|FEATURE | winter 2008
Too often, Kenyan women
victimized by unsafe
abortions end up in a
hospital—if they’re lucky.
Blame U.S. policies, not
just local law and culture.
Wangui already had give birth to
four children, but could barely put bread on
the table for them, being a peasant farmer
with a husband who earns just $1 a day as a
laborer. When she learned she was pregnant again, she knew
her family couldn’t afford another child.
So, following a friend’s advice, she drank a boiled concoction
made from various trees to abort the fetus. When it wasn’t expelled
after a couple of days, she also took several doses of the antimalaria
drug Malariaquin—which rendered her unconscious.
Wangui (not her real name) ended up where so many other
Kenyan women do following botched abortions—in Ward 1D,
the maternity ward of Kenyatta National Hospital in Nairobi—
where she required an urgent blood transfusion. Lying in the
hospital bed, she looked traumatized.
Abortion is illegal in Kenya, with no Exceptions
unless the pregnant woman’s life is in danger—a
loophole that some compassionate doctors interpret liberally,
especially because they know that desperate women
who cannot afford a safe, if illegal, abortion will risk their
lives to abort anyway. The riskier self-induction abortion
methods include drinking highly concentrated teas, taking
an overdose of malaria drugs, douching with poisonous
and caustic substances, inflicting physical abuse
(blows to the abdomen, jumping from heights) and inserting
foreign objects into their uterus (sticks, knitting needles,
Unintended pregnancies are common in Kenya—a
2003 health survey in the country showed that 20 percent
of births were unintended and another 25 percent mistimed.
Women may lack access to, or money for, contraceptives
(including emergency contraception). They may
have been raped or been victims of incest. They may fear
social ostracism if they’re single, hope to continue their
education, or suffer from maternal exhaustion caused by
births clustered too closely together.
“The notion that only single or poor women terminate
a pregnancy is a fallacy,” says Dr. Solomon Orero, a
Kenyan physician who has long worked to provide safe
abortions for women in his country (see “The Price of
Silence” in Ms., Summer 2003). “Emerging evidence
shows that more married women and working women terminate
pregnancies for all sorts of reasons.”
An estimated 300,000 abortions are carried out in the
country each year, with the unsafe procedures causing a
shocking toll. In public hospitals such as Kenyatta National
alone, about 20,000 Kenyan women are treated each year
for abortion-related complications. Nearly two-thirds of
the beds in Ward 1D are occupied by those patients, who
suffer everything from excessive bleeding to injured organs
to sepsis. Globally, 13 percent of maternal deaths result
from abortion-related complications, but in Kenya it’s
as high as 40 percent. One in 39 Kenyan women will die
during pregnancy or in childbirth.
Women’s-rights groups in Kenya, such as the Federation
of Women Lawyers-Kenya (FIDA Kenya), have been
pushing for a new national law on reproductive rights, as well as supporting a continental protocol on the rights of
African women and a patients’ bill of rights. But they’re
not helped in their efforts to improve reproductive health
care by the U.S. global gag rule (see page 42), which has
forced a number of clinics to turn down U.S. funds rather
than stop discussing abortion. Three clinics of the Family
Planning Association of Kenya (an affiliate of the International
Planned Parenthood Federation) and two clinics of
Marie Stopes International (the U.K.-based reproductive health
NGO) have been closed for loss of funds, according
to a 2004 report from the Center for Reproductive
Health Research and Policy in San Francisco.
Salma was 15 years old when she was gang-raped by five
men over the course of one horrific night. Coming from a strict
Muslim family, she could not tell her father or stepmother for
fear they would reject her. She simply went home, showered and
wept. She would take many showers in the next week, never
When she learned that she was pregnant, she feared rejection
by her family and mosque if anyone knew. So she took a home
remedy of boiled tea leaves, which worked too well—the bleeding
from her uterus wouldn’t stop. Fortunately a local clinic was
able to stanch it; she was much luckier than other young women
who have died from such bleeding.
The stigma attached to abortion is strong in
Kenya, and it even carries over onto Ward 1D. Some of
the attendants refer to the women being treated as killers.
One attendant says to a patient in Swahili, “Kwa nini
unaua mtotto, si ungezaa, nani alikutuma kumtafuta…”
(Why are you killing a baby? Why can’t you just give
birth?) The patient, lying on her bed in agony, grimaces
in even more pain from the words.
Maternity care in general is problematic in Kenya’s public
hospitals. The 2007 report “Failure to Deliver,” produced by
FIDA Kenya and the Center for Reproductive Rights in
New York, pointed out that public health facilities often suffer
from lack of supplies and congestion. Claris Ogangah-
Onyango, legal counsel for FIDA Kenya, points out the
obvious: When the majority of beds in maternity hospitals
are occupied by women with post-abortion complications,
there is not enough space and care for other women.
“The government is mostly concerned with postabortion
care,” she says, “and most funding goes to that. But
they’re not doing anything to stop [unsafe] abortions."
Rose is a 25-year-old law student at the University of Nairobi.
She wasn’t prepared to become a mother yet, so when she learned
she was pregnant she decided to terminate. But since she couldn’t
afford $100 for a safe abortion, she visited what Kenyans call a
quack in the Nairobi neighborhood of Mathare North, adjacent
to the teeming Mathare slum. A hollow object was inserted into
her uterus and kept there for several hours; then other devices
were inserted to complete the abortion.
Two days later, Rose ended up in Ward 1D, and her perforated
uterus was removed to save her life. Even when she becomes
ready for motherhood, she will no longer be able to give birth.
KENYA’S GOVERNMENT DOESN’T PROVIDE NEARLY
enough funding for reproductive health, says Ogangah-
Onyango: “The government is concentrating more on
children’s health than on women’s health.” Although it’s
committed to providing free maternal health care at public
hospitals for indigent women, it hasn’t yet offered
guidelines on how the policy would be carried out.
“What has really affected our work in Kenya is that we
have very few women in our parliament [just 18 of 222
members],” she says. “When we take our issues to the
government, they are blocked. FIDA and other women’s
organizations have approached the candidates for the next
parliament to sign a document that they will support gender-
friendly bills. Putting more women in government
would make a big difference.”
Ogangah-Onyango also hopes that former Health
Minister Charity Ngilu, who was able to get closed health
centers back into operation, will return to power. “If her
party comes into government, we hope they will appoint
her minister of health so she can continue what she was
doing,” she says.
And what can women in the U.S. do to help their
Kenyan sisters? “Lobby for change in the policies that
govern reproductive health,” she says. U.S. women can
also support the efforts of groups such as FIDA Kenya
(www.fidakenya.org), which is now part of the Reproductive
Health and Rights Alliance in Kenya.
Without changes being made, in both laws and attitudes,
this scene will remain all too common: Another
Kenyan woman has a backstreet abortion, nearly bleeds to death
and ends up in Ward 1D.
MARY KATHOMI RIUNGU is a freelance journalist and actor
based in Nairobi.