Two days earlier, she had taken pills from an unlicensed chemist in a desperate attempt to terminate her pregnancy.
In Dar es Salaam, another woman fights for her life after consuming a dangerous herbal mixture meant to induce abortion.
Their stories are not unique. They represent thousands of women across Kenya and Tanzania who risk their lives each year due to restrictive abortion laws that push them towards unsafe procedures.
Despite both countries signing the Maputo Protocol, a treaty advocating for reproductive rights, Kenya and Tanzania continue to criminalise abortion, creating a paradox where women are denied safe healthcare even when their lives are at risk.
The result? Hundreds of thousands of unsafe abortions, thousands of preventable deaths and countless women left with lifelong health complications.
This investigation by Nelly Madegwa and Rehema Mpemba delves into the harsh reality faced by women seeking post-abortion care and the legal contradictions that leave them vulnerable, exposing the hidden crisis threatening women’s lives in Kenya and Tanzania and the urgent need for reform.DESPERATE CHOICE
The pain had started two days earlier, but Akinyi ignored it. She had no choice. A second-year university student in Nairobi, she knew she couldn’t afford a visit to a private hospital. Public hospitals were out of the question; too many questions, too much judgement.
She had been raped by a relative. When she realised she was pregnant, panic set in. She couldn’t tell her parents. She couldn’t tell anyone.
Desperate, she visited a backstreet chemist and bought pills that promised to ‘fix’ the problem. But instead of relief, she was met with unbearable cramps and relentless bleeding.
By the time her roommate found her curled up in bed, barely able to speak, her sheets were soaked in blood. Rushed to the emergency room, Akinyi faced another nightmare.
"The nurse kept asking where I got the pills," she recalled. "She said they could call the police. I was so scared."
In Dar es Salaam, Zainabu, 19, made a different choice but faced the same devastating outcome. She had been assaulted by a customer at the shop where she worked.
When she discovered she was pregnant, she knew the law wouldn’t protect her. In Tanzania, where abortion is illegal in almost all cases, she had no safe options.
She turned to an old remedy whispered among women: herbs mixed with detergent. She drank the bitter mixture, hoping it would end the pregnancy. But the pain didn’t stop. For days, she bled, hiding her suffering until she collapsed at work.
"I didn’t want to go to the hospital," she said. "Everyone knows the doctors can report you."
Both women had nowhere to turn, trapped between laws that punish abortion and a healthcare system that fails them.
THE LEGAL PARADOX
In 2010, Kenya ratified the Maputo Protocol, an African Union treaty designed to protect women’s reproductive rights. Tanzania had signed it three years earlier, but both nations maintained a glaring contradiction: their laws still criminalised abortion.
Under Article 14(2)(c) of the protocol, African nations are encouraged to allow abortion in cases of rape, incest or when a pregnancy endangers a woman’s health. Neither Kenya nor Tanzania has fully implemented these provisions.
In Kenya, the 2010 Constitution offers limited protection, allowing abortion when a trained health professional determines that a woman’s life or health is at risk. However, an outdated Penal Code inherited from colonial rule continues to criminalise most abortions, creating fear and uncertainty among doctors.
"The law is unclear, and that means many healthcare providers refuse to offer abortion services or even post-abortion care," says Ngina Muyanga, an advocate of the High Court of Kenya. "Most women arrested for abortion-related offences are from low-income areas. Nobody in Runda or Karen is getting arrested."
In Tanzania, the law is even stricter. The Penal Code only permits abortion when the mother's life is at risk, offering no exceptions for rape, incest or mental health concerns. The penalties are severe: seven years in prison for women who have an abortion, 14 years for those who attempt to induce one and three years for anyone assisting in an abortion.
"The law contradicts the Maputo Protocol, which Tanzania signed without reservations," said Gertrude Dyabene, senior gender officer at the Legal and Human Rights Centre. "By criminalising abortion, the law forces women to seek unsafe procedures. It leads to unnecessary deaths, lifelong health complications and a society that punishes victims of sexual violence by forcing them to give birth to children conceived in trauma."
THE HUMAN COST
The consequences of these policies are staggering. In Kenya, more than 14 per cent of pregnancies result in unsafe abortions annually.
More than 260,000 women who are hospitalised each year due to obstetric complications do not receive proper care, which represents 60 per cent of all women who present with obstetric complications. And unsafe abortions account for 17 per cent of all maternal deaths.
In a landmark 2020 High Court ruling, Kenya affirmed that abortion care is a constitutional right and that arbitrary arrests of patients and healthcare providers for abortion services are illegal. However, enforcement remains weak.
In Tanzania, 405,000 women undergo unsafe abortions every year. Shockingly, 61 per cent of those who suffer complications never receive medical care. Every year, more than 66,600 women are treated for complications, but nearly 100,000 others who need care never make it to a health facility. Unsafe abortions account for 30 per cent of all maternal deaths.
“If these services were easily available without stigma or opposition, we would save lives and reduce the financial strain on women and healthcare facilities. The money spent managing complications from unsafe abortions could be redirected to improving maternal healthcare in general,” says Dr Daniel Oketch, a gynaecologist and obstetrician at Marie Stopes.
He says there’s confusion among medical officers regarding the legality of abortion in Kenya. Many are unaware that the Constitution allows for abortion when a woman’s physical, mental or emotional health is at risk.
“Some health workers refuse to provide post-abortion care simply because they think it is illegal. Others are unsure about the limits of the law, which results in unnecessary delays in treatment and sometimes the death of the patient,” he says.
AFRICAN LESSONS
Some African nations have found ways to balance cultural sensitivities with women’s health. Ethiopia expanded its abortion law in 2005, allowing the procedure in cases of rape, incest, foetal impairment and risks to a woman’s health.
This legal reform, along with improved access to safe abortion services, led to a 30 per cent drop in maternal deaths from unsafe abortions within a decade. The government also trained midwives to provide post-abortion care, especially in rural areas.
Similarly, Mozambique reformed its abortion law in 2014, permitting abortion on request within the first 12 weeks of pregnancy and up to 16 weeks in cases of rape or incest. The government worked with religious and community leaders to reduce stigma, leading to a significant decline in unsafe abortion complications.
South Africa, despite having one of Africa’s most liberal abortion laws, still faces challenges with stigma and accessibility. In 2008, the country amended its abortion law to allow trained nurses to provide the procedure, significantly reducing deaths from unsafe abortions.
The government has since introduced telemedicine services for counselling and trained healthcare workers at all levels to provide post-abortion care, ensuring safer reproductive healthcare for women, even in rural areas.
THE WAY FORWARD
For thousands of women in Kenya and Tanzania, access to safe post-abortion care remains a matter of life and death. But change is possible. Across Africa, countries that have embraced legal reforms, improved healthcare access and addressed stigma have seen maternal deaths from unsafe abortions decline.
Legal experts and human rights advocates argue that aligning national laws with the Maputo Protocol is a crucial first step. Removing criminal penalties for women seeking post-abortion care and ensuring that medical professionals can provide care without fear of prosecution would help save lives.
Beyond legal reforms, training healthcare workers, especially midwives and community health providers, is essential. Countries like Ethiopia have successfully trained mid-level providers to offer safe abortion and post-abortion care.
Kenya and Tanzania could adopt similar models to ensure that women, regardless of location, have access to life-saving treatment.
Addressing stigma is equally critical. Public education campaigns, engaging religious and cultural leaders, and introducing comprehensive sexuality education in schools could reshape attitudes and reduce the need for unsafe abortions.
For Akinyi and Zainabu, survival came at the cost of fear, stigma and lasting trauma. But their stories are not unique. Other African nations have shown that change is possible. The question now is, will Kenya and Tanzania act before more women suffer in silence?
This article was produced as part of the Aftershocks Data Fellowship (22-23) with support from the Africa Women’s Journalism Project (AWJP) in partnership with The ONE Campaign and the International Center for Journalists (ICFJ).
