It was a word that Sarah was familiar with. One that had already impacted her family and as she stared down at the little white pregnancy stick in her hand, it was one that was going to be in her future.
Narrating her family’s story, Sarah says “My family is not wealthy. We lost my father when I was three years old and I grew up with my mother and older sister. I was 14 years old when I found out my sister Beth was pregnant.”
Sarah’s elder sister Beth, then 17, was terrified at the prospect of having a child. She had planned to start university soon, after struggling to find the fees and even getting a partial scholarship. It was her chance to make something of herself and the thought of disappointing her mother, who had struggled to put her through school, was not an option. She decided to have an abortion.
“She never told me where she was going, she just said 'I’m going to go get rid of it'. Her friend was going to take her to someone who could help her. I was scared for her, but I couldn’t tell her what to do,” Sarah says.
A day later, Beth returned home after telling her mother that she was staying at a friend's house. She immediately went straight to her bed in the room she shared with her sister.
“She was fine when I checked on her in the morning but after lunch when I went to see her, she was sweating and shivering. Then she started bleeding,” Sarah says.
Beth was rushed to hospital, but unfortunately she had lost a lot of blood, making her too weak to fight the infection that followed. She never made it home.
“I don’t know who it was or what they did to her, but they killed her. They killed my sister and every day my mother and I cry for her. She didn’t have to die.”
In 2014 the Kenya Demographic and Health Survey (KDHS) found that 36 per cent of births in the preceding five years were reported as unintended or mistimed and this figure rises to 47 per cent among adolescents.
The study also found unsafe abortions are estimated to account for 35 per cent of maternal deaths – a figure significantly higher than the global average of 13 per cent. This equates to an average of seven women daily or 2,600 deaths annually.
Abortion is an emotive and extremely divisive issue all over the world, and it is no different in Kenya. Previously, the 1970 Penal Code stated that any person who intended to procure the miscarriage of a woman would be guilty of a felony, liable to imprisonment for 14 years.
It was not until the 2010 Constitution when this was changed with Article 26 (4) stating:
“Abortion is not permitted unless in the opinion of a trained health care professional, if there is need for emergency treatment or the life or health of the mother in in danger, or if permitted by any other written law.”
While therefore legal, there was a lack of guidance which has meant that the circumstances in which abortion was permitted were uncertain. This uncertainty meant that there were three court cases every week where women were charged with having an illegal abortion, and studies showed that 10 out of 20 cases examined involved schoolgirls – some of whom were minors.
“An unsafe abortion is defined as a procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking minimal medical standards or both,” says Dr Caroline Tatua, a senior health systems adviser.
According to research conducted by Ipas Health Alliance in Kenya, nearly 500,000 abortions are conducted in Kenya every year, with 20,000 of them in government health centres.
There are a number of reasons why women seek abortion services.
“For girls between the ages of 10 and 24 it is often the stigma of childbirth outside of marriage, the inability to support a child financially and being compelled to drop out of school. For older women, tough economic conditions are usually cited as their reasons for an abortion,” adds Dr Tatua.
It is this stigma that leads desperate women to seek dangerous illegal abortions. It was found that among the nearly 500,000 induced abortions, over 120,000 women were hospitalised for complications from unsafe abortions each year – 45 per cent of those that had severe complications were under the age of 19.
In addition to the stigma of having a procedure, those suffering from complications caused by an unsafe abortion may not even take themselves to a clinic for help, should problems arise.
A report by the Kenya National Commission on Human Rights (KNCHR) found unsafe abortions rampant among adolescents and youth, especially in universities and technical colleges. One Nairobi University student says, “Foetuses are collected from dustbins in universities…most girls do not seek safe abortion services, including post-abortion care, as they fear being known to have aborted.”
In a report published by safeabortionswomensright.org, it was found that not only are women dying from complications but health professionals are also being affected.
In one case, a nurse received a client that came seeking medical help after a botched abortion and who died soon after. While he insists that the woman had undergone the abortion elsewhere, he was arrested and sentenced to death. He is waiting for an appeal.
In another case, in 2011, a 40-year old woman was held in Murang’a police station for allegedly having an abortion by swallowing chemicals. Instead of getting medical help, she was locked in the cell where she died after developing complications.
In an even more alarming incident, a 21-year-old woman was arrested for attempting to have an abortion. She was marched to the nearby chief's camp with a crowd assaulting her and calling her names, all while carrying a basin full of blood and the fetus.
Whereas fear of being stigmatised for having an abortion leads to having it done illegally, because there is no after care and because the consequences of doing it are so high, women are less likely to seek medical help causing more deaths.
Not only is there a significant loss of life, but there is an additional strain on the already burdened health system. According to a report by the Ministry of Health and the African Population and Health Research Center, Kenya has spent Sh533 million treating complications of unsafe abortions in public health facilities. It is important to remember that there are many more unreported cases.
Also read: Children by choice, not chance
Studies demonstrate that it is far more affordable to prevent unwanted pregnancies than it is to treat the complexities that emerge from unsafe abortions. Specialists recommend tending to the drivers of unsafe abortions by upgrading the access to contraceptives, comprehensive sexuality education and honest discussions with adolescents about the best way to avoid unwanted pregnancies. We should be operating on a “children by choice, not chance” ideology.
Sarah says, “When I found out I was pregnant, immediately my heart stopped. I knew what people would think. I know they would say that I was careless, but I knew I could not have a child. I was 16, a child myself, but I remembered my sister and I knew I couldn’t do it the way she had. I could not leave my mother on her own.”
For Sarah the memory of her sisters’ death was still fresh in her mind, it was after all, only two years later. She was in the same position as her sister, unable to support a child and unwilling to disappoint her mother.
“I was scared! I thought that they would cut me and that I would die. But I didn’t know who to talk to or where to go. In the end I called the Marie Stopes hotline who sent me to a good clinic where a doctor helped me. He told me what to expect and what I needed to do. I was lucky, it was still early so they gave me some pills," she adds.
“I think that’s why my sister went to that butcher. She didn’t know what else to do. She didn’t know what would happen. She was scared.
“I don’t regret doing what I did. I know people may judge me, but I could not have had that child. It would not have been fair to the child and myself. I think about it everyday though. Would it have been a boy or girl? What would it have looked like?
“But I know that now I’ve almost finished school, I can get a better job and make enough money to have a family. I know I will never forget it. It was not an easy decision to make, it should not be an easy decision to make. But it was mine.”
While Sarah’s story may have ended on a positive note, lack of access to a safe abortion or even information on reproductive health is resulting in the deaths of thousands of Kenyan women and girls every year.
The World Health Organization recommends the use of four misoprostol tablets and one mifepristone tablet for the safe termination of a pregnancy under nine weeks. A minor surgical procedure can also be used by a trained health professional.
The social stigma around abortion and lack of service delivery policies are pushing women to resort to quacks (backstreet or untrained providers). Unintended pregnancies are the main cause of unsafe abortions. The high number of unwanted pregnancies stems largely from the unmet need for family planning, which currently stands at 18 per cent.
Various organisations offer pregnancy crisis counselling services which can assist women and girls in desperate situations so that they avoid endangering themselves. This matter therefore needs to be brought to the fore, otherwise we shall continue to lose more women and girls over an issue that can be resolved.