http://www.irishtimes.com/newspaper/health/2011/1108/1224307199241.html

The Irish Times – Tuesday, November 8, 2011

Abortion: a class issue

Following the creation of a new constitution last year, the abortion issue in Kenya is heating up, writes JODY CLARKE SHARON

OKELLO (17) grips her stomach, writhing with agony from the surgery that removed one of her fallopian tubes. The bleeding has eased, but the pain has not, filling her one-room house in Kibera slum with faint cries on the days it decides to swell up inside her. “I got pregnant but my boyfriend ran away and my mother was supporting my elder sister through school by herself. She couldn’t afford to take on another mouth to feed, so I felt like I had no choice.” Okello came to the decision by herself, taking a cocktail of pills recommended by a friend. A day later, she collapsed at the door of the house she shares with her mother, blood streaming down her legs. She survived after an emergency operation, but is one of the lucky ones. Some 21,000 Kenyan women are hospitalised every year because of complications from unsafe abortions. According to Kenya’s Obstetrical and Gynaecological Society, 2,600 die from procedures carried out by untrained “professionals” in back alleys and people’s homes, well away from proper health facilities where women can be reported to the police and jailed for up to 14 years if convicted of terminating a pregnancy. Many are reported by neighbours, with some women believed to have died in police cells as they bled to death. It is, says Muhtoni Ndungu of the Reproductive Health and Rights Alliance, a problem that affects only the poor. People from all backgrounds, young and old, can become pregnant when they least expect it, she says, but it is only those with no money who are left to deal with the worst consequences of using herbs, detergents and drug cocktails to end their pregnancies. Coat hangers and other wires are often used, while another method involves blowing tobacco into a straw inserted into the woman’s uterus.

“Rich people can afford abortions by travelling to South Africa or elsewhere but the poor cannot. This is a class issue. Wealthy women know where to go, making it legal for the rich but not the poor.” The abortion issue is heating up in Kenya. Following the creation of a new constitution last year, women are permitted to procure abortions if their life is in danger. But, according to anti-abortion campaigners, the provision which allows for this was just a means of pushing abortions on demand through the back door. “This is just the first step which means we have to step up our campaign against proponents of abortion who are better funded than us,” says Richard Kakeeto, a lawyer with Human Life International Kenya. Two weeks ago, the Kenya Medical Association held a two-day meeting to discuss the implications of the 2010 constitution on maternal health. It was addressed by Sir David Steel, the man behind Britain’s 1967 Abortion Act, raising concern among many Kenyans that abortions on demand are on the way.

“Those who want abortion say, ‘What other option do women in desperate situations have?’. But this is the wrong question. We need to ask what is driving women to have abortions in the first place. “Abortion in this country is a social issue and we need to form policies to address this. “Give me jobs so that women are not too poor to have children and hospitals to support them, so when someone gets pregnant they don’t feel like they are being condemned to hell.” On this, Ndungu agrees. But she says that another problem is that sex is a taboo subject in Kenya, with no comprehensive sexual education in schools for children.

“More than 40 per cent of births in Kenya are unplanned, and one in four married women has an unmet need for contraceptives. Yet women are ostracised if they have children out of wedlock. So the fact that women are getting abortions should not surprise us.” It’s certainly no surprise, according to gynaecologist Prof Joseph Karanja. Rolling his thumbs behind his desk at Kenyatta National Hospital in Nairobi, he has just stepped off the maternal health ward, where he says 10 out of the 20 or so admissions the unit receives every day are related to complications from unsafe abortions. “I have been here since I was a student and it has been like this the whole way through,” he says. “Women will seek abortions, no matter what the safety issues.”