A 33-year-old woman from Mombasa who is struggling with recurrent miscarriage believes a crude abortion she procured four years ago may have ruined her life.
Fatma Juma says she procured an illegal abortion at a small clinic in Mombasa because her new employer did not hire pregnant women.
“I hustled for four years without getting any better job. It was even disheartening that the places I secured employment male bosses would make sexual advances, but I refused. This would eventually cost me jobs,” she says.
She eventually got a new job with a bank in Diani in 2011, but says her female boss was harsh toward female employees.
“I was told that the institution does not employ a lady who is already pregnant. I should get pregnant at least after one year in the institution,” says Fatma.
“I was two months pregnant and I opted to abort so that I do not lose the well-paying job, which I looked for over many years.”
After advice from close friends, she visited a small clinic in Mombasa. She was never counselled and the “doctor” proceeded to conduct an abortion. Fatma bled for about one month after the ordeal.
She eventually received some medication which stopped the bleeding.
“I got the job and after sometime I married my man of my dream at a church wedding. However, after several months, it became apparent I cannot carry pregnancy to term,” she says.
She has conceived about four times but lost each pregnancy after two to three months.
“My husband divorced me after three years in marriage because I could not bear him a kid. I still regret the abortion I procured while looking for employment,” she says.
The Constitution allows safe abortion or termination of pregnancy when a woman’s life is in danger.
However, the Ministry of Health in 2012 crafted the guidelines that would guide the process but suspended them in 2014. The regulations guided medics how to receive women like Fatma and in cases where the life is not in danger, counsel against abortion.
At Coast General Hospital, the biggest referral hospital in the region, doctors say they receive many cases of post-abortion complications.
Deputy Administrator at the hospital, Dr Victor Njom, says they receive cases from all the six counties of the coast – Mombasa, Kwale, Taita Taveta, Lamu, Tana River and Kilifi.
“We receive very many incidents here, but you see, many of the cases are those that were procured outside there and the women are brought in with complications,” he says.
“Currently, I do not have the exact number of cases handled, but I can confirm there are so many and we have to deal with them so as to save lives.”
The hospital can only officer post-abortion care, which is legal in Kenya.
In earlier interview with Kenya’s the Star newspaper, Njom said a woman who is brought to the hospital after trying to induce an abortion undergoes a Manual Vacuum Aspiration to complete the process.
The MVA is a process that removes uterine contents through the cervix.
It is normally used to induce an abortion, or as a therapeutic procedure after a miscarriage or to obtain a sample for endometrial biopsy.
Unless the uterus remains are cleared from the woman’s womb, she might acquire infections that could lead to infertility.
Experts say the high rates of back-street abortions clearly underscore the need to improve and expand access to effective contraceptive services.
This would ensure that women also receive comprehensive information about how to use their chosen method consistently and correctly.
“Investing in modern contraceptive methods would be far less costly to women and society than the costs of managing the outcomes of unintended pregnancies,” says Dr Evans Waweru, a gynecologist in Nairobi.
However, he says unintended pregnancies also occur among women using contraceptive methods who experience method failure or those who become pregnant as a result of rape.
“Women may also seek abortion for other reasons related to their health or other circumstances. In such situations, they should have access to safe abortion services to the full extent of the law. Where safe abortion services are not available, women may resort to an unsafe procedure and be at risk of severe complications and possibly death,” he says.
The “Standards and Guidelines for Reducing Morbidity and Mortality from Unsafe Abortion in Kenya”, which the ministry suspended, direct health workers on how to assess the necessity and terminate pregnancies for health reasons.
Then director of medical services Nicholas Muraguri withdrew the regulations saying the Constitution was clear that abortion on demand was illegal.
Reproductive health lobbies have since then been lobbying the ministry to reinstate the guidelines.
Nairobi-based Centre for Reproductive Rights (CRR) mid May led 150 participants from a community and policy dialogue on unsafe abortion meeting in Nairobi to request the State to reinstate the guidelines.
Well-known obstetricians Dr John Nyamu and Dr Nehemiah Kimathi also signed the final communique to support the demand.
They said that unsafe abortion remains one of the five leading causes of maternal morbidity and mortality in Kenya with close to half a million women undergoing unsafe abortions yearly.
The participants noted that although the Constitution conditionally permits termination of pregnancy, the necessary legal and policy framework is yet to be put in place to give effect to the implementation of Articles 26(4) and 43 (1) (2) (3).
“Majority of the women who procure unsafe abortion are young and poor and end up with serious health complications or dead,” the participants said in a communique.
“Factors that push women to seek unsafe abortion services such as lack of information, comprehensive sexuality education, failure to access quality and affordable contraceptives of their choice are yet to be addressed.”
They also petitioned Parliament to enact laws and review other prohibitive laws and policies around abortion to allow for the delivery of safe abortion services.
“We recommend to state and non-state actors to increase budgetary allocation to contraceptives, post abortion care, safe abortion and comprehensive sexuality education services including comprehensive post-rape care services in Kenya,” they said.
Last year, CRR filed a petition at the High Court demanding that the government upholds reproductive health rights for women.
The case was filed against the Attorney General, the Ministry of Health and the Director of Medical Services on behalf of the Federation of Women Lawyers (FIDA) Kenya, two community human rights mobilisers, and an adolescent rape survivor suffering from kidney failure and other health complications due to an unsafe abortion.
Says Evelyne Opondo, the regional director for Africa at CRR:
“The Kenyan government is allowing thousands of women in Kenya to needlessly die or suffer severe complications every year due to unsafe abortion, and it must be held accountable. Denying a woman access to the critical health care she needs can lead to devastating consequences in her life, her family, her community, and Kenyan society as a whole.”
One of the petitioners was the legal guardian of a 15-year-old girl who was impregnated by a rapist and sought an unsafe abortion.
She developed complications, leading to chronic kidney disease. She now receives dialysis regularly until she can get a kidney transplant.
Fatma, who requested us not to use her real name or picture, says she is lucky she has not experienced such complications. Research shows recurrent miscarriage can eventually be managed.
“I should not have procured the abortion, but the problem is that in those (backstreet) clinics, they don’t even try to counsel you. They just want money,” she says.
