Unsafe Abortion: What is the Way Forward?

By Isaiah Esipisu

Though Kenya does not have clear legal structures to allow abortion services to be offered in any of its health facilities, the Kenyatta National Hospital receives more than ten women seeking post-abortion care services every day, an indication that the practice is rampant in the country.

According to Dr Njoroge Waithaka, a consultant obstetrician and gynaecologist at the hospital, most women who present themselves for the services have already suffered life threatening injuries, some that may lead to permanent health complications or even death.
“The patients sometimes come with rotting wounds around the cervix area, perforated uterus and sometimes with injured abdominal cavity suffered in attempts to procure abortions,” said Dr Waithaka.

Most of these injuries, according to the expert, are caused after crude equipments are forced into the uterus to induce bleeding thus interfering with the developing foetus.

“Interviews with the patients have revealed that some of them push coat hungers through the cervix, some use sticks, while most of them use crochet needles to induce abortion,” said the gynaecologist.

However, several other cases have been witnessed at the hospital where patients come with urine catheters abandoned inside the uterus, an indication that such cases are likely to have emanated from an environment of a clinic or a health facility.

A catheter is a fine tube inserted into the body to introduce or remove fluids. The urinary catheter that passed by way of the urethra (the duct that leads urine away from the bladder) was the first to be used. But in today's practice, catheters can be inserted into blood vessels, either in the limbs or trunk, to provide blood samples and local pressure measurements. Catheters may also be used to deliver drugs or nutrients directly into the bloodstream.

“Perforation of the uterus and injuring of the gut is life threatening. It can easily lead to excessive bleeding, hence to death, or it can lead to impotence. Some patients develop tetanus through the wound, while some induce gas into the uterus, which is also very dangerous. This happens mainly because most people who offer such services do not understand the human anatomy,” said Dr Waithaka.

Experts say that main complications associated with unsafe abortion include heavy bleeding, damage/injury to the uterus, intestines and other organs, infection (post-abortion sepsis), infertility and related disabilities, social and psychological consequences, and sometimes death.

At the same time, some women drink chemicals, detergents and take excess medical drugs to induce abortion. Such cases are sometimes treated as food poisoning or attempted suicide. However, as a result, those who survive sometimes become impotent or develop stomach ulcers.

Studies have indicated that women seek abortion services, whether safe or unsafe because of various reasons ranging from pregnancies as a result of rape, incest, health reasons, socio-economic reasons among many others.

Statistics
Prof Joseph Karanja, an Associate Professor of obstetrician and gynecologist at the University of Nairobi quotes a UN report which indicates that 380 women globally become pregnant every single minute. Among the pregnancies, 190 are unplanned or unwanted. 110 of the women experience a pregnancy related complication, while 40 procure unsafe abortion, which leads to death of one of them.

And on the African continent, 100 women die as a result of unsafe abortion every day, according to statistics by Ipas Africa Alliance for Women’s Reproductive Health and Rights.

In Kenya, official government statistics indicate that 800 women procure unsafe abortion every day. As a result, 30 to 50 per cent of all maternal mortalities in the country are as a result of unsafe abortion. As well, the government spends Sh19 million of taxpayers’ money every year to treat post-abortion related complications.

Policy
And now experts say that the solution lies in drafting of clear policy guidelines that will allow health facilities to offer safe abortion services whenever the patients have valid reasons for it.

“Even without clear legal structures in place, abortion is happening on daily basis due to reasons best known to the survivors. And since it is perceived to be illegal, most of them do it unsafely, thus threatening their own lives,” said Prof Karanja.

However, this remains a delicate issue because some religious groups, individual moral values and some organization do not justify any act of abortion for any given reason.

But according to Abdullatif Sheikh of the Supreme Council of Kenya Muslims, the Muslim religion permits any woman to have an abortion for valid reasons during the first three months of pregnancy.

“All Muslim scholars agree that the foetus changes to a human being after 120 days of conception. But after the stage of ensoulment, abortion is completely prohibited except where it is imperative to save the mother's life,” he said.

According to some legal experts, developing clear policies on safe abortions could easily reduce related deaths by a big percentage. “Evidence from countries with progressive safe abortion laws do indicate that appropriate laws, policies and services can eliminate deaths and injuries related to unsafe abortion,” said Winfred Lichuma, a commissioner with the Kenya National Commission of Human Rights, and a former magistrate.

However, Dr Waithaka says that remedies have to include safe usage of contraceptives and other family planning methods including abstinence, introduction of a care center for children born as a result of unwanted pregnancies especially among the poor, and introduction of abortion friendly laws.

So far, all countries in the developed world have liberalized their laws on safe abortion, though with difficulties. As a result, injuries and deaths due to the act are said negligible.

Technology Yields to Water in Eastern Kenya

By Isaiah Esipisu

Residents of Katitika village in the Eastern part of Kenya have always stared into the azure blue skies. Pondering and wondering of when the heavens will release the elusive rains. They need water to plant food-crops, harvest some for drinking and domestic use, and restore their shallow wells.

The entire Kitui district is dry. Really, dry. The last drop of the rain was seen three years ago.

Yet for their survival, residents of Katitika village have to trek 11 kilometres to the seasonal Kaiti River, where they sink a well at its base to tap the underground water.

But last month, technology came to their rescue, thanks to the mobile telephony network coverage in the area. They watched with excitement as the Kenyan Minister for Water and Natural Resources Hon Charity Ngilu officially opened a water pump that is fully operated by technology, within the village.

Safaricon, a communication company in collaboration with Grundfos Lifelink, a division of the Danish pump maker Grundfos Group, had developed a solar-powered, pay-for-use water vending system using an M-PESA payment method.

M-PESA is an innovative money transfer system using a mobile phone. The system, which allows cash to be deposited on a phone, can be used to pay bills, buy goods and services and transfer cash from one person to another within the network coverage area.

To access the water, residents have been supplied with smart cards, which are charged using the M-PESA. The solar-powered borehole is activated using the card, which allows water to flow until either the card is removed or the user’s account runs out of credit.

“For the system to operate, we have connected the water pump to 18 strong solar panels, which supply power to the battery bank all day long. 14 of them supply power for the pumping system, and the remaining four provide energy for other electronic systems,” said Edgar Kaniu, the lead engineer of the system.

“This is a blessing to our community. It is unbelievable that we can now access water very easily from a village pump. This is amazing,” said Wanza Mwende, as she watched the site tirelessly with hands- akimbo.

According to Kaniu, the project is owned and will always be run by the community members of Katitika village. However, they will have to pay off the cost of construction for a full ownership.

“The means of payment is simple. The credit card is customised in a manner that every 20 litres drown charges three Kenya shillings. In other words, one US dollar can fetch 500 litres of clean water, per litre billing,” said Kaniu.

The money is electronically received by the Safaricom Company, and is used to pay off the $41,000 loan.

So far, the pump serves 6000 litres on average, generating close to $360 a month. “Once they finish paying the loan, they can decide whether they want the cost of a litre of water to be lowered, or remain the same so that they use it as a business venture and collect profits.

Similar facilities have been constructed in other parts of the Eastern province including Yata, Ruiru, and Kalukuni.