KENYA: Boosting contraceptive use to cut unsafe abortions
NAIROBI, 3 October 2012 (IRIN) – A year ago, when Peggy*, 23, became pregnant, her boyfriend abandoned her. Unemployed and already a single mother, she decided to terminate the pregnancy – and she nearly died in the process.
Photo: Siegfried Modola/IRIN – Risky business
“We have a clinic here in Dandora [a slum in the Kenyan capital, Nairobi] where an old lady helps many women have abortions,” she told IRIN. “I [bled] for two days non-stop.”
Her mother took her to Kenyatta National Hospital, where a blood transfusion and other emergency medical interventions saved her life.
Peggy knew about contraceptives, but misinformation had convinced her to avoid them. “People tell you many things about these [contraceptives]. Some say you will grow thin, others say they can make you fat and others claim you might never give birth again. I feared using them,” she said.
Despite the medical risks associated with unsafe abortions, many women in Kenya continue to seek these services. Experts say only a scale-up of access to, and promotion of, contraceptives among sexually active women can reduce it.
Abortions largely prohibited
While Kenya’s pre-2010 constitution permitted abortion only when a woman’s life was threatened, the new constitution allows the procedure when a trained health professional deems it necessary for emergency treatment, either if a woman’s life or health are in danger or if it is permitted under any other written law.
The new wording would make procuring safe medical abortions less legally risky, but according to the Guttmacher Institute, a reproductive health organization, sections of the penal code “have not been revised to reflect the language in the new constitution; thus, many medical providers may be reluctant to perform abortions for any reason for fear of legal consequences”.
According to one of the only studies available on the subject, conducted by the Ministry of Health in 2004, some 300,000 women and girls procure abortions each year – 20,000 of which lead to hospitalization as a result of abortion-related complications.
Prisca Wanderi, a traditional birth attendant who offers abortion services to women in Dandora, is kept busy by the demand. “I receive at least five women daily who want me to help them abort their pregnancies. Many of them are young girls, and they tell me they want to abort because they are not married,” she said.
Contraceptives needed
While there are ongoing efforts to legalize abortion, the strong cultural and religious beliefs of most Kenyans mean it will be some time before proponents of legalization make any real headway. Experts say that for practical purposes, the government must do more to enable women and girls to prevent unwanted pregnancies.
“Legal restriction is not deterrent enough, the government must ensure women can easily access contraceptives along other reproductive health services,” James Maina, lecturer and obstetrician-gynaecologist at Kenyatta National Hospital, told IRIN.
The unmet need for contraception in Kenya is high. The 2009 Kenya Demographic and Health Survey found that 25 percent of currently married women in Kenya have an unmet need for family planning – they would like to space their children or stop having children but are not using any form of contraception.
Shahnaz Sharif, director of public health, told IRIN the government was working to increase awareness and uptake of contraceptives. “We provide contraceptives for free in government facilities, and we create a lot of media campaigns around the issue. Through private franchising, women are able to get contraceptives at subsidized prices.”
Overcoming resistance
But Sharif acknowledged that tackling firm religious and cultural beliefs against contraception and premarital sex made spreading the message more difficult.
“Cultural and religious beliefs at times might hamper wide uptake of contraceptives, but we are trying to be diplomatic about this to have everybody on board,” he added. “The introduction of sex education in school to target adolescent girls has, for instance, been very controversial.”
Violet Murunga, a reproductive health researcher at the Africa Institute for Development Policy, a think tank, focused on the concrete steps necessary to increase contraceptive use.
“Ensure service delivery points have a choice of all methods; increase awareness of the benefits of contraceptive use to reduce myths and misconceptions related to use of contraceptives,” she said. “Train more health workers to provide contraceptive services to people who need the services; increase service delivery points where contraceptive services are available.”
