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Thursday, August 17, 2017

What it is like to have unsafe abortion

False doctor
False doctor

Close to 21,000 Kenyan women end up in hospitals every year, with complications of unsafe abortions.

Some of them succumb. But apart from physical injuries, survivors endure years of emotional and psychological trauma, yet they cannot talk about it.

Talk on abortion remains highly emotive and stigmatised, but counsellors say silence is not golden. It can kill.

Which is why some community groups in Western Kenya now encourage women — and men — to freely share their unsafe abortion experiences.

Some find closure after releasing emotions bottled up for close to 40 years. Others boil over with rage, reliving moments when quacks raped them before helping them.

Samson Wekesa says he's haunted by fresh memories of a 14-year-old girl raped by her father but was denied abortion because police said that would kill the evidence.

“The man chased away his wife in September last year. He rented one room and stayed there with the children: a girl aged 14, another girl five years old, and a nine-year-old boy.

“He started sleeping with his elder daughter and eventually impregnated her.

I asked the boy what happens at night. He said his father and sister sleep together on the same bed and make a lot of noise.”

Wekesa, a sub chief, says the man is a cobbler and has since run away.

The extended family demanded the pregnancy be terminated. But the police opposed it.

“The police accused the grandfather of planning to kill the evidence, and they arrested him. I intervened. I told the sergeant to let the girl abort because this pregnancy is from the father and it is an abomination. He refused.”

“Eventually the girl gave birth in Kericho, in a relative’s house and abandoned the child. I do not know where the newborn is. The father is still at large, we are still looking for him.”

MATERNAL DEATHS

The community groups met recently through the help of Ipas, a reproductive health and rights lobby that works to reduce maternal deaths, including those that arise from unsafe abortion.

The villagers received counselling to deal with the psychological and emotional trauma from rape and rejection.

A national study on the magnitude of unsafe abortion, titled Incidence and Complications of Unsafe Abortion in Kenya, estimates that 464,690 induced abortions occurred in Kenya in 2012.

An estimated 119,912 women received care for complications from unsafe abortions, such as organ or systems failure, shock, and in some instances these complications led to death.

The study was published by the Health ministry in 2013. It also found that 48 per cent of those who sought post-abortion care after unsafe abortion were women aged less than 25 years, while 17 per cent were teenagers aged 10-19 years.

This means that a fifth of all pregnancies in Kenya are terminated through unsafe abortion.

Eunice Wafula, a 50-year-old primary school head teacher, found herself in the predicament in 2010.

She fell pregnant and confronted the reality every mother-to-be dreads: giving birth to a child who would die early because of a genetic condition.

She suspects that both her and the husband are carriers of sickle cell traits, because all their two children were born with sickle cell.

They died one after the other.

“In 2010, I got pregnant but my husband insisted we have to abort. There was no point giving birth to a child who was just going to die,” she says.

She says although they remain childless, they are loving parents and did what they felt was best.

Eunice visited a private ‘doctor’ in Kakamega, who demanded Sh5,000. She took a loan and paid the fee.

“He placed my feet apart and thrust metal rods into my private parts. It was very painful. He didn’t even remove everything. After a month, chunks of smelly blood used to come out of my body. I was very sick and went to a government hospital. They did Manual Vacuum Aspiration (MVA). Now I’m fine but I did not have any more children.”

Eunice says no one can comprehend the sheer agony and complexity of making such a decision until faced with it yourself.

WHAT THE LAW SAYS

The constitution provides for grounds under which abortion is permitted. These grounds are contained under Article 26 (4), which provides that “abortion is not permitted unless, in the opinion of a trained health professional, there is need for emergency treatment, or the life or health of the mother is in danger, or if permitted by any other written law.”

Kenya is also a signatory to international treaties that seek to end unsafe abortion.

The World Health Organisation defines health as a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.

Lydia Amolo, a counsellor who works with some of the groups in Kakamega, says many village women still lose lives to unsafe abortion.

She encourages survivors to speak out.

“Unsafe abortion is killing our women and when we speak, we also advise those seeking such services the right place to go,” she says.

Rachel Awuor, a 55-year-old grandmother, had bottled up her emotions for 37 years.

She sought abortion from a quack who raped her, before terminating the pregnancy so crudely he nearly killed her.

“It was in 1980, when I ran away from home (in Western Kenya) to Mombasa and got pregnant there. My dad was a very stern man. I was 18 years old and those days, only people 30 years and above would get contraception,” she explains.

“A lady friend took me to a man who claimed to be a doctor. But he demanded sex before helping me.”

Awuor gave in as long as the doctor would terminate the pregnancy.

The “doctor” then whipped out an object that resembled a spoon. “He started forcing it into my private parts. Every part of my body was aching,” she says.

“I bled for three months, and one day something dry came out. Then I bled even more. I thought I was about to die. But God was merciful to me. I’m glad there’s safe abortion these days.”

Nowadays, Awuor openly talks openly with her children about termination of pregnancy.

“I tell them if one is not comfortable with a pregnancy they have a right to abort,” she says.

Another woman says a quack nearly killed her by abandoning a plastic straw inside her private parts to induce abortion.

Nancy, now 42, shared her experience for the first time after more than 10 years of silence.

Her husband, a police officer, was charged with manslaughter and denied bail after an operation went chaotic and a civilian lost his life.

The trial was long and exhausting. She ran out of financial support to follow up the case. The husband's parents did little to support her.

“I moved from office to office seeking help. I found a kind officer who offered to support me with some money for transport, to enable me attend hearings.”

However, the officer soon started demanding sex before helping her. Her husband was later jailed for three years, but she also fell pregnant.

“I was shocked. What would my husband say when he’s released?” A teacher at the school led her to a “doctor” who charged Sh2,000 for abortion.

“He then stretched my legs apart and inserted some things inside my private parts. After several days I felt sickly; It felt like malaria. Then I started bleeding.”

“One day as I bled heavily, a straw for drinking soda came out of my private parts. I said God loves me because I survived.”

“My husband was finally freed and now lives with me. Both my two children are now in high school. But I cannot get pregnant again; my uterus was messed up with.”

MINISTRY GUIDELINES

In September 2012, the Health ministry published principles known as “Standards and Guidelines for Reducing Morbidity and Mortality from Unsafe Abortion in Kenya.”

They were meant to standardise and improve the knowledge and skills of health care workers to prevent and manage complications associated with abortion and miscarriage.

Former Medical Services director Dr Francis Kimani withdrew them hastily in December 2013, leaving health care professionals without proper guidance.

The guidelines could have benefited Susan, a 20-year-old college student who was raped by her biology teacher during the 2014 KCSE exam.

He was a “nice” teacher, always revising together with the girls before exams.

But one evening, he requested Susan to take some books to his house, within the staff quarters. He followed her behind.

He then asked Susan to linger in the house longer as he advised her how to succeed in life.

“He was sad that this would be the last day we met, because after the exam we’d be going home. He told me how he loved me. He got closer to me and said how he would miss me. He started caressing me. He told me if I shouted he would beat me and the head teacher would hear it. We had sex.”

Susan realised she was pregnant in February 2015, when the KCSE results were announced. She decided to abort.

“So I took concentrated tea leaves, I also took Jik, a bleach. Nothing happened.”

She went to a woman who gave her some bitter herbs but this did not help. “She told me that maybe the man who impregnated me spoke evil things about my pregnancy that’s why it didn’t abort.”

Susan was finally linked to a doctor who gave her two pills. After two days, she bled heavily. It was done.

“When I returned to the hospital, the doctor gave me contraceptives. He said I needed them so that I do not return for abortion. Nowadays, I practise safe sex. I always share my experience to help other people.”

Amolo, the counsellor, says a woman or girl would do anything to terminate an unplanned pregnancy, regardless of the possible health consequences.

She explains this is why women and young girls go to quacks or resort to crude herbs, chemicals and objects.

“As long as there are no clear standards and guidelines that enable health workers to provide comprehensive abortion care, deaths related to unsafe abortion are likely to rise,” she says.

(Names and some locations have been changed to protect privacy)


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