Sarah Nduta* (not her real name) recently sought an abortion. Instead, she endured a traumatic experience where she lost huge amounts of blood and gained an infection that ravaged her body. She needed a blood transfusion to save her life. Sarah got a second chance at life, but not many Kenyan women are as lucky. A study conducted by Marie Stopes and the Ministry of Health in Kenya showed that 2,600 women die annually from unsafe abortions. This translates to seven deaths a day. Women are resorting to inserting foreign objects such as plastics, screwdrivers and metal hangers into their private parts, in an attempt to perforate the amniotic sac and terminate the pregnancy.
Despite the existence of progressive laws and policies on sexual and reproductive health in Kenya, women are still making risky decisions because these policies are rarely implemented.
Article 43 of the Constitution explicitly recognises reproductive rights as health rights. Article 26 (4) provides for medical abortion in cases where the health or life of the mother is in danger; in emergency situations; and under any other written law. Additionally, there is the Adolescent Sexual and Reproductive Health Policy; and the National Guidelines for Provision of Adolescent Youth Friendly Services. In the past 8 to 10 years, the courts have also stepped up by making transformational judgements on reproductive health, including the June 2019 landmark High Court ruling that reinstated the Standards and Guidelines for Reducing Morbidity and Mortality from Unsafe Abortions, that had been arbitrarily withdrawn in 2012, creating uncertainty as to the status of legal abortion.
But nine months after the judgment, the implementation is yet to take place. The Ministry of Health has not withdrawn the memo that led to the court case in the first place.
The withdrawal of the memo is an administrative process that is important to inform and advise medical personnel on the judgement as they are unable to implement the orders of the court without direction from the ministry.
Moreover, many health care providers remain untrained on provision of safe abortions and post abortion care.
Consequently, women continue to suffer severe health complications including sepsis, shock, organ failure; and in worst case scenarios, death.
It is easy to argue that there simply isn’t enough money to make policies like this a reality. In the shadow of looming health crises like the coronavirus scare, and the funding crisis of the national health insurance fund, providing money for policy implementation can be easily sidelined. However, great policies that are never implemented leave women like Sarah stuck between death and suffering.
Moreover, inadequate policy implementation only leads to more expensive medical outcomes in the long term. The African Population and Health Research Centre estimated that in 2012, the consequences of unsafe abortions cost the government of Kenya approximately Sh510 million ($5.1million) at current exchange rates).
Worth noting is that these grim statistics only reflect reported cases. There are many more cases that are directly tied to unsafe abortions that remain undeclared. The urgency of implementation of these policies can therefore not be over emphasised. Women cannot afford to wait any longer as decision makers continue to churn out policies that remain unimplemented.
In 1995 at the world’s women’s conference in Beijing, 189 member states of the United Nations – Kenya included, adopted the Beijing Declaration and Platform for Action that had 12 critical areas of concern to guide the main-streaming of gender in policies and strategies. Women’s sexual and reproductive health was highlighted among these critical areas. The declaration further called upon member states to commit to the advancement of the goals of equality.
On this International Women’s Day, as we commemorate the 25th anniversary of the adoption of the Declaration, it is timely for our governments to recall the commitments and act. There is dire need to stop ticking boxes; and shift from paper to practice.
The writer is a human rights lawyer