Improving maternal health is 1 of the 8 Millennium Development Goals (MDGs) adopted by the international community in 2000. Under MDG5, countries committed to reducing maternal mortality by three quarters between 1990 and 2015. Already this is currently the M.D.G with the least progress in Kenya, which is a point of major concern. When the Jubilee government took office, its first action was to implement free maternal healthcare in all public hospitals. The waiver took effect on June 1st 2013 and was in a bid to reduce maternal mortality in the country. First Lady, Margaret Kenyatta has been particularly committed to this cause, as she spearheads the Beyond Zero Campaign, an initiative that seeks to improve maternal and child health outcomes in Kenya.
According to their website, The Beyond Zero Foundation is hinged on the following objectives:
- To raise awareness on the link between good health and a strong prosperous nation, and demonstrate the centrality of good maternal and child health to this linkage
- Raise awareness on the challenges surrounding maternal, newborn and children’s health in Kenya
- Mobilize support and raise funds to support initiatives for enhancing maternal, newborn and children’s health
- Encourage women to adopt a healthy lifestyle by participating in sports activities, as well as urge them to be conscious of their health and to practice preventive health strategies.
While the Government has shown that they are making an effort to reducing the maternal mortality rates in the country, more needs to be done.
First of all, what is maternal mortality?
According to the United Nations Maternal Mortality Estimation Inter-agency Group, which consists of representatives from the World Health Organization (WHO), United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA), United Nations Population Division, the World Bank and world-renowned academics, maternal death is:
“The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.”  – Wikipedia
The 2010 maternal mortality rate per 100,000 births for Kenya was 488. As per the MDG’s, Kenya was to have reduced this to 147 per 100,ooo by 2015. However we are a long way from this.
Women die as a result of complications during and following pregnancy and childbirth. Most of these complications develop during pregnancy. Other complications may exist before pregnancy but are worsened during pregnancy. The major complications that account for nearly 75% of all maternal deaths are:
- severe bleeding (mostly bleeding after childbirth)
- infections (usually after childbirth)
- high blood pressure during pregnancy (pre-eclampsia and eclampsia)
- complications from delivery
- unsafe abortion.
Another cause for the high maternal mortality rate that simply cannot be ignored is unsafe abortions. An unsafe abortion is defined by the WHO (World Health Organization) as a procedure for terminating pregnancy carried out either by persons lacking the necessary skills or in an environment that does not conform to minimum medical standards, or both. Unsafe abortions account for up to 35% of all maternal mortalities in Kenya. Kenya has one of the highest abortion rates in the world at 48 abortions per 1000 women of reproductive age. Unsafe abortions in Kenya have long been recognized as a leading cause of maternal morbidity.
–Why Do Kenyan Women Lives Matter So Little? – Mwende Ngao
The largest proportion and highest rate of unsafe abortion currently occurs in Africa, where most countries have restrictive abortion laws, limited access to reproductive health services and high unmet need for family planning services.
In 2012, it is estimated that there were nearly 465,000 induced abortions procured in Kenya. An induced abortion is an abortion that was not spontaneous (e.g. not miscarriages); this refers to both safe/legal and unsafe/illegal abortions. Majority of induced abortions are unsafe. Unsafe abortion is one of the leading causes of maternal mortality in Kenya, with approximately 266 deaths per 100,000 unsafe abortions. This contributes to the unacceptably high maternal mortality rate in the country. However each and every one of these deaths could have been prevented.
So, what is the government doing to tackle the issue of unsafe abortions?
As part of the implementation of the 2010 constitution the Ministry of Health developed standards and guidelines for reducing morbidity and mortality from unsafe abortion. They were adopted then withdrawn in unclear circumstances. In Feb 2014 the Director of Medical Services issued a memo to all health workers stating that the constitution of Kenya 2010 is clear that abortion on demand is illegal. The memo did not clarify under which grounds abortion is legal. This has meant that medical professionals can not carry out safe abortions even if it is to save a woman’s life. The memo also stated that there is no need for training health workers on safe abortion care. All trainings were to be stopped and failure to comply could lead to legal and professional recourse. This puts the lives of women who need an abortion for medical or emergency reasons at risk because no medical professional would want to risk the legal ramifications to carry out such an abortion.
This is a move in the wrong direction, whether you are pro-life or pro-choice. First of all this memo contradicts Article 26(4) right to life which says “abortion is not permitted unless, in the opinion of a trained health professional, there is need for emergency treatment, or the life or health of the mother is in danger, or if permitted by any other written law.” While abortion in itself is illegal in Kenya, post abortion care is NOT. It is treatment given to a woman who presents at a medical facility with bleeding complications due to an incomplete abortion or miscarriage and the pregnancy is not viable. Medical care is given to the woman to evacuate the uterus and to save her life. A memo that disregards the training of health workers especially in such a delicate issue is going to do more harm than good, as a lot of women are affected by this poorly researched implementation, whether their abortion was induced or a miscarriage. This directive will limit women’s access to quality health services and expose women to untrained workers which will risk their lives. It also violates their right to health, since the refusal to provide post abortion care will cause complications or aggravate pre-existing ones. It also will affect poor women and those in remote areas more drastically.
Another reason this is a problematic issue is because it is DOCTORS, not governments who should be the people to make medical recommendations and opinions. The government does not interfere with blood transfusions and organ transplants, so it is outrageous that they are interfering with health care worker’s training and women’s access to medical information.
Laws against abortion do not stop abortion, they simply make it less safe. The number of women who seek abortions does not decrease because it is illegal, in fact more of them die. The illegal nature of the practice has led desperate women to seek alternative routes, either by performing dangerous self induced abortions or seeking back alley physicians. Because of this thousands of women die and tens of thousands are mutilated, simply because all of them were forced to behave like criminals. Sometimes a botched abortion can lead to a child being born with severe physical and mental deformities which furthers the suffering. If abortion was legalised fully it would reduce the number of deaths as abortions that are conducted by a trained provider and under sanitary conditions, typically have extremely low rates of complications. What is legal is not always right.
Legal abortions would also protect women’s health and in the long run, their lives. Women who suffer from heart disease, kidney disease, severe hypertension, sickle-cell anaemia and severe diabetes can be spared from serious medical complications that could occur either during or after the pregnancy.
One of the major arguments that is against abortion is based in religion. The Catholic Church, for example, is very vocal in matters of abortion and reproductive rights. Earlier last year, Pope Francis condemned abortion, calling it a “horrific symptom of a throwaway culture that places too little value on human life.” The Catholic Church speaks from a point of religious ideology which is perfectly okay, however religious ideology is not a foundation for any law. The Kenyan constitution provides for a freedom of religion, but what people forget is that we are also allowed freedom from it. Why should one religion mandate laws for an entire country? We live in a pluralistic society which should allow several ideologies to thrive and not just the beliefs of one faction hence why we push for the separation of church and state. Reproductive freedom is just as sacred and constitutional as religious freedom.
A free society should not invade the privacy of a woman’s body. Women must be able to control their OWN fertility. When external factors such as governments and religious institutions try to control and dictate the processes of pregnancy and childbirth, they become a burden rather than being a privilege and a gift. A lot of pro-life arguments insist that pregnancy affects the man as well therefore the choice cannot rest solely on the woman, however this is not true if you examine it critically. Women alone deal with the physiological hurdles that come with pregnancy, they alone face the risk of complications and death as they carry the child to term. It is only fair that she dictate the terms of what will happen within her body. Because of the gender disparity in the institutions that actively oppose abortions i.e.. Parliament and The Catholic Church, the decisions that affect reproductive rights are made primarily by men, who have a very limited experience in the matter. If a law would never, in any circumstance, apply to a man, a man creating that law would be viewed as preposterous. It is akin to men creating laws that ban women from voting, owning property, or showing skin in public, only that this time, these laws could be the separation between life and death.
One of the proposed solutions is to give women more access to contraceptives and other methods of birth control (which is still a matter of contention in the religious context.) No matter how many precautions one can take, accidents can and still will happen. Some households can withstand the pressure of an unintended pregnancy, however others do not. Unplanned pregnancy can increase tension in the home, disrupt financial stability and push people below the line of economic survival.
The consequences of an unwanted pregnancy can be worse than the ‘benefits’ that come from irresponsible sex, even if that benefit is a child. All family planning options must remain open. Pro-lifers say that “abortion is wrong”, pro-choicers are simply saying “abortion IS.” If performed safely abortion can be a solution that will help save women’s lives.
However as it stands, abortion on demand is illegal in Kenya, so the best way to prevent the prevalence of unsafe abortions is to prevent unwanted pregnancies. Improved access to high-quality comprehensive abortion care which includes counselling, safe and accessible abortion care, rapid and accessible treatment of incomplete abortions and other complications, contraceptive and family planning services and other reproductive health services at all levels of the country’s health system, will not only save lives, but also reduce costs to the health system.
Conversations on this matters should also stop being labelled taboo and discussed openly and freely. If you would like to see more views on this please follow the #KeepWanjikuSafe hashtag on Twitter and Google+.