Unsafe Abortions Continue to Plague Kenya

By Robert Kibet
NAIROBI, May 2 2015 (IPS)

She is just 14, but Janida avoids eye contact with others, preferring to look down at the ground and nodding her head if someone tries to engage her in conversation.

Janida (not her real name) was once a sociable and playful child, but that was before she was sexually abused by her stepfather and giving birth to a baby who is now four months old.

Her days marked by trauma and depression, Janida is just one of many girl children in Kenya who have been abused and robbed of their childhood, leaving them emotionally scarred.

“The little girl [Janida] underwent both physical and mental torture,” Teresa Omondi, Deputy Executive Director and Head of Programmes at the Federation of Women Lawyers (FIDA) Kenya, told IPS. ”Her best option was to terminate the pregnancy rather than suffer the mental and physical torture, but she could not afford the cost of a safe abortion.”Many of the induced abortions taking place continue to be unsafe and complications are common” – Teresa Omondi, Federation of Women Lawyers (FIDA) Kenya

Under Article 26 (4) of the Kenyan constitution, “abortion is not permitted unless, 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.”

In September 2010, Kenya’s Ministry of Health released national guidelines on the medical management of rape or sexual violence – guidelines that allow for termination of pregnancy as an option in the case of conception, but require psychiatric evaluation and recommendation.

Then, in September 2012, the health ministry released standards and guidelines on the prevention and management of unsafe abortions to the extent allowed by Kenyan law, only to withdraw them three months later under unclear circumstances.

According to Omondi, “the law has not yet been fully put into operation and many providers have not been trained to provide safe abortion, meaning many of the induced abortions taking place continue to be unsafe and complications are common.”

The health ministry is responsible for doctors and nurses not being permitted to be trained on providing safe abortion, said Omondi, so “it is ridiculous that while Kenya’s Ministry of Health accepts that post-abortion care is a public health issue regarding numbers, practitioners have their hands tied.”

The issue of unsafe abortions in Kenya hit the headlines in September last year, when Jackson Namunya Tali, a 41-year-old nurse, was sentenced to death by the high court in Nairobi for murder, after the death of both Christine Atieno and her unborn baby in a botched illegal abortion.

Various inter-African meetings attended by Kenya have been held on reducing maternal mortality rates by providing safe abortions, with health ministers agreeing that statistics show that countries that do provide safe abortions have reduced their maternal mortality rates.

In a recent analysis, Saoyo Tabitha Griffith, Reproductive Health Rights Officer at FIDA and an advocate at the High Court of Kenya, said that despite Kenya having adopted a Constitution that affirms among others, women’s rights to reproductive health and access to safe abortion, Kenyan women continue to die from unsafe abortion – a preventable cause of maternal mortality.

For Dr Ong’ech John, a health specialist in Nairobi, perforated uteruses and intestines, heart and kidney failures, anaemia requiring blood transfusion as well as renal problems are just a few of the health complications arising from an abortion that goes wrong.

“Unsafe abortion complications are not just about removal of the products of conception that were not completely removed. One can evacuate but the perforated uterus has to be repaired, or you remove the uterus and it is rotten,” Dr Ong’ech told IPS.

“When the health ministry issued a directive in February this year instructing all health workers, whether from public, private or faith-based organisations, not to participate in any training on safe abortion practices and the use of the medication abortion, many questions were left unanswered,” said Omondi.

A highly respected Kenyan doctor, Dr John Nyamu, spent one year in prison in 2004 after his clinic was raided following the discovery of 15 foetuses on major roads together with planted documents from a hospital he had worked for but had since closed.

Speaking of his ordeal with Mary Fjerstand, a senior clinical advisor at Ipas, a global non-governmental organisation dedicated to ending preventable deaths and disabilities from unsafe abortion, Nyamu said that the publicity surrounding his imprisonment helped people to “realise the magnitude and consequences of unsafe abortion in Kenya; women were dying in great numbers. Before that, abortion was never spoken of in public.”

He went on to say that Kenya wants to achieve the Millennium Development Goal of a 75 percent reduction in maternal mortality, but that “it can’t be achieved if safe abortion is not available.”

A May 2014 World Health Organisation (WHO) updated fact sheet indicates that every day, approximately 800 women die worldwide from preventable causes related to pregnancy and childbirth, with 99 percent of all maternal deaths occurring in developing countries.

Edited by Phil Harris   

Q&A: “People Need to Be at the Centre of Development”

Indonesian Vice President Jusuf Kalla and UNFPA Executive Director Dr. Babatunde Osotimehin discussed how Indonesia could harness its demographic dividend on the sidelines of the World Economic Forum on East Asia in Jakarta on Apr. 20. Credit: Courtesy of UNFPA Indonesia.

Indonesian Vice President Jusuf Kalla and UNFPA Executive Director Dr. Babatunde Osotimehin discussed how Indonesia could harness its demographic dividend on the sidelines of the World Economic Forum on East Asia in Jakarta on Apr. 20. Credit: Courtesy of UNFPA Indonesia.

By Sandra Siagian
JAKARATA, May 2 2015 (IPS)

In a populous archipelago nation like Indonesia, where 250 million live spread across some 17,500 islands, speaking over 300 languages, the question of development is a tricky one.

A lower-middle-income country with a poverty rate of 11.4 percent – with a further 65 million people living just below the poverty line – the government is forced to make tough choices between where to invest limited funds: education or health, job creation or infrastructure development?

A demographic dividend arises when a high ratio of working people relative to population size frees up resources for private and public investment in human and physical capital.
These issues are further complicated by the fact that over 62 percent of the population – about 153 million people – lives in rural areas, largely cut off from easy access to hospitals, schools and job markets outside of the agricultural sector. About 27 percent of this population, roughly 66.1 million people, are women of reproductive age.

In addition, Indonesia currently has the highest rate of working-age people that it has ever had, both in absolute numbers – with 157 million potential workers – and as a proportion of the total population – accounting for 66 percent of all Indonesians.

While this puts a huge strain on the government to provide jobs, it also offers the country a chance to reap the benefits of its demographic dividend, defined by the International Labour Organisation (ILO) as a period in which the rising number of working people relative to population size frees up resources for private and public investment in human and physical capital.

This, in turn, allows the country to achieve far higher rates of income per capita, thus boosting the national economy.

At the recently concluded World Economic Forum on East Asia, which ran from Apr. 19-21 in Indonesia’s capital, Jakarta, experts from around the world urged the country to capitalise on its demographic dividend by investing heavily in its own people.

Among the nearly 700 participants in the conference was the executive director of the United Nations Population Fund (UNFPA), former Nigerian Health Minister Dr. Babatunde Osotimehin, who stressed throughout his three-day visit that “people need to be at the centre of development.”

While this may seem a simple recipe, it bears repeating in Indonesia, where half of the population falls into the ‘youth’ category (15-24 years), a demographic that also has one of the highest unemployment rates in the country.

With Indonesia’s population set to increase by 19 percent, to about 293 million people by 2030, according to the UNFPA, the country would be well advised to heed the words of population experts.

In the midst of his whirlwind visit to Jakarta, Osotimehin sat down with IPS to discuss how Indonesia can harness the potential of its people, and to share some strategies on how the young democracy can optimise on changing population dynamics.

Excerpts from the interview follow.

Q: Where is Indonesia in terms of its demographic dividend?

A: Indonesia needs to take advantage of its demographic window of opportunity, which is expected to peak between 2020 and 2030. I think that there is the consciousness in Indonesia that this [demographic dividend] is an important national planning process, which they must invest in.

I believe that Indonesia has both the analytics and the political commitment, but I believe that going forward, we will have to encourage Indonesia to investment [strategically] for the demographic dividend to succeed.

Q: What kinds of investments need to be made?

A: Investments in health, youth education and employment need to be scaled up considerably. I think that social systems need strengthening – we need to address the issue of early marriage and make sure that girls are allowed to go to school, stay in school and reach maturity. We want to make sure that girls and women can make choices for themselves going forward, that is a key point.

Every young person must be taught about themselves and their bodies, and every woman needs to have access to voluntary family planning and sexual reproductive health services so that they are empowered to make choices. Having comprehensive sexuality education would ensure that we could reduce things like HIV infections, sexually transmitted infections and teenage pregnancies.

I think that within the educational framework we also want a situation where the curriculum is diversified so that we can encourage vocational training and entrepreneurship training. We need to be able to inspire small and medium-sized enterprises, which usually form the basis of a thriving economy.

Q: Why is it particularly important for Indonesia to focus on young people?

A: It’s important for Indonesia to invest in young people for many reasons. It gives a sense of belonging [for] a young person and it ensures that they can participate in national development. Young people will be part of the demographic transition and fertility reduction needs to include them. So really, they have to be part of the process.

Once you realise the potential of young people and they enter employment they are then able to save and earn, which in turn will help the economy grow.

Q: Is Indonesia moving in the right direction?

I think Indonesia has always had some of the necessary policies in place; they just need to be revitalised. New investments and political leadership have to come into it.

In the past, Indonesia was the leader in family planning after they implemented a national family planning programme in the 1970s. But it fell off the radar after Indonesia’s democratic transition in the 2000s, when family planning services were decentralised.

I think this new government is committed to bringing it back and I hear from discussions with various government leaders that this is something that they are paying close attention to.

Indonesia should also consider working with the private sector to help create decent jobs. Making sure that everybody, from the youth to the elderly, has social protection that provides basic [services] will be most important.

Edited by Kanya D’Almeida