Bottlenecks in the law against abortion fueling deaths in post abortion care

Monday, April 29th, 2024 07:00 | By

Remove hurdles that stand in the way of safe abortion for women in the country, especially teenagers, a group of civil society organisations and individual pharmacists have urged the government.

The argument is that even as the country’s laws have criminalised abortion, unintended pregnancies among young women in Kenya are still on the spiral, same as unsafe terminations of pregnancies, and in[1]creased trips to pharmacies for emergency contraceptives.

This, Steve Biko, the User Centered Design Advisor with Ipas Africa Alliance, says, calls for an urgent solution. “Almost half of all pregnancies in Kenya are unplanned, and 41 per cent of that end in abortion,” he said during a workshop bringing together several reproductive health rights activists and pharmacists. Rethink law Biko and the other activists’ arguments are based on the availability of abortion drugs through the law, yet the same constitution has criminalised post-abortion medication.

“So, currently in Kenya, medical abortion drugs have been enlisted in the essential drugs list, meaning that this has made them more available through different channels, including clinics and in pharmacies,” he explained, calling on the government to rethink this law, and possibly subject it to a review, to make it easier for young women to access safe abortion when it is necessary.

It should be of great concern to everyone, especially to those who are in power, the activists argued, that the rising number of deaths related to unsafe abortion and post-abortion medication, should be brought down through removal of harmful barriers and collaborative efforts.

“So for the young women and girls who are accessing the medical abortion drugs through pharmacy channels, are not safe as the available pharmacists, mainly focus on drug composition and dispensing, but lack the necessary capacity to provide comprehensive care,” Biko said, explaining that these pharmacists can’t counsel properly, support follow up medication, and everything that defines comprehensive care.

Expand services He argued further that because of the distribution, and perhaps the location of the pharmacy, and the fact that people are going there to seek services, if the pharmacists had the requisite capacity, they could provide a good opportunity to expand contraceptive services- especially for these people who are terminating pregnancy.

Diana Elima, a young pharmacist operating in Nakuru, where a project; Post Medication Abortion Contraception in Pharmacies in Kenya is being piloted, confirms that even as the government continues to criminalise abortion issues, pharmacists are dispensing Medication Abortion (MA) drugs.

Speaking to People Daily, Elima is advocating for the removal of bottlenecks that hinder proper attention to a number of issues around abortion that are likely to fuel fatalities among young women and girls seeking abortion through the backdoor.

“As a pharmacist, MA should be legalised because when you look at the current data, 49 per cent of women get unintended pregnancy, and out of those, 41 per cent end up doing MA, and now despite the government criminalising it, on the ground things are different,” she said, and noted that if they continue with the trend, the maternal mortality rate will continue increasing.

Issues around stigma, unfriendly healthcare system, poverty and sexual gender-based violence, she argues are fuelling the search for backdoor medical attention among this age group, between 18 and 25 years old.

“It’s high time the government relooks this law, which we consider retrogressive so that we can ensure we are preventing deaths caused by backdoor abortions by these young girls, because they get stigmatised leading to them doing it clandestinely.

“So most of the time, they will not go to a health facility, because they know they will be stigmatised,” she said.

“To remove the fear, reduce stigmatisation. That it will prevent deaths,” she added.

The young women and girls, most of them, her clients, she said, cite economic challenges, unintended pregnancies through rape, and others due to single motherhood, and therefore, MA for her, becomes the best ready option.

“This group is usually financially challenged, and can’t even afford to procure contraceptives, and opt for MA to terminate the pregnancy,” she said.

In order to ensure women’s access to contraceptive information and care after using medication abortion, Ipas Africa Alliance, Impact 4 Health, Think Place, Population Council and Nivi, are in the process of validating the pilot project, through some findings, in order to have it rolled out to the country.

“So this project seeks to develop solutions that are scalable, evidence-based and are able to improve contraceptive use rates among women who are ending their pregnancy outside the health system,” Biko said.

Training on family planing He explained that the difference between a health system and pharmacy is that the former has an array of cadres that can deal with many conditions, whereas pharmacy has one trained on drug composition and dispensing, so provision of quality care is not really possible within that kind of set up.

“But if you train them on the provision of family planning wholly, then they can be able to support those managing the pregnancy, to facilitate access to contraceptives, and prevention of unintended pregnancy leading to termination. An estimated 49 per cent, and annually, around 464, 000 of induced abortion happen every year.

This represents, partly, those that are considered a backdoor avenue for abortion drugs, he said, noting that in terms of maternal mortality, deaths associated with abortion, and 13 per cent of maternal mortality and injuries are directly associated with abortion.

So the project, he said, brings together partners who operate within the contraceptive space to develop strategies that they can be able to reach these women and girls, but also strengthen the role of the pharmacist to provide contraceptives.

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