The Scarlet ‘A’ for Abortion (Part 1)

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First published in the November 2012 issue of Destination Magazine

(By Rose Odengo) Abortion is a hard topic for any nation, but in Kenya it’s done, not spoken of. Hundreds of thousands of women have them each year, but they rarely speak of it. Worse still, many seriously harm themselves with unsafe methods, all in an effort to keep the secret.

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Abortion in Kenya is a tricky thing to pin down. No one knows for sure how many go on – the only national figures come from a three-month study of women hospitalised for abortion related complications that happened in 2002. According to that, somewhere around 300,000 abortions occur annually. But it’s hard to stand by 10-year-old reports.

Asking Kenyans, many people will animatedly talk about a friend of theirs who’s had one, or at least a friend of a friend. They were asked to go with her, or she got pills off a website or she had one at seven months pregnant. But it’s extremely rare that someone will come out and say they personally have had an abortion.

Part of this is due to the procedure’s still dubious legality – yes, the new constitution has expanded the parameters for having one, but few women feel confident interpreting the laws. However, an even bigger reason to keep the silence is the general stigma attached to abortions. Because of this, women are finding the most secretive methods they can to have it carried out, and telling as few people as possible. They deal with the guilt alone, and if there are complications they try to hide them, leading to a staggering amount of serious injuries and deaths when unsafe methods are used. All to keep the silence.

The Scarlet “A”

Abortion is any termination of a pregnancy. That means even naturally occurring miscarriages fall under the word’s definition, they’re just referred to as spontaneous. But when most speak of abortion, they’re referring to the induced termination of a pregnancy.

Induced abortions are brought on by a variety of methods, ranging from clinical to gruesome. The most famous is probably the manual vacuum aspiration, or MVA. As the name suggests, MVA is a procedure whereby the embryo is removed from the uterus with a suction device. This is considered a surgical option, but a less invasive method is available as well – the abortion pills, typically mifepristone and misoprostol. The combination of drugs causes the uterus to shed its lining and lose the embryo. The pills, however, are only recommended to terminate pregnancies up to nine weeks.

These are the safe versions – typically conducted at a certified health facility and by a trained medical professional. The technical descriptions may sound horrible, but the other side of the coin is far worse. Unsafe abortions, which the World Health Organisation (WHO) defines as an abortion conducted outside of health facilities or any other place recognised by law or provided by an unskilled person, are far more common. Some of them are done by ingestion – swallowing litres of concentrated black tea or swigs of caustic material like bleach. Others are invasive, with all manner of tools being forcefully pushed into the uterus.

In Kenya, unsafe abortions are far and away the more common choice. They are cheaper – legal abortions require multiple visits to a hospital – and quieter.

Fix the Problem before It Starts

Regardless of where they stand on the moral implications of abortion, most people agree that avoiding unwanted pregnancies is the best option. Some advocate abstinence, while others push natural methods or modern contraceptives, but the idea behind all of this is that women who don’t want to be pregnant have options to avoid it. Despite these options, the Guttmacher Institute released a report on abortion and unintended pregnancy in Kenya in May 2012 that found 45 percent of sexually active unmarried women, who want to prevent pregnancy, do not use any family planning method.

Paul Mugambi is a lawyer with the Kenyan Chapter of Human Life International, a prolife organisation, based in Nyeri. Mugambi believes there is a link between abortion and contraception use in society. “The culture that entertains and propagates the contraception mentality [does not] want to have children. And [we] take it in our hands to use artificial methods,” Mugambi says. Essentially, artificial contraception creates a cultural disinterest in child bearing, making abortion the next step when prevention methods fail.

Instead, Human Life International promotes the use of natural family planning. “It is a matter of understanding the way the body operates. You learn to know when your body is or is not fertile, and when to or when not to engage in sex,” explains Mugambi. He further states that there are four methods around these principles that the organisation teaches married couples to use.

Muchira Muraguri is the Programme Director at Family Health Options Kenya (FHOK). While he doesn’t completely disagree with Human Life International – he believes that increased education and use of family planning will reduce the current rate of unwanted pregnancies and subsequent unsafe abortions – he is certainly a proponent of modern contraceptive methods.

Muraguri gestures to a word document printed out and stuck on his office wall. It reads, “Family Planning reduces 71 percent of unwanted pregnancies.” These are statistics from the WHO. Yet the Guttmacher Institute found that only 12 to 17 percent of Kenya’s poorest and uneducated married women use modern contraceptives. This is compared to 48 to 52 percent of the wealthiest and most educated. All the barriers, pills, patches, devices and methods in the world won’t prevent pregnancies if they aren’t used.

Margaret* is 30 years old. She has three children from separate fathers who are all either dead or unsupportive. After her first child was born, Margaret started using contraception, but it immediately had adverse symptoms. “I felt dizzy and I would bleed from the first to the 30th of every month. The doctor told me to stop using the contraceptives because of this,” she recalls. Margaret eventually conceived again. Her two elder children now live with her mother. She lives with her third child.

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