It has been two years since Mary Mwangi's pregnancy was terminated at a backstreet clinic on the periphery of Mathare, Nairobi.
She was only 17 years at the time. According to medical reports, the gruesome procedure conducted by a quack has affected her uterus, resulting in recurring urinary tract infections.
Mary’s family has had to spend thousands of shillings to meet the cost of corrective surgery.
Mary’s case is one of many that have caused health and reproductive rights advocates to demand the gazettement of standards and guidelines on maternal morbidity and mortality that have been finalised by the government.
The advocates are accusing the government of dragging its feet as women continue to suffer from unsafe abortions.
Unsafe abortions have been reported among the main causes of maternal deaths in the country.
In 2012, almost 120,000 women were admitted to public hospitals and health centres for abortion-related complications, likely due to unsafe abortions.
An estimated 266 Kenyan women die per 100,000 unsafe abortions annually.
One key focus of the standards and guidelines is to ensure that health facilities assist women who deserve safe abortion services.
“Though post-abortion care is accessible in nearly all health facilities, it is the extreme cases that are difficult to manage,” Dr John Ong’ech, a leading reproductive health specialist in Nairobi says.
He says unsafe abortion complications that lead to heart, renal or kidney failure can only be managed at Kenyatta National Hospital or Moi Teaching and Referral Hospital in Eldoret.
“There are no other county hospitals with a dialysis machine or with the capacity for kidney dialysis,” he says.
Reproductive health advocates believe that if the guidelines are adopted, then resources will be allocated to help some of the health facilities to provide these critical services.
A case has been filed in court demanding the reinstatement of the guidelines. The petitioners are challenging a memo that was issued by the Ministry of Health in 2014 regarding the Standards and Guidelines on safe and legal abortion that were withdrawn by the ministry.
The petitioners include the Federation of Women Lawyers in Kenya (Fida), two community human rights mobilisers and an adolescent girl who developed complications after an unsafe abortion.
The ministry’s Director of Medical Services stated in a 2014 memo to all public and private health workers that the the 2010 Constitution "is clear that abortion on demand is illegal….”
According to the petitioners, the memo further stated that it is illegal for health workers to participate in training on either safe abortion care or the use of the drug Medabon for medical abortion.
The memo warned that health professionals who disregard the directive would be slapped with legal and professional sanctions.
The memo came shortly after the withdrawal of the ministry’s “Standards and Guidelines for Reducing Morbidity and Mortality from Unsafe Abortion in Kenya”, adopted in 2012 as part of implementing the Constitution and its abortion provisions.
The guidelines, withdrawn nearly a year after they were released, were said to be essential in clarifying when medical professionals could perform safe abortion services under the Constitution.
The petitioners in their case argue that the ministry’s actions have created confusion among healthcare workers and denied women access to safe and legal abortion services.
They are seeking to have safe abortions as a right recognised by the Constitution, meaning that the government would be obligated to proactively provide an enabling environment to procure a safe abortion.
The Constitution states that trained health professionals are allowed to perform safe abortions when the health or life of a pregnant woman is at risk, in cases of emergency, or if allowed by any other written law.
(Editing by Beatrice Obwocha and Henry Gekonde)