Urgent Evoke

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Abortion and maternal mortality - Breaking the Silence

On April 08, 2010 the WomenWatch news feed posted a story on the UN-led campaign to provide affordable health care for Indian women in a bid to improve access to maternal and child health services. This reminded me of a post I wrote on international women’s day this year, in memory of women lost during child birth an issue that is near and dear to my heart.

Every minute somewhere in the world a woman dies in pregnancy or childbirth. In my country Kenya, 22 women die each day from pregnancy related complications - 80% of these deaths are preventable. Official statistics show that 30 to 50% of all maternal deaths in Kenya are directly attributed to unsafe abortion. Abortion is illegal in Kenya and only allowed when a woman's life is in danger. Despite this about 300,000 terminations take place in Kenya each year with an estimated 20,000 women and girls being admitted with abortion-related complications in the hospital.

According to the World Health Organization (WHO) nearly 42 million women faced with an unintended pregnancy have an abortion each year 20 million of which are unsafe abortions. What is an unsafe abortion? These are numerous and include:

  • The use herbs, roots and leaves inserted into a woman's vagina in order to remove the foetus. This is usually done by traditional midwives
  • Inserting sharp objects like a coat hanger, knitting needle, bicycle spoke or a stem of a local herb into the vagina or cervix
  • Ingesting high doses of malaria pills
  • Some girls/women visit shady clinics who do not meet minimal medical standards, are unsanitary and lack blood and oxygen supplies and whose staff generally lack knowledge of anaesthesia obstetrics or gynaecology.

There are many reasons for the prevalence of abortion in Kenya. Pregnancy out of wedlock is scorned, with many girls ousted from school and even from home once it is obvious that they are pregnant. Because abortion remains shrouded in secrecy it is difficulty to initiate positive action. Funding policies by some donor agencies restricts provision of funds to organisations that provide abortions, lobby for them or in any way facilitate them further silencing activism.

Is legalizing abortion the answer? Is the pro-choice argument a women’s reproductive health right issue or a human rights issue? Do we make contraception more available to girls and women to reduce the incidence of unplanned pregnancies? How do we reconcile possible solutions with Kenyan law, cultural and religious beliefs? Please share your views and let us break the silence and reduce maternal mortality today.

Views: 65

Comment by nomadHAR on April 9, 2010 at 9:01pm
while i am Pro-Choice (which means i believe women should have the right to choose to have an abortion), i live in an area of the USA that is strongly against abortions. in Oklahoma, they actually passed a law that uses a looph*** to reveal any and all women that have abortions, making them vulnerable to retribution. they publish all identifying information except for the name, and that information can be easily used to determine the identity of the woman. thus, i am familiar with extreme resistance to Pro-Choice.

i think this situation that you described makes this a health and human rights issue. access to proper medical care is a human right (which is why i am for socialized health care in the USA, but that is another issue). women are DYING in Kenya and other places in the world because of lack of access and lack of options; it still just shocks and saddens me that some people still fight against this for POLITICAL reasons.

i am sorry that i do not know much about culture in Kenya, so i have some questions for you.

what is the level of resistance in the culture and community to legalizing abortions and the use of contraceptives? do you think it is possible to try to change and reverse that resistance?
Comment by Michele Baron on April 10, 2010 at 3:01am
Many hospitals in the US call even miscarriages "abortions" and make information available as if losing the baby were a crime and the fault of the woman. Health issues should not involve judgements of "fault"
Proper health care should be a human right, abortions are not the only poorly-supervised "medical" practices that endanger women's health and raise mortality rates.
Comment by Benjamin H on April 10, 2010 at 12:12pm
The first step needs to be a combined push for female education and access to contraception. I believe that this will reduce the number of women who need an abortion. This will also lower the rate at which STDs/STIs spread.
Comment by FRANCIS ORONDO GWER on April 10, 2010 at 2:25pm
what i may want to know, and maybe you can find out for me is that in countries where abortion is legal, is it a legal 'carte blanche' such that as long as a woman wants an abortion she can go and procure one, or are there some restrictions imposed as to the circ***tances when one can get an abortion?
i am pro choice but against the idea of giving a free hand to procure an abortion whenever ones wants. it should be with some restrictions, like if the woman was raped, or is a minor. if we allow a free hand, it will mean that the society is seeking escapism by not dealing with the circ***tances that necessitated the need for the abortion in the first place, like inadequate education on contraceptives options available, dealing with unsafe sex and such.
those issues need to be sorted out first before we can talk about abortion.
Comment by Edwige Lelievre on April 10, 2010 at 5:12pm
In France, abortion is a right for women since quite a long time, and it is relatively easy to access. It has been a really tough time when the law was voted (like in the USA right now), but now it is just normal for the majority of the population that this right exists. It doesn't mean everyone should abort or have sex without thinking of consequences. It just means, when there is no other choice, you can do it safely.

Even if medically, abortion is safe in France now, it is still really hard to deal with (painful both physically and emotionally) and it should be avoided as much as possible. Actually I don't really think any women in the world was ever happy to do that, it was just the less worst solution.

It is really important to teach as soon as possible contraception to children, boys and girls, and to give an easy access to it to avoid undesired pregnancy and abortion.

More generally, I think it is important for women to have the choice of having child, and when to have them. France has the highest natality rate in Europe, so the possibility to abort safely and to access contraception is certainly just a better things for families. For instance, in Poland or Spain where abortion is illegal or very hard to access, the natality rate is much lower !

I insist on the fact that sometimes, there must be a political will to change things even if the people disagree, if it is for greater good. European construction, for instance, was not something French and German people would have agree to in 1952. But it was a real good thing that stops the cycle of war in West Europe.

So I really hope politicians of the all world to be brave about contraception and abortion ! There are just too many death !
Comment by nomadHAR on April 10, 2010 at 5:41pm
is it rational to think that women get abortions just for fun? that women would just go out and get abortions all the time if it is legal? of course not. those are the same kinds of faulty fears and beliefs that i keep hearing from bogus conservative PROPAGANDA. there are men out there that are absolutely terrified of the thought of women having rights, so they spread LIES that cause people to go against legalizing abortion.

it is a harrowing and painful procedure, as far as i know. i wish for the procedure to be as safe as possible, as it has been shown time and time again that desperate women will resort to dangerous and sometimes deadly methods. this safety is only assured when the procedure is legal.
Comment by Cynawynn on April 10, 2010 at 7:10pm
@nomadHAR We're fighting against that law

I have often wondered how the anti-abortion crowd gets away with calling themselves pro-life as if anyone who disagrees with them is anti-life. I wish they were as concerned about the life of the mother. And sadly they also tend to be the same people who vote against any measure intended to improve pre-natal care, early childhood development of health care for all children.

Changing the definitions and assumptions of the for and against groups seems to be one place to start in any country.
Comment by Shakwei Mbindyo on April 11, 2010 at 6:22am
Thank you all very much for your feekback.
@nomadHAR Kenya is predominantly christian and there is very aggressive resistance to legalizing abortion. Aside from religion, culture is also an issue. Many parents do not speak with their children about sex. Traditionally this was a task for aunties but with the steady disintergration of family and cultural structures, many girls receive sex education from friends. One fear is the providing information / condoms to the youth is like telling them that it is ok to have sex.
@Michele / @Cynawynn - a question that many Kenyans are asking is who will speak for the unborn child? Many equate abortion with murder.
@Francis, as @Edwige has indicated, legalizing abortion means that anyone can procure one as they wish. I believe in most (all?) countries there is a speification on how many months along you are which doctors will not (should not) provide abortion services.
Comment by Oliver Hohlstein on April 11, 2010 at 6:21pm
Great article, Agent Shakwei.

In Germany, as far as I know, abortion is legal in the first three month of pregnancy. After that, it is only legal if special conditions are given (e.g. if the pregnancy is the result of a rape or if the birth would endanger the mother's life). There are maybe some groups who disagree with this law, but they are not as loud as maybe in the USA.
The current system in Kenya as you have described it, seems somehow hypocritical to me. Young people are left alone when it comes to sex and then they are doomed if they get pregnant.
Personally, I consider myself a christian, though I still would support a pro-choice attitude in this area.
Maybe if the culture could provide excellent care for children to mothers who couldn't raise the child herself and if young mothers would get constant medical care during pregnancy, maybe I would reconsider my choice. I can see the "christian" point in not wanting to destroy any kind of human life ... the three month time in the German law seems a bit arbitrary (is the unborn child alive after three month and one day when it was not alive the day before?)... but the life must still be lived. If Kenya really wants abortion to be illegal, it should provide better education and better care for unwanted mothers.
The worst thing I can imagine is a mother who is forced to raise a child she doesn't want. A hell for both the mother and the child. :(
Comment by Yumna Moosa on April 11, 2010 at 6:48pm
Abortions are legal in South Africa. Up until 3 months, a woman can have her pregnancy terminated on request. Under special circ***tances (including rape, incest, poverty, etc.), it can be terminated between 3 and 5 months, and after 5 months only if there is serious risk to mother or baby.

When the new laws came in (in the mid-90s I think), maternal deaths due to unsafe abortions plummeted. But they are once again on the rise. The reason?

Our wonderful Constitution, that so carefully protects our human rights, protects the health care worker's right NOT to perform a termination of pregnancy. The mother's right to access to safe abortions is up against the doctor or midwife's right to freedom of belief. However, they are legally bound to refer to a safe abortion practitioner.

And the majority of my medical school class at the University of Cape Town refuse to perform abortions. It is scary. My plan: at graduation, pass around a list of names and contact details of the people in our class who WILL perform abortions. At least this way there's no excuse not to refer... ;)


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