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FEATURE | winter 2008

Dying in the Backstreets
Too often, Kenyan women victimized by unsafe abortions end up in a last-chance Nairobi 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, wire).

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 feeling clean.

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.