Ambiguity in abortion guidelines causing death of women and girls

The International Women’s Day provides an opportunity to reflect on the progress we have made towards gender equality — and we must as well consider the work that still needs to be done to ensure women and girls can participate with dignity as equal members of society.

Improving maternal health outcomes is an integral component in achieving gender equality. While the maternal mortality rate has declined in Kenya, the risk of women dying from pregnancy complications remains high.

According to Unicef, at least 6,000 women die every year as a result of pregnancy complications in Kenya and the country’s infant mortality rate is 22 deaths per 1,000 live births.

The key drivers for maternal mortality are post-partum haemorrhage, pre-eclampsia and eclampsia, and unsafe abortion — all of which are preventable and treatable.

Every day, seven women and girls in Kenya die from unsafe abortion. a 2012 study by the Ministry of Health and the African Population and Health Research Center (APHRC), puts the figure at 2,600 a year.

Despite these alarming numbers, the government has done little to address the issue and civil society is largely unwilling to engage on the subject.

This inertia has contributed to a high level of stigma, creating an environment where even women who need abortion due to risk to their life or health are scared or shamed to seek safe services. This stigma extends to health providers as well, who are often penalised and shunned by communities even when they provide safe abortion services.

The stigma and lack of accessibility is surprising, given that Kenya has a robust legal framework that protects sexual and reproductive rights. The right to health — including reproductive health and emergency treatment — is guaranteed by the Constitution.

Article 26(4) of the Constitution specifically permits abortion in cases where a trained health professional deems the pregnant woman’s life or health is at risk. The Health Act affirms the right to reproductive healthcare.

In addition, Kenya is a signatory to several regional treaties promoting health in general and reproductive and maternal health specifically. These include the 2001 Abuja Declaration, where signatories pledged to commit at least 15 percent of their national budgets to healthcare, and the African Union’s Campaign on Accelerated Reduction of Maternal Mortality in Africa.

Despite this, the lack of clear policies regarding access to reproductive health information and services, including for abortion care, means that we continue to lose women and girls from preventable deaths.

In September 2012, the Health ministry published “Standards and Guidelines for Reducing Morbidity and Mortality from Unsafe Abortion in Kenya”. In December 2013, the Director of Medical Services withdrew the standards and guidelines in unclear circumstances, causing confusion on when health providers can offer safe abortion services within the law.

Kenya has made big strides in curbing maternal mortality. We have a strong legal framework and policies that mandate free maternal healthcare as part of universal health coverage. Besides, the First Lady’s Beyond Zero campaign is a critical initiative that raises awareness and funds to prevent maternal death.

However, without a holistic approach to combating maternal mortality, which includes abolishing abortion stigma.

As we celebrate women this month, let us remember the sisters we lost to maternal mortality and commit ourselves to abolishing the stigma that prevents women from accessing the quality healthcare services they deserve.

Ms Opondo is the regional director for Africa at the Center for Reproductive Rights.