Imagine waking up one morning with a really bad flu. Your immediate recourse would be to take fluids and maybe some medication. Should a sore throat develop, you might take cough syrup or lozenges. Commonly here in Kenya, a ‘dawa’ (a hot drink of honey, ginger and lemon) might hit the spot. Now, imagine that the law requires you to acquire permission from your boyfriend, husband, parent, guardian, neighbour, religious and faith leader, Ministry of Health, County Governor or even your President to go into a pharmacy, health center or hospital to receive the healthcare you need.
This scenario seems intrusive, unfair and even irrational. What justification beguiles such restrictive control on your flu? You obviously know you have it, you know how and where to seek medical treatment and you understand which actions would help you recover. Despite this, you need permission from others before seeking medical attention.
This scenario, whilst metaphorical, represents many of the challenges encountered by women and girls in Kenya and elsewhere in Africa when it comes to their bodily autonomy. Specifically, when it comes to their access to comprehensive Sexual and Reproductive Health and Rights (SRHR).
Girls and young women bear the brunt of the unmet need for contraception in Kenya, resulting in almost a quarter of Kenyan women giving birth before they are 18.
Restrictive abortion laws in the region have not translated into a reduction in the incidences of abortion. Instead, they have increased the magnitude of unsafe abortion – 3 out of every 4 abortions in Africa are unsafe. Here in Kenya, the Constitution provides for instances under which a woman can access safe and legal abortion services. Article 26(4) of the Constitution states that “abortion is not permitted except, in the opinion of a trained health professional, there is a need for emergency treatment, or the life or health of the mother is in danger, or if permitted by any other written law”.
Ultimately, women in Kenya are not trusted to seek their own sexual and reproductive health care. The decision to access safe abortion as espoused in the Constitution places the entire burden on the trained health professional – leaving no room for the woman’s right to access.
Moving from law to practice and implementation is a whole other ball game. Existing evidence attributes high levels of severe maternal health outcomes to adverse complications such as sepsis, cervical and uterine ruptures, haemorrhage and death – the ‘terrible 5’ as coined by Sexual and Reproductive Justice advocates in the country. In addition, these specific outcomes vary across the country. SRH services are devolved to county level, and so the quality of care you can access is a postcode lottery, depending on which of the 47 counties you happen to live in. For example, the proportion of women with high fertility risk ranges from 24% in Nairobi to 66% in Migori.
Fighting the barriers to good quality reproductive health care forms the crux of one of KELIN’s projects, funded by the Safe Abortion Action Fund.
The ultimate goal is to have model SRHR Laws developed to promote women’s right to access safe abortion in Kenya. The intervention targets counties of Kilifi and Nakuru. We engage local communities through community-centered and community-driven dialogues in a bid to empower them with knowledge of how to engage with their county’s legislative processes. This is intended to increase public participation in policy making and to strengthen and build community movements to monitor implementation and champion legal reform.
Ultimately, laws are intended to create social change, spur on reform and maintain social order. But this is dependent on how they are made, implemented and interpreted. Even if a law is considered ‘good’, with its spirit and intent seen to be in the right place, it does not necessarily translate to a ‘good’ outcome.
We at KELIN envision a country and a world where women and girls can make decisions and enjoy rights related to their sexual and reproductive health. This includes the right to access safe abortion. We want to make reproductive care as simple as getting flu medication at the pharmacy or seeing a doctor without barriers, judgement or condemnation.
KELIN is a Safe Abortion Action Fund grantee partner.