Health Ministry should address mushrooming illegal abortion clinics

Many women in Nairobi’s informal settlements are not aware of what the constitution says about abortion in Kenya. I should know because I interact with many of them regularly as I go about my work.

As an individual who has been born, raised and still lives in one of the biggest slums areas in Africa, I have heard of at least 20 abandoned fetuses or newborn babies in the past few months. Some of these were discovered by someone in the area where I reside – a community gatekeeper, a garbage collector, a grocery vendor as they leave their homes early in the morning to go pick vegetables from the market and even school going children heading to classes at dawn. 

Ignorance about the provisions of the constitution on abortion in Kenya has been a barrier for most women and girls in the capital city that, for myriad reasons, want to safely terminate their pregnancies.

Most of them believe that abortion is illegal from popular and religious perspectives. The scarcity of public health facilities that offer safe abortion services and the high cost of safe abortion drive women in these informal settlements to procure unsafe abortions from unqualified providers. This is the reason local civil society groups in Mathare recently asked the government to crack down on illegal abortion clinics that have mushroomed in the area.

The stigma associated with abortions has made them to procure unsafe abortions from backstreet providers, putting their health and lives at great risk.

Unlike other places where such services are being advertised through plastered materials where people live, in Nairobi’s informal settlements, referrals are often made by dodgy individuals who just happen to know where one can procure these “same day” abortion services. 

The terminations are achieved without any pre-screening and in unhygienic conditions that don’t meet medical standards. Some of these illegal operators do perform abortions on women as far along as six months pregnant, something that has shocked many.

One study by Guttmacher found that as many as 60% of all gynecologic emergency hospital admissions are due to abortion complications. This is despite having legislation being in place that allows women to walk into a public hospital or clinic, confirm their pregnancy and gestation period, and receive a safe abortion under the parameters set in the constitution. 

It is often considered faster and easier to get an illegal abortion in Nairobi’s informal settlements because of the secrecy and anonymity provided. The backstreet providers also perform the procedures when the pregnancies are too far along to be terminated legally. 

These quacks often provide pills, which range from around KSh3,000 to KSh5,000 to abort pregnancies but have also been known to scrape the lining of the uterus with a surgical tool and use other invasive methods, some of which have proven deadly. 

Most of the women that seek these backstreet abortions are not aware of the complications that can arise from unsafe abortions which include heavy bleeding, uterine perforation, the tearing of the cervix, severe damage to genitalia and the abdomen, internal infections, pelvic inflammatory disease, blood poisoning and even death. 

Many of these illegal clinics, which are also mobile, offer no aftercare services and sever ties with patients as soon as the procedure is over. They avoid detection by law enforcement through changing contact details and disappearing when clinical complications arise, as documented reports of the same show. 

The high rates of teenage pregnancy have long been an issue when it comes to unsafe abortions, especially in our informal settlements, as healthcare providers have repeatedly raised concerns about their spike during pandemics, holidays, and times like now when many are reeling from the high cost of living.  

We need to redefine the parameters and take into consideration the mental and socio-economic well-being of pregnant women. Safe abortion is part of reproductive health, which every woman is entitled to. It is something that all stakeholders must create guidelines on, keeping in mind the constitutional limits and parameters.

Policy makers and reproductive healthcare advocates should support programs that employ harm reduction strategies and increase women’s knowledge of and access to medication abortion outside the formal healthcare system – especially in low-income regions.

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