Abstract

In this study, a total of 519 patients were interviewed. 82.5% had incomplete abortion. The implication of abortion especially when induced is emphasised. Economic implications that are contributed by the youth are stressed. 83.6% of the patients had not used any contraception. The role of contraception in preventing unwanted pregnancy and therefore induced abortion is stressed. The role of the physician in providing contraception and appropriate contraceptive knowledge is discussed. Women with little or no source of income and teenagers account for most cases of unsafe abortions in public hospitals. Doctors say this group is disadvantaged largely due to lack of access to reproductive health services. Dr Njoroge Waithaka, the chairman of the Kenya Obstetrical and Gynaecological Society, says rich women have many options for terminating a pregnancy. "In Kenya today, women leaders who want to terminate pregnancies have it easy. They just drive to leading private hospitals, consult a gynaecologist, undergo counselling and the abortion is done in no time, although at a high cost," says Waithaka. On the other hand, poor women depend on quacks in backstreet clinics, risking their lives. Dr Sarah Onyango, the regional director of Planned Parenthood, also accuses leaders of double standards, saying well-heeled women have been easily procuring abortions abroad while making it difficult for the poor to access similar services locally. "I know of many wealthy women who have been purchasing air tickets to South Africa and even having abortions done free of charge there. But what of the poor girl who cannot afford the air ticket?" Onyango asks. In South Africa, a woman can procure an abortion if she is less than 12 weeks pregnant. Waithaka says Kenyatta National Hospital currently receives an average of 10 patients with abortion-related complications daily. "Both young and old, most come here with perforated intestines and serious injuries to the uterus, bladder, and rectum, but we do our very best to save their lives," he says. Waithaka says even after developing complications most women who have procured unsafe abortions fear visiting hospitals for proper medical attention. They will only do so when it is too late and the situation has worsened. "At times that hook may go to the right place but because this is a trial and error method, mostly, it will either tear the stool passage, the bladder or the uterus," says the Kenya Obstetrical and Gynaecological Society chairman. Statistics from Kenyatta National Hospital indicate that at least 10 women are received at the facility each day after developing complications.

"These figures might seem small but if we take into account all other hospitals, they could be appalling," says Waithaka. 300,000 abortions The WHO reports that worldwide, nearly 42 million women abort annually. About 20 million of them 19 million in developing countries do so at backstreet clinics. Of these abortions, 300,000 take place in Kenya, according to WHO. Waithaka blames this on the restrictive laws on abortion and poverty. The new constitution could portend harder times for women after the Parliamentary Select Committee inserted an even more restrictive clause in the draft saying life starts at birth. Currently, abortion is permissible under the Penal Code if a woman has been raped, conceives in an incestuous relationship or if she is of unsound mind. But reproductive health specialist Joachim Osur argues that people do not abort because it is legal or illegal. "What worries doctors is the increase in unsafe abortions that lead to death. Entrenching this issue in the Constitution is like tying the hands of a doctor, who would have saved at least one life when both are in danger," says Dr Osur. Despite the provisions in the law, desperate women continue to self-induce abortions or obtain clandestine abortions carried out by untrained persons under poor hygienic conditions. "Abortion is here to stay whether illegal or legal. The big question is how safe is it," said Waithaka. Complications WHO says about 67,000 women die annually due to complications of unsafe abortion, 17,600 of them in East Africa. Of all the women admitted to KNH due to abortion-related complications, Waithaka says half of them have severe complications, easily leading to death. WHO says the treatment of abortion-related complications in public hospitals consumes a lot of resources, including hospital beds, blood supply, medications, and often operating theatres, anaesthesia and medical specialists. Thus, the consequences of unsafe abortion place great demands on the scarce clinical, material and nancial resources of the hospitals, compromising other emergency services. Major physiological, nancial and emotional costs are also incurred by the women who undergo unsafe abortion. "That bill is being footed and might continue being footed by the taxpayers if we adopt the new constitution," said Waithaka. WHO estimates the combined impact of mortality and morbidity due to unsafe abortion at 65,000 to 70,000 deaths and close to ve million women with temporary or permanent disability due to unsafe abortion.

The abortion issue has become one of the most discussed and contentious issues in the Constitutional debate. Though both sides of the debate- pro and anti abortion- agree that there is a problem, there seems to be confusion as to a) what the problem is and b) what the solution is. The pro- abortionist claim that there are too many women dying each day due to unsafe abortions and that women need to have a choice about their bodies and health. The Pro-lifers counter that since life begins at conception, there are two lives at stake here both of which need protection and that legalising abortions will not necessarily make them safe as it will neither increase the number of registered medical practitioners nor make the conditions any safer. Both sides have used figures on the mortality rates and the number of abortions performed in Kenya per year to defend their position. What is strange however is the fact that no one seems to know where most of the quoted figures come from. Since most abortions are said to occur on so called back street clinics and even at home, it would be interesting to know where these figures are sourced. Below are three different reports from various sources, have a look and have you say According to a report by Merlin which is a body that has been operational in Kenya since 1998 and indicates that it currently works in three Provinces (Rift Valley, North Eastern and Nyanza) supporting the Ministry of health to strengthen its own capacity as well as respond to the needs of the community, the projected number of women with abortion complications admitted to public hospitals in Kenya is 20,893 per annum. An estimated 182 of these women die annually. The annual incidence of incomplete abortion and other abortion-related complications per 1000 women aged 15 to 49 years is projected to be 3. According to the Federation of Women lawyers -Kenya (FIDA Kenya) in A SHADOW REPORT TO THE 5TH AND 6TH COMBINED REPORT OF THE GOVERNMENT OF THE REPUBLIC OF KENYA, ON THE INTERNATIONAL CONVENTION ON THE ELIMINATION OF ALL FORMS OF DISCRIMINATION AGAINST WOMEN (CEDAW) and quoting research done by various organizations, 300,000 women die each year due to unsafe abortions. The report does not indicate the number if any of women who die as a result of safe abortion. It is also not clear whether the 300,000 figure is a Kenyan number or a global number, some people have however quoted it as a Kenyan figure. According to an article published in PubMed Central by Fred Mbugua, a study of abortion in Kenya conducted jointly by the Ministry of Health, the Kenya Medical Association, and two non-governmental organisations, and which covered only 60 public hospitals, it was estimated that up to 800 unsafe abortions are performed every day in Kenya, leading to an average of 2600 deaths each year.