In 2005 Margaret met someone, fell in love and got pregnant with a fourth child. After some deliberation however, Margaret decided she was going to have an abortion. “I sat back and thought to myself, if injections didn’t work, and neither did the pill, I [already] have three children, why give birth to a fourth?” she asks distraught. She did not want another child to grow up in uncertainty and struggle like her three children were. She searched for a provider and was informed of a lady who conducted abortions. And she had it done.
“To this date I am tired all the time. I have no strength to do anything,” she says.
It used to be that abortion was only allowed if the mother’s life was in danger. While this law could certainly be seen as the root of Kenya’s silence on the subject, laws are more often a reflection of society. Internationally, the largest pro-life groups are typically tied to religion, whether officially or by their supporters’ beliefs. The majority of Kenya’s population is religious, with Christians making up 78 percent of the population and Muslims 10 percent. Both religions vehemently oppose abortion, but in countries like the US, religious views only serve to intensify the conversation. Kenya’s silence is in part due to the importance of religion here, but it goes beyond that.
Children are cherished in cultures worldwide, but the “It takes a village” mentality in Kenya makes any child the responsibility of society, and pregnancy is usually seen as a blessing. But roles have changed as the world has. The thousands of street children in the country are evidence enough that society as a whole doesn’t rally behind youth anymore, and poverty and hard lives make many women question the joy of bringing a child into the world. When a woman sees pregnancy as a burden and sees her only way out as getting rid of her child, there’s a great deal of pressure and shame.
The country’s iciness on the subject is cracking, but slightly. Kenya’s new constitution makes abortion permissible under various circumstances – if it is recommended by a trained health professional, if emergency treatment is required and if the life or health of the mother is in danger.
But Muraguri is concerned about the legislation’s scope and effectiveness. For example, even with the constitutional changes, the Kenya penal code has not been updated, which he says hinders women from access to proper comprehensive abortive care. In the penal code, an abortion is considered a felony with individuals found guilty facing a sentence of up to 14 years. Doctors and other medical personnel guilty of conducting an abortion will have their practicing license revoked.
This fear is echoed by the many doctors who were reluctant to talk about abortion. Some actually hung up rather than be interviewed, and those who did schedule appointments cancelled them at the 11th hour. One person who would talk, however, was Dr. Joseph Karanja, who is a registered Obstetrician/Gynaecologist and a former chairperson of Kenya Obstetrical Gynaecology Society (KOGS). He does not see the penal code as a problem.
“It doesn’t matter what any other law says. The constitution is supreme,” Dr. Karanja states. “And any law that is inconsistent with the constitution is null and void to the extent of that consistency,” he concludes. As he flips to the opening pages of his white, pocket edition constitution, he adds “You don’t even have to change the law. It is there but it does not apply.”
Despite being adamant on abortion’s legality, many women in Kenya are still unaware of or unable to access legal abortion methods.
When it comes to the pills, Dr. Karanja says the medication is recommended for use within 12 weeks of pregnancy, but only under proper professional observation because of the risk of complications such as excessive bleeding. Muraguri is quick to point out the challenge with this. “You need a prescription [for the abortion pill] not from any medical practitioner but a gynaecologist registered by KOGS. And there are only 250 in the whole country,” he states.
Dr. Karanja says the other common legal method, the MVA, takes less time and is less harmful to the mother. “This will take 15 to 20 minutes. The patient can rest a bit then go home,” he observes. But the women still have to get approval.
Any woman considering a legal abortion is required to consult with a gynaecologist, psychiatrist and physician. But Dr. David Kiragu, an OB/GYN who performs abortions, said that it was easier for women in cleancut situations, for instance a woman with a stillbirth, with a fetus with gross anomalies or taking chemotherapy, which is lethal to an unborn baby. “It is only for contestable situations, e.g maternal mental disease [or] pregnancy following rape that protracted consultations are required. Doctors are not easy to access though, to get all the consultant clinicians to reach agreement is a nightmare.”
On top of that, the consultations will run up her costs. For a legal abortion, costs vary incredibly. The further along in a pregnancy the more it will be. After three months the procedure becomes more complicated and requires better facilities. Dr. Kiragu says that these later abortions can be “very expensive comparable in many cases to the cost of a normal delivery,” which can be KSH 95,000 or more. Some insurance policies will cover abortion considering it a complication of pregnancy. But the conditions and costs add up to many women opting for illegal procedures.
Janet* is 41 years old and has had a legal abortion. She married her high school sweetheart, and they had two children together, a girl and a boy. But they weren’t born healthy; they are both deaf and mute. In 1998, just five years into marriage, Janet got pregnant again. Her husband was not interested in having another child, but she was.
“He told me that if I gave birth to this child, it would be mine; he would not take care of it,” she remembers. Janet gave in; she did not have the means to take care of her children. They only had a sole income, which her husband provided. He took her to a private doctor’s clinic to have an abortion. “The doctor was there and two nurses assisted me,” Janet says. The nurses injected her with an anaesthetic and walked her through the procedure step by step. “I had no clue what was going on. I was just there,” she recalls.
….watch out for part 2….
Originally published in the November 2012 issue of Destination Magazine, authored by Rose Odengo.