Kenya
Kenya: Reproductive Health and Abortion
- Legality:
- Abortion is allowed when provided by a trained health professionals, if the pregnant woman or girl needs emergency treatment, her mental or physical health or life is in danger, in the case of rape, or if indicated by any other written law (e.g., an act of parliament such as the one addressing the management of sexual violence and rape, Health act 2017, or the Maputo protocol).
- Abortion is not allowed in cases of incest, fetal impairment, socioeconomic challenges, or upon request.
- Contraception:
- While the government provides more than half of contraceptives at no cost, stock-outs are common and can include shortages of the injectable, the most popular method with limited availability due to provision regulations.
- Many women do not have the resources to purchase contraceptives.
- Women in rural settings, urban slums, and informal settlement have the highest unmet need for contraceptives, as they often lack sufficient public services and the private-sector may not offer adequate or accurate services and information and may be costly.
- From 2007-2012, 43% of births were unwanted or mistimed.
- More than 70% of women seeking post abortion care were not using a method of contraception prior to becoming pregnant.
- Complications:
- Unsafe abortion remains a leading cause of maternal morbidity and mortality.
- Abortion access in public health facilities is limited due to the lack of a clear policy on abortion in Ministry of Health facilities. Only women with financial resources may access safe abortions in the private sector.
- Treatment of unsafe abortion consumes significant health systems resources.
- ~464,690 abortions occurred at a rate of 48 abortions per 1,000 women, and an induced abortion ratio of 30 abortions per 100 births (2012).
- ~ 119,912 women received care for complications from induced abortion, which is approximately a 24% complication rate (2012).
- Severe complications were most common among women aged 10-19 (45%), divorced women (56%), and women who reported that they had interfered with the continuation of the pregnancy (58%).
- Note: Women who sought abortions were heterogeneous socially, demographically, economically, and religiously, and in terms of education, employment, marital status, and urban and rural.
- Sources:
- https://www.guttmacher.org/report/incidence-and-complications-unsafe-abortion-kenya
- https://www.guttmacher.org/sites/default/files/report_pdf/ib_unsafeabortionkenya.pdf
- www.un.org/esa/population/publications/abortion/doc/kenya.doc
Doctors for Choice Kenya: Recent Accomplishments
- Engaged in political advocacy initiatives:
- Contributed to the Nairobi High Court decision that the Director of Medical Services and Ministry of Health violated the rights of Kenyan women and girls when they arbitrarily withdrew the “Standard and Guidelines for Reducing Morbidity and Mortality from Unsafe Abortion in Kenya” and thus created uncertainty regarding the legal status of abortion and discouraged practitioners from providing abortions out of fear of prosecution. Additionally, the High Court ruled that survivors of rape have the right to an abortion.
- The Doctors for Choice Kenya team contributed to the creation, content, and approval of both the Standard and Guidelines and the 2019 Post Abortion Care (PAC) Guidelines to help ensure high quality of health care provision.
- Collaborated with the Ministry of Health to create and receive approval for the Post Abortion Care (PAC) Guidelines.
- Formulated the Ministry of Health Polices Standards and Guidelines for the prevention of maternal morbidity and mortality in Kenya.
- Formulated the Ministry of Health Post Abortion Care Handbook for service providers.
- Continues to advocate for additional liberalization of the abortion law.
- Urged Ministry of Health to reinstate the previously-published-but-then-revoked abortion guidelines – to support providers to offer safe abortions as the law allows (e.g., for women’s physical and mental health and in cases of emergencies). (Received harsh backlash and threats for this initiative.)
- Developed – in collaboration with Royal College of OB/GYNs of the UK – MoH Post-Abortion Care (PAC) guidelines, which have been approved by the Reproductive and Maternal Health Services Unit and are now waiting for official signature by the Ministry of Health Director of Medical Services.
- Successfully lobbied Ministry of Health to lift the ban on Marie Stopes Kenya abortion services provision.
- Called on the Catholic Church to end their opposition to contraceptives.
- Perseveres as outspoken leaders for reproductive health rights, despite the challenge of their local context.
- Continually provides media rapid response to anti-choice propaganda against abortion, contraception, and immunizations.
- Contributed to the Nairobi High Court decision that the Director of Medical Services and Ministry of Health violated the rights of Kenyan women and girls when they arbitrarily withdrew the “Standard and Guidelines for Reducing Morbidity and Mortality from Unsafe Abortion in Kenya” and thus created uncertainty regarding the legal status of abortion and discouraged practitioners from providing abortions out of fear of prosecution. Additionally, the High Court ruled that survivors of rape have the right to an abortion.
- Shared expertise and led presentations to provide tools for reproductive health advocacy:
- Invited to speak by the Research Council of Norway as an advocate for building capacity to improve women’s access to sexual and reproductive health services.
- Became the RCOG Best Practice Champion and adapted the Best Practice Papers in Comprehensive Post-abortion Care.
- Recognized as key leaders of the reproductive health movement within Kenya and internationally.
- Dr. Joseph Karanja urged the Kenyan High Court to reinstate guidelines for medical practitioners to provide safe abortions – as allowed by law. The guidelines will help save lives of women who are at risk from clandestine, botched abortions. In 2013, the Ministry of Health banned the use of one medical abortion medication and banned healthcare workers from participating in any training on safe abortion.
- Dr. John Nyamu presented his work to expand safe abortion services in Kenya at the International Women’s Health Coalition.
- Dr. Anne Beatrice Kihara presented how to build capacity to improve reproductive health services at The Research Council of Norway.
- Dr. Joseph Karanja shared his experience with unsafe abortion in Kenya.
- Drs. Joseph Karanja and Anne Beatrice Kihara spoke about maternal health and risks in Kenya
Doctors for Choice Kenya Drs. Nyamu and Karanja lead the movement to liberalize abortion and increase access within Kenya.
Doctors for Choice Kenya trains healthcare providers on the legality of abortion and post-abortion care.
The Doctors for Choice Kenya team shares their expertise globally, including how to build capacity to improve services at The Research Council of Norway.
Doctors for Choice Kenya urges the liberalization of abortion in order to provide comprehensive reproductive health services and respect bodily autonomy and well-being.
Doctors for Choice Kenya: Leadership
Dr. Anne Kihara serves as the Secretary, and Dr. John Nyamu serves as the Treasurer and Coordinator of this physician-advocacy group.
The Kenya Doctors for Choice team consists of a handful of closely connected, key advocates for reproductive health.
Doctors for Choice Kenya: Lead Doctor Profiles
Dr. John Nyamu
A consultant gynecologist with over 20 years of specializing in reproductive health, Dr. Nyamu operates a private practice in Nairobi. As the National Chairman of Reproductive Health Network, a network of over 400 private practitioners, he offers mentorship and supportive supervision targeting surgical contraception and comprehensive abortion care. He has trained over 400 private practitioners in Kenya in insertion and removal of contraceptive implants, including clinicians from Reproductive Health Network and Family Health Options Kenya. Additionally, he has also worked with Catholics for Choice to train doctors in communication and abortion values.
In addition to coaching doctors, Dr. Nyamu has been the lead advocate in the formulation of Ministry of Health policy documents on prevention and management of unsafe abortion, was instrumental in the registration of the first combipack for use in medical abortion (Medabon), and has promoted the use of Misoprostol and medical abortion drugs in the community, especially the use by the young women in colleges and universities.
Dr. Anne Beatrice Kihara
Since 1999, Dr. Kihara has served as a consultant obstetrician and gynecologist in public and private hospitals in Kenya. She serves both as a Senior Lecturer at the University of Nairobi in the Department of Obstetrics and Gynecology, and provides leadership in the mentorship program of undergraduates and postgraduates in medical school. After six years in leadership, Dr. Kihara is now the President Emeritus of the Kenya Obstetrical and Gynecological Society (KOGS) and is the in-coming President of the Arab-African Federation of Obstetricians and Gynecologists (AFOG).
She is constantly in pursuit to provide leadership in women’s health through advocacy, policy, and quality service delivery. She has several scientific publications and been a key note speaker on many occasions both within Kenya and internationally.
