In Kenya, abortion is regulated by article 26(4) of the Constitution which states that: abortion is permitted (and legal) when 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. Unsafe abortion in Kenya is among the highest in Africa. According to Dr Ann Kihara from the International Federation of Gygaecology and Obstetrics (FIGO) maternal mortality is high at about 6,000 deaths per year and 17% of them are as a result of complications from unsafe abortion. Most of these cases have moderate to severe complications requiring specialized treatment and often have lasting health effects.
Despite these statistics, most healthcare providers in Kenya lack comprehensive knowledge on the laws that and access to abortion care, and the skills to effectively assess, recommend and provide abortion care within the constitutional provision. Moreover, existing adverse social cultural and religious beliefs create barriers for effective counseling, assessment, referrals, and provision of life saving comprehensive abortion services.
Through the support of the Guttmacher Institute and the International Plan Parenthood Federation Africa Region (IPPFAR), Reproductive Health Network Kenya (RHNK) conducted a training for private healthcare providers on Comprehensive Abortion Care (CAC) from 17th to 21st October 2022 in Bungoma County, Western Kenya. The training included in depth learning activities and discussions on the legal framework for comprehensive abortion care, consequences of unsafe abortion in Kenya, counselling for post abortion care (PAC), infection prevention, complications and management, counselling for informed decision making in post abortion care and pain management. The main objective of the training was to contribute towards reduction of abortion stigma and creating an enabling environment for quality service provision by private healthcare providers in the County.
Beverlynn Juma, a service provider in Misikhu, shared: “Bungoma County has high incidents of unsafe abortions because people are not open about it, so many unsafe abortions go unreported. CAC training will enable most service providers to be open about the fact that they provide safe abortion services, leading to increased awareness of the availability of these services. Reproductive Health Network Kenya in partnership with the county government will improve the state of abortion by enabling girls to be able to go for the procedure freely hence reducing mortality rates’’.
From the testimonials shared by Beverly and other healthcare providers in the training; access to safe abortion information in Bungoma County is also limited due to knowledge gaps on the legality of the service and their obligation as providers.
Martin Onyango, the Strategic Legal Expert at the Centre for Reproductive Rights Africa Region stated that his hope and wish is that “…the training invokes the desire to offer safe services by providers and equally empower them to be champions and advocates for safe abortion in their county”.
The Bungoma County Reproductive Health Coordinator, Mrs. Christine Naliaka expressed her appreciation for the training and partnership between RHNK and the County government of Bungoma, which in her opinion is very timely and said: “there still exists stigma of CAC & PAC services, clients still hide and don’t open up to safe abortion services despite inevitable conditions like miscarriages. Some of the challenges faced by the facilities in provision of abortion services is that the providers don’t display PAC services on their service charters, no financial allocation of PAC/CAC services from the county government, reporting tools are not available in all facilities, and there is no capacity building of the providers”.
She acknowledged the contribution of partners in promoting service access as most clients from Bungoma receive services from private facilities. Christine also recommended support supervision visits after the training to ascertain whether the providers are compliant and giving quality services such as PAC/CAC as an emergency service. She also mentioned that collaborations and partnership between should be deepened to bridge the information gap in service access, and critically partners should work seamlessly with the county structures to provide more information to the public while working on building the capacity of the providers to create a favorable working environment, and stronger continuum of care.
“The training has been successful especially in terms of establishing a network of providers in Bungoma County as well as filling the gaps in terms of skills gap and having necessary knowledge to provide the services. We believe that the providers we have trained will be part of the network for Bungoma County under RHNK umbrella and provide quality services especially to the under-reached population, the youth, adolescents and women in the rural areas.’’ Dr. Wambulwa, Bungoma County Pharmacist.
In order to reduce maternal mortality, it is critical that key stakeholders’ intensify preventive promotive SRHR campaigns for right holders’ awareness of their needs. Stakeholders’ should also promote public-private partnership in building the capacity of Health Care Providers in understanding their professional roles and provision of fundamental human rights.
“We applaud the County Government of Bungoma, and all the other partnerships and actors who are working continually and untiringly to expand access to abortion care. Almost 90% of abortions in countries with liberal abortion laws are considered safe, compared to only 25% in countries where abortion is banned. This is a serious violation of human rights. Medical abortion has revolutionised access to care and safe abortion, both inside and outside the health system. These advances must be protected, and at IPPF we are committed to expanding the knowledge of and acceptance around abortion care, reducing the number of deaths of women and girls who are forced to turn to unsafe abortion methods,” said Marie-Evelyne Petrus-Barry, Regional Director of the International Planned Parenthood Federation, Africa Region.
The government should prioritize aligning SRHR legal frameworks to create an enabling environment for access to information and healthcare by all. They should ensure increased funds allocation to SRHR including abortion commodities and equipment in both public and private facilities for access to quality and comprehensive SRHR. In conclusion there is need for investment in research for continuous SRHR evidence generation to inform current and future programming centered on the needs of providers, communities and other stakeholders.