Unsafe Abortion A Leading Cause for Maternal Deaths in Kenya

By Jamillah Kilahama, Nairobi

ONE Hundred African women and girls die unnecessarily from unsafe abortions every day due to reliance on unqualified medical practitioners or practicing self-induced abortion involving ingestion of poisonous substances or insertion of tools into the uterus.

Africa has the highest percentage of maternal deaths due to unsafe abortions of which 60 percent of abortion related deaths occur in women and girls  under the age of 25.

“Abortion is a reality we are living with. It is hypocritical to keep burying our heads in the sand while we lose millions of born and unborn lives. Whatever excuse we use, the arithmetic is simple; Let the medics do what they are best at and the clergy/ moralists do what they are best at,” Says Naomi Barasa a Campaign Officer at Amnesty International, Kenya.

According to Ms. Barasa, losing 500,000 globally and 8,000 women in Kenya annually equals to losing an equal proportion of the workforce, creativity and innovation, expertise and skills.

During the 2nd State of Maternal and Mortality in Kenya Conference held in September 2011, themed ‘’The Lives and Health of Women in Kenya are Worth Preserving in Harmony with the New Constitution”, the issue of unsafe abortion was highly identified as the main cause of maternal deaths.

The meeting organized by the Kenya Medical Association (KMA) brought together media practitioners, medical personnel, researchers, international organizations, religious leaders, human rights activists and political leaders to discuss the possible ways to reduce maternal deaths.

In her presentation, “Advocacy with Policy Makers to Reduce Unsafe Abortion and Maternal Deaths in Kenya”, Ms Barasa appealed to the government to review and enforce all relevant enabling medical/health policies and Acts to allow health professionals determine life’s best interests.

She also advocated for the adoption of all treaties/conventions ratified by Kenya that guarantee women’s reproductive rights in addition to implementing laws that facilitate the constitutional right to information.

‘’The government should develop and implement a comprehensive national strategy for promoting women’s right to health. Such  a strategy should include interventions aimed at the prevention and treatment of diseases affecting women, as well as policies to provide access to a full range of high quality and affordable health care, including sexual and reproductive health services,’’ she said.

Globally, an estimated five million disability-adjusted life years are lost per year by women of reproductive age as a result of mortality and morbidity from unsafe abortion.

According to a study on one hospital, approximately 21,000 women are admitted annually to Kenya’s public hospitals for treatment of complications from incomplete and unsafe, spontaneous or induced abortion. More than 40% of these women “fall into the categories of probable or likely induced abortion.”

However, these statistics represent only a fraction of the actual number of abortion-related complications; they do not capture women who seek treatment at private healthcare facilities or those who cannot, or do not, obtain treatment at all.

A 2005 study found that close to 30% of Kenyan women hospitalized annually with abortion related complications have complications of high severity, including uterine perforation, haemorrhage (loss of blood) , sepsis (inflammatory state of the body), pelvic abscess and shock. 

In a 2002 study conducted at the Provincial General Hospital in Kakamega, the referral hospital for Western Province, abortion was found to be “the most common acute gynaecological ailment with its complications accounting for the longest hospital stay in comparison with other acute gynasecological conditions.” 51% of patients with abortion complications were under 20 years old.

According to  a lecturer from Kenyatta University Abdallah Kheir, many cases of unwanted pregnancies lead to abortion.

Dr Kheir in his presentation, “Pregnancy and Induced Abortion; An Islamic Point of View”, insists that people should practice Islam, Christianity and be God conscious, abstain from fornication, get married when time comes, avoid single motherhood, and have a good upbringing of children in order to avoid abortion.

“There are many causes that could lead to unwanted pregnancies, among them moral decay, poverty and economic challenges and the main actors in this practice are single mothers, couples, un-married teenagers, raped women and prostitutes,’’ he said.

He said research has proven that unwanted pregnancies result in about 42 million deaths due to induced abortions per year worldwide, adding that  it is very interesting to note that many of the pre-disposing factors that lead to unwanted pregnancy are prohibited in Islam.

“For example, Islam prohibits single motherhood, sexual relation before marriage and prostitution among others. For a raped woman, she needs to be consoled and advised not to abort especially if the baby has already been blown the breath of life,’’ he said.

But according to Dr. Owuor  Olunga from the Institute of Anthropology, Gender and African Studies at the University of Nairobi, it is very crucial to identify the main reasons which compel women to terminate certain pregnancies.

He said the main reasons include the need to postpone childbearing, inability to afford a child’s upkeep, lack of partner support or partner desertion, disruption of education, relationship problems with husband/partner, unemployment and the perception of being young.

“We should allow women to be the conscious agents of their health and see them as rational and thinking human beings who also have mouths to articulate their position.  Let us as a country accept to legalize abortion and save souls. The situation is pathetic and let us not procrastinate any further,’’ he added.

The laws governing safe abortion in African countries vary from one country to another ranging from very restrictive, for instance in Kenya where abortion is permitted only to save a woman’s life, to liberal such as South Africa where abortion is permitted until the 12th week of pregnancy or in certain circumstances even later.

Abortion is also illegal in Tanzania (except to save the mother’s life or health), so women and girls turn to amateurs, who may give them herbs or other concoctions, pummel (hit) their bellies or insert objects vaginally.

Infections, bleeding and punctures of the uterus or bowel can result, and can be fatal. Doctors treating women after these bungled attempts sometimes have no choice but to remove the uterus.

Maternal mortality is high in Tanzania. For every 100,000 births, 950 women die. In the United States, the figure is 11, and it is even lower in other developed countries. But Tanzania’s record is neither the best nor the worst in Africa. 

Worldwide, there are 19 million unsafe abortions a year, and they kill 70,000 women (accounting for 13 percent of maternal deaths), mostly in poor countries like Tanzania and Kenya where abortion is illegal.

According to the World Health Organization, more than two million women a year suffer serious complications. According to UNICEF, unsafe abortions cause 4 percent of deaths among pregnant women in Africa, 6 percent in Asia and 12 percent in Latin America and the Caribbean.

WHO data shows that more than five million African women have unsafe abortions each year and more than half of the 67,000 global deaths from unsafe abortion occur in Africa.