As the effects of the pandemic bites, women and girls are losing their reproductive health, with some turning to unsafe abortion due to dire economic situations.

Jasmine Atieno @sparkleMine

With the pandemic hitting its core in Kenya, lifestyles became harder to manage, especially for families already living from hand-to-mouth.

For Lucy Kwamboka*, a mother of four and in an early pregnancy, everything seemed at stake. 

“My husband is a mason, and we depended mostly on what he got. I get called to wash clothes for people and when this happens I am able to support where needed. Things were already hard as they were.

And when the first Covid-19 case was announced, everything shut down. There was no work for my husband, and no one allowed visitors to come to their houses; so no work for me either.

As much as we had accepted the pregnancy, the outbreak changed everything,” says Lucy.

Using homemade herbal infusion, she initiated a miscarriage in early September.

She was not sure how things would really turn out, but a day later the pains started and became more unbearable eventually causing her extremely heavy bleeding that put her life at risk.

She informed her husband, Cyprian*, on the on goings, but he could not do anything to help then. 

“My husband left early in the morning to try get some work. The pain intensified even further. By evening, he came back, but with no money.

I had not even started going for pre-natal clinic either because I did not have any money.

It is not free; it used to cost Sh100 and nowadays, it’s Sh200,” Lucy says. 

She expressed her fear of going to the hospital as she did not know what could happen. 

“Once my situation passes for an abortion, I could be arrested or something worse, so I just stayed indoors,” she explains. 

She isolated herself while undergoing the tough, painful and most depressing experience in her life.

Luckily one neighbour called to check on her after she had complained of exhaustion the day before. 

“She told me she lost the pregnancy. We went to a nearby private hospital, but they wanted Sh8,000 to treat her.

They said they needed to clean her womb well to ensure there were no placenta remains.

Since she had no money, we were advised to get her strong antibiotics to heal the wound and a blood supplement as she had lost a lot of blood,” says her neighbour, Agnes*. 

It was a by luck that her husband came home with Sh1,000 that evening, which Agnes used to purchase drugs over the counter for Lucy. 

“After starting the dose, the placenta came out and finally Lucy was out of danger.

She had suffered fainting spells, and her stomach and legs were swollen,” adds the neighbour. 

While all these things were happening right under his roof, Cyprian felt completely depressed for his inability to do anything, afraid of going to the hospital in fear of being arrested together with his wife for abortion.

“I could not rush her to hospital because of fear of straight out being criminalised; abortion is a police case.

There needs to be a policy that protects women. At least they need to find out more before criminalising women for such.

Family planning fees should be waivered. Because my wife did not go for these things for lack of money. My hands were really tied,” he shares. 

While there are woman who have successfully used herbal arbotifants, there is never a guarantee all could end well.

A simple overdose or underdose of the same could easily send them to their graveyards. While some women have survived the ordeal, it is not an easy one to live with. 

According to Mombasa Chair, Kenya National Union of Nurses, Miriam Wambua, the pandemic has resulted to loss of income, which has made many families reconsider their reproductive health options, including terminating pregnancies. Unfortunately, she says, may resort to unsafe procedures.

Accurate information

“Complications of unsafe abortions include, excess bleeding, which could lead to loss of life, pelvic inflammatory disease due to use of crude and unsafe instruments, perforation to the uterus, which could lead to loss of the uterus eventually due to severe infection and if immediate intervention is not sought for can lead to death.

In severe cases of infection this could lead to complete infertility due to blocked fallopian tubes, she says.

Besides the physical impact there is also psychological effect due to lack of counselling and guidance from qualified personnel.

In Mombasa county, where Lucy and Cyprian live, the Reproductive Health Care Act, 2017 provides for recognition of reproductive rights and for provision of family planning services, including contraceptive options, counselling, information and education by the county. 

It also maintains the Constitutional provision on abortion, only permitting it if a doctor determines that continued pregnancy would endanger the health of the mother or that the life or health of the mother is in danger. It criminalises termination without the patient’s consent.

“The available data from 2019 shows there were 910 unsafe abortions in girls aged 10-19 years and 950 in ages 20-49 in Mombasa county.

This year only 36 cases in ages 10-19 and 212 in ages 20-49 have been reported,” Mirriam says.  

The right to health is a fundamental human right guaranteed in the Constitution of Kenya.

According to the United Nations Population Fund, good sexual and reproductive health means that people are able to have a satisfying and safe sex life, the capability to reproduce, and the freedom to decide if, when, and how often to do so.

“To maintain one’s sexual and reproductive health, people need access to accurate information and the safe, effective, affordable and acceptable contraception method of their choice.

They must be informed and empowered to protect themselves from sexually transmitted infections,” says Kenya country director at Deutsche Stiftung Weltbevoelkerung, Evelyn Samba.

She adds, ”And when they decide to have children, women must have access to services that can help them have a fit pregnancy, safe delivery and healthy baby/babies.

For too many Kenyan women and girls, reproductive health is the most debilitating barrier to their well-being. Kenya has an unacceptably high maternal mortality rate.” 

Maternal mortality ratio for Kenya stands at 342 deaths per 100,000 live births, well above the global rate of 210 deaths per 100,000.

Between 5,000 and 7,000 women die every year due to complications during pregnancy or related to childbirth in Kenya.Unsafe abortion remains a leading cause of deaths and injuries related to pregnancy in Kenya.

The 2014 Kenya Demographic Health Survey shows that unsafe abortions account for 35 per cent of the maternal deaths.

An estimated 2,600 women die from unsafe abortions annually, translating to seven deaths a day according to a study by the African Population and Health Research Centre and the Ministry of Health. 

Right policy

“Actualising the right to the highest standards of reproductive healthcare Article 43 (1) (a) of the Constitution of Kenya (2010) by passing a good reproductive healthcare bill such as the one proposed by Senator Susan Kihika, gives us a good shot at reversing these shameful and negative trends,” recommends Samba. 

The proposed bill seeks to flesh out the details of what the highest standard of reproductive healthcare means.

It covers areas of reproductive healthcare such as access to family planning, assisted reproduction, safe motherhood, and termination of pregnancy and the reproductive health of adolescents.

“Despite the differing points of view in the whole debate on reproductive healthcare in Kenya, the most important thing to be clear about is that the right to reproductive healthcare is not only a constitutional obligation, it is also the right policy decision to implement,”  advises Samba.