On August 4, 2013, Mary Omollo (not her real name), a young house help, was frog-marched from her home in Nairobi’s Mathare slums to Muthaiga Police Station. She was accused of procuring an unsafe abortion.
Mary was humiliated in the full glare of the media. More importantly, she was kept in custody without any medical attention.
The police had treated her like any other criminal, and over the course of her two-day detention, she risked infection, bleeding out and even death.
When she walked into court, blood was still dripping down her legs, staining her weatherworn skirt in dark, angry patches.
Thankfully, on noticing the bloodstains, the magistrate gave directions that she first receive medical attention.
In Kenya, unsafe abortion remains one of the five leading causes of maternal death. While abortions remain illegal, post-abortal care – the medical treatment given to a woman after she has had an induced abortion – is legally considered an emergency medical intervention.
Yet many women die because they do not receive adequate post-abortal care.
A 2013 national study by the Ministry of Health estimates that there are 464,690 induced abortions annually, although these numbers sadly represent the known cases of women who go to hospital when things get worse.
The study also revealed that severe complications most commonly occur amongst girls aged 10-19 years.
In 2018, the ministry again launched a study that revealed that the costs of managing complications from unsafe abortion are substantial, ranging between Sh433 million and Sh533 million.
These costs are calculated based on extended hospital stays, intensive care and attendance by skilled health providers.
Public health facilities continue to bear these costs and there has been little effort to avert this crisis.
And while the ministry does not dispute this data, to date it lacks guidelines to regulate access to safe abortion.
Then Director of Medical Services suspended existing guidelines in December 2013, citing “a lack of stakeholder engagement”.
The suspension of the guidelines was thereafter followed by stern letters warning medical providers of dire consequences should they participate in any trainings on safe abortion.
As such, nothing much has been done to put in place systems to guide medical providers on how and when to offer safe abortion services as regulated in the Constitution.
Yet our Constitution reassures women of their right to life. It guarantees women the right to emergency medical treatment and the freedom to enjoy their reproductive health.
The law further bestows an obligation on medical providers under Article 26(4) to offer safe abortion services if, in their opinion, the life or health of the mother is in danger.
The absence of an enabling policy framework has therefore contributed to fear amongst medical providers who are often in doubt of the circumstances under which to offer services.
The absence of guidelines has also led to criminalisation of abortion by police officers who do not appreciate the legal bandwidth granted to perform safe abortion.
This leads women to backstreet abortions even when they qualify for safe and legal options.
This leads to deaths and malicious prosecution of medical providers.
Interestingly, many of these criminal cases ultimately end with acquittal of the healthcare provider, but in the meantime many women and health providers continue to suffer stigmatisation and prejudice as a result of this gap.
After we celebrated International Women’s Day on Friday, what better gift can Kenyan women get than for the Ministry of Health to re-instate the guidelines on safe abortion?
The day, celebrated every year on March 8, is a time to reflect on women’s political, economic and social achievements.
The 2019 campaign theme, #BalanceforBetter fits perfectly with the call to Cabinet Secretary Sicily Kariuki to reinstate the guidelines on access to safe abortion to protect women like Mary who need this kind of protection.
The writer, a lawyer working on maternal health matters, is the Deputy Director of KELIN and an Aspen New Voices Fellow.