Unsafe abortion in Kenya: Poor women, teenagers most affected

15.02.2010 Women with little or no source of income and teenagers account for most cases of unsafe abortions in public hospitals. Doctors say this group is disadvantaged largely due to lack of access to reproductive health services.

Dr Njoroge Waithaka, the chairman of the Kenya Obstetrical and Gynaecological Society, says rich women have many options for terminating a pregnancy.

"In Kenya today, women leaders who want to terminate pregnancies have it easy. They just drive to leading private hospitals, consult a gynaecologist, undergo counselling and the abortion is done in no time, although at a high cost," says Waithaka.

On the other hand, poor women depend on quacks in backstreet clinics, risking their lives.

Dr Sarah Onyango, the regional director of Planned Parenthood, also accuses leaders of double standards, saying well-heeled women have been easily procuring abortions abroad while making it difficult for the poor to access similar services locally.

"I know of many wealthy women who have been purchasing air tickets to South Africa and even having abortions done free of charge there. But what of the poor girl who cannot afford the air ticket?" Onyango asks. In South Africa, a woman can procure an abortion if she is less than 12 weeks pregnant.

Waithaka says Kenyatta National Hospital currently receives an average of 10 patients with abortion-related complications daily. "Both young and old, most come here with perforated intestines and serious injuries to the uterus, bladder, and rectum, but we do our very best to save their lives," he says.

Waithaka says even after developing complications most women who have procured unsafe abortions fear visiting hospitals for proper medical attention. They will only do so when it is too late and the situation has worsened.

"At times that hook may go to the right place but because this is a trial and error method, mostly, it will either tear the stool passage, the bladder or the uterus," says the Kenya Obstetrical and Gynaecological Society chairman.

Statistics from Kenyatta National Hospital indicate that at least 10 women are received at the facility each day after developing complications.

"These figures might seem small but if we take into account all other hospitals, they could be appalling," says Waithaka.

300,000 abortions

The WHO reports that worldwide, nearly 42 million women abort annually. About 20 million of them —19 million in developing countries — do so at backstreet clinics. Of these abortions, 300,000 take place in Kenya, according to WHO.

Waithaka blames this on the restrictive laws on abortion and poverty.

The new constitution could portend harder times for women after the Parliamentary Select Committee inserted an even more restrictive clause in the draft saying life starts at birth.

Currently, abortion is permissible under the Penal Code if a woman has been raped, conceives in an incestuous relationship or if she is of unsound mind. But reproductive health specialist Joachim Osur argues that people do not abort because it is legal or illegal. "What worries doctors is the increase in unsafe abortions that lead to death. Entrenching this issue in the Constitution is like tying the hands of a doctor, who would have saved at least one life when both are in danger," says Dr Osur. Despite the provisions in the law, desperate women continue to self-induce abortions or obtain clandestine abortions carried out by untrained persons under poor hygienic conditions.

"Abortion is here to stay whether illegal or legal. The big question is how safe is it," said Waithaka.

Complications

WHO says about 67,000 women die annually due to complications of unsafe abortion, 17,600 of them in East Africa. Of all the women admitted to KNH due to abortion-related complications, Waithaka says half of them have severe complications, easily leading to death.

WHO says the treatment of abortion-related complications in public hospitals consumes a lot of resources, including hospital beds, blood supply, medications, and often operating theatres, anaesthesia and medical specialists.

Thus, the consequences of unsafe abortion place great demands on the scarce clinical, material and ﬁnancial resources of the hospitals, compromising other emergency services.

Major physiological, ﬁnancial and emotional costs are also incurred by the women who undergo unsafe abortion. "That bill is being footed and might continue being footed by the taxpayers if we adopt the new constitution," said Waithaka.

WHO estimates the combined impact of mortality and morbidity due to unsafe abortion at 65,000 to 70,000 deaths and close to ﬁve million women with temporary or permanent disability due to unsafe abortion.

Source: K. Kiberenge and J. Kiarie, The standard, 12 February 2010