Non-governmental health organisations in Kenya are alarmed at a decision made thousands of kilometres away that is bound to have devastating consequences on their operations. Recently, US President Donald Trump reinstated a government policy prohibiting granting of American foreign aid to NGOs in developing countries that offer abortion-related services.
This means that any Kenyan and other international organisations that have been receiving US funds for health programmes will now be required to certify that it does not provide abortion services, which include counselling, referrals, information or advocate the liberalisation of abortion laws, even with non-US funds. If a provider fails to sign the ‘global gag rule’, they lose the US funding, donated contraceptives and leadership and technical expertise.
This is a big blow to many Kenya health NGOs since the US government grants Sh60 billion annually for comprehensive reproductive health services. Several NGOs rely on the USAID fund to carry out more than just the abortion related services.
The ‘global gag rule’ will see most of these NGOs being forced to scale down on their services.
The majority of Kenyans live in abject poverty, defined as surviving on under one US dollar a day. They will lose access to family planning options. This will result in an increase of unwanted pregnancies, automatically increasing maternal morbidity and mortality aggravated by number of unsafe abortions. It will also see an increase in new HIV infections, increased infant and child morbidity and mortality among other adverse effects. Marie Stopes International estimates that there will be additional 2.2 million abortions annually, of which 2.1 million will be unsafe.
The situation has been complicated by failure by the Kenyan government to act on some of these issues. The National Policies, Standards, and Guidelines on reducing maternal morbidity and mortality in Kenya were published in line with the Constitution in 2012.
These guidelines offered a conducive environment for addressing abortion-related issues. These were then suspended by the Ministry of Health in 2014, which said they will be revised.
The new revised guidelines, although ready for use, are yet to be published in the Kenya Gazette to make them legal for operationalisation and use by medical personnel. This will ensure Kenyans’ rights to life and health are respected in terms of reduction of the number of unsafe abortions. This remains a major challenge in Kenya.
Statistics show that 56 million induced (safe or unsafe) abortions occurred worldwide each year according to a new study undertaken by Guttmacher Institute and WHO (2010 to 2014). Abortion rate was found to be at 35 abortions per 1,000 women of reproductive age compared to Kenya’s 48 per 1,000. This national abortion rate was among the highest in East African region in 2012.
Abortion is defined as the termination of a pregnancy before the foetus is viable that is before 28 weeks according to Ministry of Health, Kenya.
It can be spontaneous or induced. Induced abortions can be safe or unsafe. WHO defines unsafe abortion as a procedure where a pregnancy is terminated either by unskilled persons or in an environment that does not conform to minimal medical standards or both.
A new survey conducted in 2012 in Kenya showed that, there were 464,690 abortions procured in Kenya. Out of these, nearly 120,000 received care in registered health facilities for complications arising from unsafe abortions. The fatality rate stood at 266 per 100,000 unsafe abortions.
This high number of unsafe abortions can be reduced by adequate sex education, prevention of unwanted pregnancies through effective contraceptive use and increasing access to post-abortion care services.
Dr Sarah Agunda is a medical officer and a researcher with Women’s Rights Empowerment and Partnerships in Africa based in Kakamega.