Legalise safe abortions, once and for all

Unsafe abortion is one of the causes of maternal deaths, accounting for 13 per cent of all maternal deaths globally, according to the World Health Organisation (WHO). Abortions are safe when carried out by a skilled person using a method recommended by WHO and that is appropriate to the pregnancy duration.    

Such abortions can be done using tablets (medical abortion) or a simple outpatient procedure. Unsafe abortions, however, are the kind carried out either by an unskilled person or in an environment with minimal medical standards, or both.

The people, skills and medical standards considered safe in the provision of induced abortions are different for medical abortion (performed with drugs alone), and surgical abortion (performed with a manual or electric aspirator). Skills and medical standards required for safe abortion also vary depending on the duration of the pregnancy and evolving scientific advances.

Annually, 22 million women have an unsafe abortion worldwide and virtually all (98 per cent) occur in developing countries, says WHO. Data from four years to 2014 reveal that about 45 per cent of all abortions worldwide were unsafe and one-third of all abortions were performed by untrained persons using dangerous and invasive methods.

In Africa, nearly half of all abortions are unsafe with the mortality disproportionately affecting women in a continent which accounts for 29 per cent of all unsafe abortions with 62 per cent of unsafe abortion-related deaths.

In Kenya, for instance, over 3,000 women die of complications of unsafe abortion and another half a million more suffer short and long-term morbidities, annually. A 2012 national study involving 328 public and private health facilities reported that almost 465,000 induced abortions occurred, translating to a national abortion rate of 48 per 1,000 women of reproductive age (15- 49 years).

In Kenya abortion is illegal, except “in the opinion of a trained health professional, there is need for emergency treatment, or the life or health of the mother is in danger, or if permitted by any other written law”. On the other hand, the Penal Code Cap 63, Laws of Kenya, sections 158-160 criminalizes the procurement of abortion as well as the supply of drugs or instruments for procuring abortion.

Yet, research shows that restrictive laws, poor/availability of services, high cost, stigma, conscientious objection of healthcare providers, and unnecessary requirements, such as mandatory waiting periods, mandatory counselling, provision of misleading information, third-party authorization, and medically unnecessary tests that delay care are impediments to safe abortion services.  

In 2010 Kenya ratified the Maputo Protocol (2013) committing to ensure that the right to health of women, including sexual and reproductive health is respected and promoted and appropriate measures taken to protect the reproductive rights of women by authorising medical abortion in cases of sexual assault, rape, incest, and where the continued pregnancy endangers the mental and physical health of the mother or the life of the mother or the fetus.

Because abortion is highly stigmatised in Kenya, deaths and disability due to unsafe abortion is difficult to measure partly due to underreporting and that current data within Health Information System (Dhis2) in Kenya does not capture deaths and complications.

This happens on the face of about 120,000 women annually receiving care for complications from unsafe abortions with three-quarters of the victims treated for moderate or severe complications-with young women accounting for 45 per cent of patients aged 19 and younger who reported for post-abortion care or experienced severe complications, according to the Ministry of Health.

The women were from diverse social-economic backgrounds, but significantly, more than 70 per cent of those who sought post-abortion care were not using contraception. Pregnancy with abortive outcomes contributed to of 8.3 per cent of maternal deaths, reports the Ministry of Health.

Indeed, unsafe abortions are so rampant and call for urgent safe abortions to reduce this problem. Although abortion is legal in exceptional circumstances, it remains largely illegal causing a dilemma for service providers and safe abortions are thus provided in a clandestine manner. Advocacy for safe abortion faces many challenges including traditional norms and entrenched religious beliefs. Strengthening advocacy for safe abortion requires the engagement of various stakeholders.

Kenya has post-abortion guidelines that are currently being disseminated and supported by several implementing partners. These guidelines partly address the policy environment for offering safe abortion services, training of health workers, information dissemination, availability of MA drugs and MVA kits, space to offer services, attitudes and commodity management in the facilities.