Why Do Kenyan Women’s Lives Matter So Little?
Maternal health in Kenya has been at the forefront of the country’s agenda. The Jubilee government implemented free maternal healthcare in all public hospitals as its first action in office. The waiver took effect on June 1st 2013 and was in a bid to reduce maternal mortality in the country. Maternal mortality is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. The Constitution of Kenya, 2010 provides the framework for free maternal health services. Article 43(1)(a) states that: ‘Every person has the right to the highest attainable standard of health, which includes the right to healthcare services, including reproductive health care.’
Goal 5 of the United Nations’ Millennium Development Goals (MDGs) is to reduce the maternal mortality rate by 75% by 2015. The 2010 maternal mortality rate per 100,000 births for Kenya was 488. Kenya had committed to reduce these deaths to 147 per 100,000 by 2015. 2015 is here and Kenya is a long way off from achieving this. The reasons for the high maternal mortality rate include: pregnancy complications, lack of access to quality health services and lack of adequate information for the pregnant women. The First Lady of Kenya, Margaret Kenyatta, has been spearheading a campaign ‘Beyond Zero’ that seeks to reduce maternal and child mortality that has seen delivery of mobile clinics to various areas in the country.
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.
Article 26(4) of the constitution states, abortion is permitted when ‘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.’ According to the Ministry of Health study, ‘Incidence and Complications of Unsafe Abortions in Kenya’, an estimated 157,762 women received PAC (Post Abortion Care) for complications of induced and spontaneous abortions in 2012. Spontaneous abortion refers to a miscarriage. These numbers are quite high and cannot be ignored.
In September 2012, the Ministry of Health went a step further by launching the Standard and Guidelines on Reducing Maternal Mortality and Morbidity from Unsafe Abortion. The Guidelines were created through the effort of various stakeholders (including representatives of religious groups) and were to give detailed direction to health professionals on the implementation of termination of pregnancy in accordance with Article 26.
On December 3rd 2013, the guidelines were withdrawn without an explanation or involvement of the stakeholders who had participated in its development. In Feb 2014, the Director of Medical Services issued a memo to all public and private health workers stating: abortion on demand is illegal and that there’s no need for training of health workers on safe abortion care or the use of the drug Medabon for medical abortion.
The memo has led to confusion among health workers as to the grounds under which abortion is legal, thereby denying women access to safe abortion services. Health workers are afraid to provide safe abortion services to the women who need them and who fit the requirement that is in the constitution, as they are worried of disciplinary action against them. Post Abortion Care on the other hand, is not only legal but is overwhelmingly sought.
It’s strange that rather than prevent complications arising from abortion, the strategy is geared towards dealing with the ugly consequences of unsafe abortion which end up draining more public resources than preventive care ever could. The majority of women that are suffering are from unprivileged backgrounds. This is a failure of the Kenyan government in protecting the right to the highest standard of healthcare including reproductive healthcare to women.
Abortion is an emotive issue. These emotions are further fuelled by religious and cultural beliefs held by the majority of Kenyans. The issue is so explosive that it was a major problem when it came to passing the new constitution in 2010. However, the constitution is clear. Abortion on demand still remains illegal. Abortion in the case of emergency is legal, however.
Article 26(4) of the constitution is clear and yet the Ministry of Health is creating confusion through the intimidation of health workers. Why? Is the answer what we have been afraid to admit, that women’s lives don’t matter enough? Or perhaps, even worse, Kenyan women’s lives only matter when the issues they face neatly fit into our various belief systems? If our lives truly mattered, the implementation of Article 26(4) would be a non-issue.
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I found this article quite interesting. This is one of the hardest things to talk about because I believe that abortion shouldn’t take place, but the problem is, the reason why abortion is so widely done, despite the fact that it is illegal. Its an alarming rate that Kenya has among the highest maternal deaths caused by abortions. Something needs to be done about that, not politically, but socially.