals (SDGs); in fact, improving women’s health is fundamental to the achievement of two of the first six SDGs.
Goal 3’s first target is to reduce the global maternal mortality rate to fewer than 70 deaths per 100,000 live births, while also aiming to ensure universal access to sexual and reproductive health-care services, including family planning, information, and education. Goal 5 includes a target that mandates universal access to sexual and reproductive health and rights.
Against this backdrop of global goals and ambitious targets, however, is the stark reality that a lack of education, a lack of access, and a lack of options means for far too many women, especially those who have just entered their childbearing years: an unacceptably high rate of unsafe abortion.
The World Health Organization definition of unsafe abortion lays out the real danger that these terminations pose to women’s lives. An unsafe abortion is either performed in an environment lacking minimal medical standards or by a person lacking the necessary skills… or both. And it is that lack of safety that yields oft-fatal consequences for the women and girls most in need of options.
A study conducted by APHRC in 2012 with the Ministry of Health found that nearly 500,000 unsafe abortions were performed annually in Kenya. This is a conservative estimate, by many accounts, as these procedures are shrouded in secrecy due to shame, guilt, and fear on the part of the recipients and providers.
But because of that shame, and that fear, many of these procedures end up with consequences that necessitate a trip to the hospital. And it’s there that the trouble can start, and the price tag can escalate. In a country like Kenya, with already limited resources to provide health care to more than 48 million people, some 42% of whom live below the global poverty line of US$2 per day, the need to channel limited resources to treat complications from dangerous procedures pokes an ever-greater number of holes into an already fragile system.
In a follow-on to our 2012 study, APHRC, the Ministry of Health and Ipas, aimed to unpack the costs to the public health system of treating complications of unsafe abortion.
What we found – in terms of the costs of human resources devoted to patient treatment and care, medication and supplies – was staggering. But more than that, it underscores the need for a new systematic approach built on strong political will that prioritizes women’s lives and equitable access to health care for all.
It takes an average of 7.4 hours of health care personnel time at the nurse or medical officer level to treat moderate complications from unsafe abortions, for an average cost of US$58 per patient seen. For the most severe cases, that cost would nearly double to $108 per patient seen: roughly three times the amount of money that the Kenyan government budgets annually for each person using public health services.
Overall, our estimates suggest that the Kenyan government spends a minimum of $5 million every year treating complications from unsafe abortion.
Imagine what that $5 million could do if it was invested in a structure of service delivery, education and awareness about sexual and reproductive health that ensures access to adolescents and women, and availability of quality providers at all levels of care.
Imagine what that $5 million could do if it supported wider access to the full range of modern family planning methods currently on the market, as part of quality post-abortion care and counseling.
Imagine what that $5 million could do if it strengthened government institutions with comprehensive mandates to protect women’s health, helped reduce the financial and economic burden of treating such complications and ensuring that every pregnancy was a wanted pregnancy.
Today, together with our partners at the Ministry of Health and Ipas, we are proud to release this study in the hopes that it can be a tool to reduce preventable maternal deaths, dramatically improve reproductive health, and champion Kenya’s efforts to achieve the SDGs.
One of the report’s key recommendations is to tackle the root causes of unsafe abortion by expanding allocations for preventing unintended pregnancy.
“I want to see increased investments for scaling quality reproductive health services,” Kenya’s Director of Medical Services Dr. Jackson Kioko urged government leadership during the launch event.
County officials were requested to review the findings of the report in detail, on a facility-by-facility basis. “Our focus remains on implementing evidence-based interventions,” Dr. Kioko said.
APHRC stands with the government of Kenya to maintain this evidence-informed approach to policymaking and remains committed to ensuring that our evidence can be transformative in the lives of Kenyans and ensure that no one is left behind, or left unsafe.