For as long as she can remember, Marina’s friends have been sexually violated within the sprawl of Mlango Kubwa in Nairobi. The wails and tears of teenage girls have become so common here that it no longer appalls to hear that a friend has just been raped.
We meet her at Bluehouse, a small health facility in the slum off Juja Road where girls nursing the consequences of rape or consensual sex converge for care and counselling.
She listens to the experiences of her friends, emotionless and expressionless. The stories are heart-wrenching — ranging in themes from rape and defilement to assault, pregnancy, and abandonment — but to her they are so humdrum.
These are the voices that have been silent in the controversial debate on abortion. The most recent national survey on the incidence and prevalence of abortion in Kenya was published in 2015, and from it experts are drawing a direct line between access to contraceptives and the outcomes of quack-induced abortion. That points to two discussions that the country must have, for the sake of its girls. One, the context in which abortion occurs, and, two, investment on family planning commodities.
The tales used to haunt her, but not any more, because she already tipped over the precipice. She recently procured an abortion, and now she is fighting the pain, regret, and social judgment.
Termination of pregnancies in Mlango Kubwa is as informal as the settlement itself. Here, government policy on the matter does not arise, and neither do religious criticism or social censure.
Marina, now aged 18, bore a child at 16, about three years after she became sexually active. She had been “lucky” not to conceive earlier because she rarely used protection, and in a country where the age of sexual debut for girls is as early as 10 years — according to the Kenya Aids Indicator Survey of 2014 — Marina, really, had the gods on her side for quite some time.
Gods on her side, and a whole lot of moralising and legal pontification against her. Consider this, for instance: the Kenya Catholics Doctors Association (KCDA) insists it is ethically and morally wrong to provide the likes of Marina with contraceptives; a recent report by United Nations Population Fund (UNFPA) on Kenya’s hospitals’ ability to provide family planning revealed that more than 80 per cent of hospitals experienced stock-outs of commodities; and the Kenya Demographic Health Survey (KDHS) 2014 indicates that while 65 per cent of unmarried women need contraception, 21 per cent of those aged between 15 and 24 have unmet needs for the same.
A 2015 report by two reproductive rights groups — Guttmacher Institute of New York and African Population and Health Research Centre (APHRC) of Nairobi — estimated the number of abortions in Kenya at 464,000 in 2012, or 48 procedures in every 1,000 women.
This must have gone up in 2016 — when Marina procured her abortion — since a global survey by Guttmacher and World Health Organisation (WHO) analysing incidence of abortion from 1995 to 2008 showed that rates of induced abortion were rising in Kenya and all the other developing nations as it, conversely, dropped in the developed world.
Noting that only 157,000 women visited hospitals for care, among them 120,000 seeking attention after unsafe abortions, the authors of the report, titled The Estimated Incidence of Induced Abortion in Kenya: A Cross-Sectional Study, warned that the numbers they were quoting could be “modest”.
Tellingly, and also worryingly, the research posited that 97 per cent of abortions in Africa are conducted by unqualified people in dingy clinics, and that the procedures often end up causing infections or fatal bleeding.
At Kenyatta National Hospital’s Ward 1D, nurse-in-charge Asena Titus has seen it all, and he is worried by the large number of young girls who are wheeled in every week on the verge of death.
“The age between 16 and 30 comprises the largest group of serious cases that we receive here,” he says. “And they usually come in a coma, with acute kidney injuries calling for immediate dialysis, suffering bleeding that has to be transfused, or nursing perforated gut or uterus.”
Knitting needles, hangers, crotchets, sticks and other foreign objects have been found in the bodies of the young girls who are wheeled into KNH, and even then, sometimes Asena and his team never really get to know what caused the gory injuries of some of the patients they attend to.
The hospital receives an average of 83 patients in a month with post-abortion complications, its records show. Some of these end up with permanent conditions like chronic kidney injuries or inability to conceive.
The cases are so many that the facility had to furnish a small chamber and label it ‘Procedure Room’, where Manual Vaccum Aspiration (MVA), or washing of the cervix, is carried out instead of booking the girls for theatre.
Mary Mugure, 22, became a mother in her teens as well, and talks of the pain that she went through when she tried to procure an abortion later.
INSERTED PILLS INTO BIRTH CANAL
“A friend referred me to a chemist where I was given some pills to swallow and a tablet to insert in my birth canal,” she says inside the special ward at KNH.
“On my way home I sat at the back of the matatu, and I think the rattling and bumping spurred the cramping. It was so painful I almost collapsed. And then within no time I started bleeding so heavily that I soaked my clothes. When I stood up rivulets of blood ran down the length of my legs. The tout asked everyone to alight and they rushed me here.”
Mary said the process of being “cleaned up”— or MVA — was more painful than the labour pangs she experienced when she delivered her baby.
Dr John Ong’ech, a senior gynaecologist at KNH, says that post-abortion care takes money and resources from the system as when they are wheeled in, most of the girls do not have a single cent on them.
“The cost of dialysis, antibiotics, tests and surgeries is therefore borne by the hospital,” says Dr Ong’ech.
Next to the modified theatre at KNH is ‘Kawangware’, the holding bay for discharged women who are unable to clear any bills the hospital is not willing to write off, some of the charges running into hundreds of thousands of shillings.
And here, the tragedy of how women’s bodies and their sexuality have been reduced to a battle between the moral purists and the progressives is laid bare in appalling fashion.
The progressives, to the chagrin of the moral and religious sticklers, are calling for wider contraceptive availability, legalising of abortion, and preaching of abstinence as ways of cutting down on pregnancy, abortion and sexually transmitted diseases.
But Dr Stephen Karanja, chair of the Kenya Catholic Doctors Association, would hear none of this, saying that any woman with a bit of common sense does not need contraceptives.
“Before contraceptives came to Kenya in the 1950s and then became available publicly in 1980s, our grandmothers knew how to space their children, but the modern woman is too lazy to listen to her body and think,” he says.
ARTICULATE BUT FOOLISH MODERN WOMAN
He also descries the modern woman as articulate but foolish since she allows “anyone to violate her body and then take it through an unforgiving battery of chemicals such as the morning-after pill”.
Dr Karanja also questions the validity and motive of studies on incidence of deaths related to HIV and pregnancy in women, saying those purveying that knowledge are friends and recipients of funding of the largest pro-abortion organisation in the world, International Planned Parenthood Federation (IPPF).
And this is not an unschooled person talking, for Dr Karanja is a trained gynaecologist who worked at KNH between 1993 and 1994, and who saw so much during his tenure there that he describes the injuries that women face after botched abortion as “nauseating and a most cruel violation of the woman’s body”.
Dr Karanja says young girls are getting pregnant because adults are too selfish to guide them and lead by example.
“The people who carry out these abortions have a medical background, because how would a common person know where the cervix is so as to insert anything there?” he poses. “These are doctors, clinical officers and nurses in some room without equipment who start the procedure and tell the patient to go to Kenyatta hospital if the patient starts bleeding.”
The Director of Medical Services at the Ministry of Health, Dr Jack Kioko, however says it is unfair to blame medics — “who work to save the lives of the affected” — for the rising number of backstreet abortions in the country.
He also says that the government will soon issue guidelines on maternal and reproductive health, including abortion, in order to bring sanity to the field.
His promise brings us to the issue of policy gaps on reproductive health in Kenya that has been the talking point in the sector for a long time.
Ms Evelyne Opondo, the regional director for Africa for Centre for Reproductive Rights, has argued before that while the Ministry of Health should lead in implementing all health related provisions, it has instead “perpetuated confusion within the sector with regard specifically to access to legal abortion and not any other medical service”.
“It made a positive step by adopting standards and guidelines to reduce unsafe abortion in Kenya in 2013 and then withdrew it within a year, creating a huge gap on service provision. To make matters worse, (the Ministry) issued a directive to all health professionals not to attend any training on abortion, completely ignoring the fact that abortion is already allowed in the Constitution under certain circumstances.”
Indeed, the 2012 global study on abortion by WHO and Guttmacher established that making abortion illegal does not reduce incidence, but only makes it more dangerous.
Abortion rates are lower in countries where it is legal. Western Europe has the world’s lowest of 12 a year for every 1,000 women of reproductive age, the rate is at 19 in North America, but in South America, where the practice is banned everywhere, the numbers are much higher, at 32.
In eastern Africa, where ferocious laws and powerful religious injunctions should have stamped out the practice long ago, 38 women out of 1,000 of reproductive age abort annually.
Dr Khamati Shilabukha, a researcher at the Institute of Anthropology, Gender and African Studies at the University of Nairobi, says that despite the evidence, the fervent religious objection to contraception is understandable.
“The passionate emotions are expected because, individually, people may be liberal to allow women to make their own choices, but, collectively, nobody wants to go against the grain that life is sacred in this religious society,” he says.
Dr Karanja, of the Catholic doctors association, champions the strategy of educating children on the “responsibility of sex physically, spiritually and emotionally”.
And, citing scans of the way the brain of a teenager develops, Prof Ruth Nduati, an expert in paediatrics, says magnetic resonance imaging (MRI) of the teenage brain has shown that the portions associated with critical decision-making — like whether or not to use protection during sex, or whether to seek contraception methods — have not developed during teenage until early 20s.
Dr Karanja says young girls are getting pregnant because adults are too selfish to guide them and lead by example.
And it seems he is right on the money, because all the girls we talked to were either orphans who had been abandoned by the community, or runaways who had severed relationships with their parents.
Pills, concoctions and injections: girls admitted at Kenyatta hospital explain how they did it
THEY REMOVED MY UTERUS
Atieno Ouma, 19, Korogocho
I remember him so well. He was a guard at the place where I lived with my aunt in Korogocho. I had moved to the city from Migori to attend college, but that was never to be. Whenever I was bored during the day I would go to his house, and he would tell me all these nice things and make me feel wanted and needed. And then one day I noticed I had missed my period. My aunt took me to a woman just a few blocks from where we lived and left me there. At night, the woman brought some herbs and numerous pills, which she placed on the table as she brew black tea. She gave me the tea, laced with herbs and bleach, to drink alongside the pills. My stomach starting aching soon afterwards. I lay on a mat on her floor and bled so much I thought I would die. I cannot remember much from that night as I woke up in a bed at Kenyatta National Hospital. A woman I did not know visited me and said she had found me lying unconscious near her shop. She is the one who had brought me here. My uterus was removed by doctors at the hospital. They said they found holes, indicating someone had puncture my womb several times. I stayed in the hospital for more than a month. My aunt did not even visit. When I left, she told I was no longer welcome in her house, so I just stay with the woman who rescued me. I have nowhere else to go because I am an orphan.
THEY INJECTED ME
Anyango Odeny, 28, Kibera
I am a widowed mother of three, and my children stay upcountry with my brother. I live in the city, where I do all sorts of menial jobs and send whatever I can to my children back home. I have been lonely since I moved here, so one day I agreed to spend time with a man who said he loved me. When I got pregnant he just went silent, and all my efforts to reach him have not borne any fruit. I was about a month pregnant when a friend gave me a phone number belong to a man who runs a chemist shop. He gave me four pills, two to swallow and two to insert in my private parts. Two months later, nothing had happened to the bump in my tummy. I bought a pregnancy test kit and discovered that I was still pregnant. The pills had not worked, and now the pregnancy was three months old. The same woman who had directed me to the chemist sent me to a private clinic in Baba Dogo. There, they injected me with a drug and asked me to stay in the hospital overnight. I started bleeding in the middle of the night and, by the time the day broke, I could barely walk. Then the nursed discharged me and sent me to the streets. I do not know how I got here (at KNH), but I have been here for two weeks now. I am healed, but I cannot go home because I do not have the money to pay the bills.
I SWALLOWED PILLS
Marina, 18, Mlango Kubwa
I already had one child living with my parents when I got pregnant, so I decided to terminate it. A friend who had procured an abortion before gave me a phone number to call. On the other end was a woman who works in a government hospital, but who performs abortions here in the ’hood. She directed me to her house, where she asked me how old my pregnancy was before giving me pills to swallow. As I left for home, she asked me not to mention her should anything happen. But then I started bleeding. The cramps immobilised me for a whole week. It was the hardest moment of my life. I had no one. My boyfriend always had my back but he was lynched for stealing. Now I live with my friends who are also struggling to get through life. We live in a one-room house for which we pay Sh2,000 in rent a month. My parents don’t talk to me because I have always been a disappointment. My sister is a nurse, the others are also working in good jobs but I scored a C- in KCSE and got pregnant later. My parents take care of my child.
I BLED IN AMATATU
Mary Mugure, 22, Kangemi
On the day I woke up feeling something hard in my tummy, I went to the hospital thinking I had a stomach upset and I was told I was expectant. My boyfriend thrashed me when I broke the news to him, and then he vanished. I was terrified. I have a one-and-half-year-old daughter already and another child would have been too much for me to bear. After primary school I came to the city to “hustle” and send money home to my mother and six siblings. I am the first born, my mother is unemployed, and my father does not live with us. There was no way I was going to keep that child. So I asked my friends at the salon where I worked what to do. A woman told me all I needed was Sh1,500 and she’d help me sort out the mess. I worked hard and raised the money, then she directed me to a man who worked in a chemist. He gave me a pill to swallow and another to insert down there. On the way home I sat at the back of the vehicle, and every bump felt like a thousand needles pricking my womb. After a few minutes, blood started streaming down my legs. The tout noticed what was happening and asked everyone to alight so that they could rush me to KNH. The nurses told me they had to wash my uterus. It was so painful. I have been here for two weeks. I have no money to pay so they have detained me here. When I called my parents they told me to look for money and go back home. They did not comment on anything about what happened to me or whether they would help me get out. My cousin, with whom I live, said she is too busy to visit me.
I DRANK A CONCOCTION
Nafula Wekesa, 17, Mlango Kubwa
I was waiting to sit my national exams at Lugulu Girls’ in 2015 when I met a boy I really liked. We only did it once and I got pregnant. As I was waiting for my results, I told him about the pregnancy and he denied being responsible. So while in the village, I was directed to another woman by my friends in the village. I visited the woman and she gave me some bitter herbs. The concoction tasted awful. I cannot describe the pain I felt a few hours after swallowing the liquid from those herbs. The bleeding made me dizzy. I did not mention it to my parents. They had struggled to educate me and they would not have approved the possibility of me bearing a child and shaming them before wedlock. I stay with my cousins in Nairobi and wash clothes for a living, hoping that one day I will join university to study medicine.