Double loss in health must surely mean something

All too often, we read about unwanted pregnancies, it is unfortunate that increasingly we are getting immune to the problems that lead to unnecessary deaths of women and girls in the society.

A local daily recently published a story on how Bomet County led with Kenya Certificate of Primary Education Examination (KCPE) sitting students who were pregnant. Another illustrated how Kilifi, Narok, and Homa Bay Counties lead in teen pregnancies.

The stories silently end with no reflection on the future of the affected girls or how the teenagers would deal with their circumstances. No doubt, majority would end up in early marriages, unsafe abortion, or abandoned to single motherhood with their basic education resulting to meaningless venture in terms of education-led gains as would be other counterparts in urban or affluent environments.

This simple story reflects at individual level to many cases that households in Kenya are dealing with, perhaps with no statistical significance to policy makers and decision makers on women and adolescent reproductive health.

The dropout rate in Kenya is Close to 30% of all the children who enroll in school, and a large percentage of the girls who drop out of school are due to unwanted or early pregnancy – they deal with the spite of the society for circumstances it (society) is not too willing to address.

Studies show that Kenya has a relatively high case-fatality rate of 266 deaths per 100,000 unsafe procedures – most of which results from unplanned pregnancies. In Africa, there are about 6 million cases of unsafe abortion that occur every year.

Unsafe abortion contributes up to 30 percent of maternal deaths in many sub-Saharan countries, and for about 14 percent of maternal deaths on the continent. These deaths have devastating effects to the affected household leading to social and economic vulnerabilities and striking cycle of poverty.

The uncontested truth is that poor people are systematically discriminated in terms of accessing reproductive health services. They have far less options to make choices on issues affecting their health.

Although preventable, the society continues to touch SRH issues with velvet gloves. There is less investment in reproductive health even though it is obvious that healthy people gainfully contribute to a nation’s economic development.

The Abuja declaration was adopted in April of 2001 by the Africa Union member states, many countries are yet to allocate the agreed 15 percent of GDP to health. Allocation for reproductive health is barely known, speaking a lot to governments’ commitment to health.

Burdensome costs

But for countries riddled with debt, high cost of living, unemployment, it would help to ignite a conversation on the cost of unsafe abortion besides loss of lives. A comprehensive review of existing cost studies related to unsafe abortion in 39 Africa Union member states’ resource allocation to sexual and reproductive health had a striking revelation.

At least one quarter of annual per capita income is spent on unsafe abortion treatment, which is often higher than the governments’ annual per capita health allocation in most African countries. Africa spends USD 490 million annually on unsafe Abortion.

Countries such as Ethiopia, Ni­geria, Kenya and Uganda spend no less than 5 mil­lion dollars annually on unsafe abortion. This weighs heavily on health systems that are already struggling with under investment.

A World Bank report indicated that in many low-income countries, households pay 60 percent of total health-care costs in addition to other logistical costs like transport. This should worry policy makers as cost has the potential to inhibit health care access.

Bringing the deaths of women and girls from unsafe abortion or the resultant cost of post abortion complication simply requires that African states do the math and take evidence informed action.

World Health Organization recommends that a decentralized system where most SRH issues are handled at lower lever facilities, would reduce unsafe abortion related cost from Kes 4,500 (USD45) to Kes. 600 (USD 6) – a saving of 86 percent. Preventing unplanned pregnancy primarily relies on providing age appropriate information and services for modern contraception, and educating adolescents on their sexuality.

It is an opportunity for the International Conference on Population and Development to reflect on the pregnant girls in Bomet County and Africa at large, and ask what it benefits to have double loss of lives and resources for totally preventable loss of lives.

 Dr Nyamato is Ipas Africa Alliance Director