• Before procuring an abortion, women should confirm they are pregnant and find out if they have any problems
• Mifepristone and Misoprostol combination is more effective, at 99 per cent efficacy
We are sitting in her studio apartment, and during the duration of our conversation, she carefully tucks herself at the corner of her bed.
She had requested me to sit at her study table, just next to the bed on a wooden chair facing her. Her eyes were swollen and she told me she was yet to change the sheets in her bed.
“I’m still cramping and bleeding,” she says.
Mabel* (not her real name), 22, is a final-year university student, and this was her first pregnancy and consequent abortion.
“I have messed so many times, I ran out of sheets so I said I’ll just wait until it’s all done.”
She has been inside her apartment for a few days, barely seeing anyone because she did not want to explain her crying.
“My friend came with some people when I first took the pills on Friday and I had to shut the door on all of them. The bleeding had just started and it hurt like hell,” she said.
When Mabel found out she was pregnant, the first thing she did was call her boyfriend. “We talked about it and then decided that abortion was the right option, we were not ready.”
“All we needed was money and we were both in school, unemployed and relying on money from home,” she said.
I just kept reminding myself I did not want to be pregnant. I have final exams, internship and graduation, there is no time for parentingMabel*
After their conversation, her boyfriend let her know he was making some calls to find out how they could do it.
Mabel also knew someone who had done it but their process had been excruciating and she did not want it.
A few hours later, she received a call from him about a cheaper alternative to Marie Stopes, an NGO that deals with contraception and safe abortion services.
“It’s the same drugs they use but you’ll have to do it at home. Are you good with that?” he asked.
Mabel was a little nervous but she decided to go through with it.
“I really wanted to not be pregnant. Imagine raising a baby with him? So the next day in the evening, I get a call from him again and he sends me the number to call,” she said.
“I asked my friend to take me to the market and I stocked up on fruits then left her at my place and went to meet with the dealer in the other side of town,” she said.
Her boyfriend had told her he knew someone who knew someone in a local nursing school and who was willing to sell them the pills at Sh2,000.
They set up a meeting for 6pm.
“I waited for about 10 minutes and I stood waiting and so restless. I had told him what I was wearing and where I was standing and I felt exposed. Weird,” she said.
“I actually noticed who he was from the crowd. I was smiling when he was approaching me so he would let his guard down a little,” she said.
He asked if she had been waiting long and explained he had to walk a small distance.
“He removed a small brown envelope that had been folded and told me there were three pills inside. He said to put one in my vagina, another in my mouth and the third was just in case I threw up,” she said. “My boyfriend had already paid, so I thanked him and left.”
When she got home, she waited a few hours before taking them. She was nervous and unsure whether or not to trust the pills.
“I just kept reminding myself I did not want to be pregnant. I was also so tired all the time and I was just six weeks along! I have final exams, internship and graduation, there is no time for parenting,” she said.
“But it hurts and when the drugs started working, as I was passing the first clot, I cried so much because I didn’t know I could feel that much pain.”
Mabel says she called the guy and asked about the cramping and the bleeding.
“He asked if I was having any other side-effects and I said no. I was just a little weak and he said that was good and after it is over, I should take a test just to be sure. So I’m waiting and hopeful I’m fine,” she said.
Speaking to journalists during the International Safe Abortions Day, obstetrician and gynaecologist Dr John Nyamu said the drugs misoprostol and mifepristone can be used for safe abortion procedures.
“There is a range of options in route, dosage and timing. The drug can be administered via oral, sublingual, buccal, vaginal and rectal routes,” he said. “Sublingual route is the most appropriate in our setup as we try and avoid vaginal route for security purposes.”
“A patient should be administered 200mg of mifepristone orally. Most women will feel no change after taking the pill, while some will begin bleeding before taking the next pill (misoprostol),” he said.
He added a few women will abort after the mifepristone dosage alone, but it works best when administered together with misoprostol.
mifepristone works by blocking progesterone activity in the uterus, leading to detachment of the pregnancy. It causes the cervix to soften and the uterus to contract. Misoprostol works by stimulating uterine contractions. It is easily absorbed orally or vaginally.
The doctor, however, warned that before procuring an abortion, women should confirm they are pregnant and find out if they have any problems.
“They should think about suitability for the procedure. Are there any precautions and contraindications to the procedure? They should know that,” he said.
“They also need to do a pregnancy test, either urinal, blood or radiology. Sometimes one can go confirm whether they are pregnant through ultrasound,” he said.
Nyamu said women should also make sure the pregnancy is 10 weeks or less and take precautions before they start the procedure at home.
“For the women who are breastfeeding, the babies are going to have side-effects of those medicines. Therefore, we recommend that they breastfeed first and then take the medicines,” he said.
“Also, those with Intrauterine Contraceptive Devices, they should have the device removed before they take the medicines. Those with freshly removed scars should also take precautions.”
Nyamu said the women with these three conditions can still take the medicine, but they first need to consult a doctor.
The doctor also warned that people performing abortions should look out for contraindications. These are factors that serve as a reason to withhold certain medical treatment due to the harm it would cause the patient.
They include suspected or confirmed ectopic pregnancy, allergy to mifepristone, misoprostol or other prostaglandins, chronic adrenal failure and hemorrhagic disorders.
Others are the current use of long-term systemic corticosteroids and inherited porphyria.
Some of the warning signs during or after an abortion include excessive bleeding, persistent fever of 38 degrees or higher or excessive pain, especially one-sided.
“Women are advised to seek advice in the nearest health facility in case of a complication or emergency,” Nyamu said.
The accusation of murder should shift to those who intentionally prevent at-risk pregnant women — who thereafter die — from accessing safe abortionHuman rights lawyer Stephanie Musho
Critics say abortion is murder and should be avoided at all costs. Human rights lawyer Stephanie Musho, who is also a reproductive justice expert, terms this a misinterpretation of facts.
“From a legal standpoint, murder is the killing of a human being by a person of sound mind, who has the intent, with malice aforethought, and with no legal excuse or authority,” she says.
“Abortion is, therefore, not murder, as malice aforethought does not exist. Women, in their right state of mind, do not plan to get pregnant in order to seek abortions. “
Additionally, she points out, the Constitution of Kenya in article 26(4) permits abortion in case of emergency treatment and when the life or health of the mother is at risk. It also allows Parliament to provide other grounds for permitting abortion.
In Kenya, an estimated 6,300 women die each year during pregnancy and childbirth. Some of these women suffer health problems that arise during pregnancy, while others have pre-existing conditions that may be exacerbated by pregnancy.
Musho cites ectopic pregnancies, where a fertilised egg implants outside the uterus. If left to grow, the foetus can cause the fallopian tube to burst, leading to severe internal bleeding and in worst-case scenarios, death.
Severe antenatal depression and anxiety can also pose great risk to the health and/or the life of the mother as it could lead to self-harm, including suicide.
Preeclampsia is yet another complication in pregnancy that causes a rise in blood pressure and increases the risk of brain injury, Musho says. It can impair kidney and liver function, cause blood clotting problems, pulmonary edema (fluid on the lungs), and in severe forms or if left untreated, maternal death.
“Many other conditions exist that could jeopardise the health and lives of pregnant women, these are just but a few,” Musho says.
“In view of that, the accusation of murder should then shift to those who intentionally prevent at-risk pregnant women — who thereafter die — from accessing safe abortion.”
Edited by T Jalio