In a dark, nondescript room, the walls caked in spots and smears whose origins she would rather not think about, a young girl sits wringing her hands, waiting for the woman she had been told could help her. She takes one deep breath after another, telling herself it will be okay, there is no other option, she has to be there.
Eventually the door slowly starts to open, bathing the room in light that does nothing other than illuminate the dilapidated hospital bed in the corner.
“You, lie over there!”
The order is barked to her by the disinterested newcomer. She does not seem to notice the scared girl, frozen to her seat. She cannot see the terror in the young girl’s eyes, or the desperate need for reassurance that she is making the right choice. To the woman, this girl is one of many who pass through her door. Nothing more than a chance to make a few thousand shillings.
This time the girl slowly makes her way to the bed, and she soon finds herself on her back, looking up at the dark ceiling with its broken fan and single light bulb swaying. She tries to concentrate on that, the swinging of the bulb. Back and forth, back and forth. Maybe if she pays attention to that, she won’t have to think about what is about to happen to her.
Out of the corner of her eye, the girl notices a new person entering the room. Suddenly, her legs have been spread and pinned down. A clammy hand is clamped over her mouth and it begins.
“She used a hanger on me. Someone was holding my legs down so I couldn’t move, then they put it inside me. I remember screaming and screaming so much I couldn’t breath. I won’t forget that pain, not for as long as I live,” she later recalls.
As the girl lies in bed, her mattress slowly soaking in blood, clutching her stomach as shooting pains render her immobile, she knows she’s one of the lucky ones. While she prays for the pain to end, she knows girls who didn’t wake up.
“I know it was dangerous. I know a girl who died when she bled too much. Her mother found her. I knew all this. But I didn’t have a choice. I didn’t have anyone to turn to, it is what it is.”
When I asked her if she would do it again, knowing now exactly what she would have to experience, her answer was quick and to the point.
The World Health Organisation has found that Middle and Eastern Africa have the highest global rate of unsafe abortions at 36 per 1,000 women. In Kenya, unsafe abortions are one of the major causes of maternal deaths.
“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.
Every year, 2,600 women die from unsafe abortions. That’s seven women dying daily, accounting for 35 per cent of maternal mortality. The global rate is 13 per cent.
Women and girls are dying every day, whether it’s because of the stigma surrounding abortions, a lack of information or not knowing your rights.
MARIE STOPES ON THE SPOT
In Kenya under the 2010 Constitution, abortions are not permitted unless in the opinion of a trained health professional, there is a need for emergency treatment, or the life or health of the mother is in danger, or if permitted by any other written law.
On Friday, the Kenya Medical Practitioners and Dentists Board caused a stir when it banned international group Marie Stopes from offering abortion services. Marie Stopes has been the stop for many who seek to undo unplanned pregnancies. It has operated in Kenya since 1985, and has set up 22 clinics and 15 mobile outreach clinics.
KMPDB boss Daniel Yumbya said: “Marie Stopes Kenya is hereby directed to immediately cease and desist offering any form of abortion services in all its facilities within the republic of Kenya.”
The move came after the Kenya Film Classification Board ordered the clinic to pull down radio and online advertisements they alleged promoted abortions.
Marie Stopes deferred comment on the matter when reached for response. However, it says on its website that it operates within the law: “We offer counselling services, including post-abortion care, to reduce the risks of any woman experiencing problems after a miscarriage or unsafe abortion procedure.”
The clinic further says it offers surgical abortion, which is safe and may be used to terminate a pregnancy at various stages of gestation. Its slogans include “Children by Choice not Chance” and “Helping You Manage Your Options”.
There is a fear that by stopping Marie Stopes from providing a service that is so desperately needed, the KMPDB is condemning thousands of women and girls to unsafe abortions, leading to complications, infections and deaths.
But what would happen if Marie Stopes didn’t exist? What if the organisation had not set up a base in Kenya to provide not only reproductive health services but abortion services, too?
IMPACT OF BAN
Approximately 464,000 abortions are conducted each year. Last year, Marie Stopes averted 208,979 unsafe abortions. If they were not there, if just 40 per cent of that number chose to have an unsafe abortion, that leaves 83,592 women who have put their lives at risk.
Of that number, if only five per cent died, that would be 4,180 women. Since abortions have only been permitted since 2010, that would be 29,258 women dead since that time.
On top of the loss in life, financially, the healthcare system would seriously be impacted. According to the Health ministry and the African Population and Health Research Centre, Kenya has spent Sh533 million treating complications of unsafe abortions in public health facilities.
Those are millions of shillings that are desperately needed in a system that is already heavily burdened, and a cost that would only increase as more and more women are driven to quack doctors. Doctors who would use crude, unhygienic methods with no thought to aftercare.
Choosing to have an abortion is more than deciding to have the procedure. There are a number of psychological demands on the body that must also be met.
Psychologically, women, and in particular young girls, can be severely affected and, therefore, need to have someone they can talk to. By removing access to trained professionals who can counsel these women, the KMPDB is arguably denying them the chance to truly heal from the experience.
That said, abortion is an extremely divisive topic in a country ruled largely by religious and moral beliefs. Counsellor Patrick Masiga told the Star he does not approve of it. He said although he believes there is safe abortion supported by the Constitution, he has received many cases of young girls who regret this dire decision.
“Everything happens for a reason. Even those who go through the pain of rape should not undergo abortion because that child is innocent. Abortion leaves a scar for many of these women,” he said.
On the other hand, one of the main reasons women choose to go the illegal, dangerous route of backstreet abortions is that they are unable to have open, honest conversations about it.
What this ban has done is say that anyone brave enough to highlight the subject, or even mention it in any way, will be met with opposition at the highest level. It vilifies a service that is desperately needed to save lives, and drives women and girls to the seedy underworld of unsafe abortions.
One thing that was made clear while talking to people on the streets about abortions is that while some may have been staunchly against it, every single person talked to either knew someone who had had an unsafe abortion, or knew where to take someone if need be.
Stopping Marie Stopes from providing abortions services will not stop abortions from happening in Kenya. But it will increase the number of women seeking unsafe abortions. And it will continue to kill our women.
Additional reporting by Melanie Mwangi