Unsafe abortions in Kenya

I am volunteering at Kisumu Medical Educational Trust (KMET), which began with the aim of breaking the silence surrounding high maternal mortality from unsafe abortions. In the Nyanza Province of Kenya, 42% of 15-19 year olds are sexually active, but only 11% use modern contraception. (Mitchel et al, 2006). Only eleven percent of sexually active teenagers use condoms, despite the fact that 15% of the population is infected with HIV/AIDS.

The KMET office has boxes and boxes of free condoms. I browsed the selection, impressed. I felt as though I was browsing the coffee options at the local Starbucks. Triple shot, no foam, tall skim latte? Meet ribbed, lubricated, vanilla-flavored, magnum-sized Trojan. I couldn’t understand why only 11% of teenagers would use condoms when they are so easily accessible, and in such a range of sizes and tastes!

Apparently, sex education classes are banned in Kenyan schools, so knowledge about reproductive health is scarce and largely inaccurate. Two KMET employees (Hesbon and Maureen) described some of the myths that circulate among teenagers in Kisumu:

• If you have sex with a condom, the condom will dislodge and swim through your body. The condom will come out of your mouth while you sleep.
• If you have sex with a condom, your body will react to the condom’s oils and your stomach will swell as if you are pregnant.
• If you have sex with a condom, you will acquire HIV. (Because supposedly companies inject condoms with the virus as a means of population control.)
• If you have sex with a condom, the female will feel intense pain.

Teenagers are largely ignorant about contraception, and as a result, 27% of 19-year old women in the Nyanza Province of Kenya are either pregnant or already mothers. (UNAIDS Report, 2006) These young mothers are usually thrown out of their homes and kicked out of school. They are left to raise their children alone, with no source of income or support from the government. In Kisumu, 100% of these teenage mothers earn less than $1/day.

The stigma and consequences of pregnancy therefore lead 252,000 15-19 year old Kenyan girls to seek abortions every year. (Kiragu et al, 1998) The problem is – - abortion is illegal, expensive and misunderstood. Girls are told that if they seek an abortion at a hosptial, the doctors will either sterilize them or block their vaginas so they are unable to have sex again. As a result, the majority of the abortions are performed in horrific conditions, often by the girls themselves. 1 in 10 women who obtain an abortion in Kenya will die. (UNAIDS Report, 2006)

Maureen told me about her friend Mary, who became pregnant at 17. In her bedroom, she took 12 malarial pills, strong juice extract, and an herbal drink she received from a back-door abortion clinic (which likely included turpentine.) While waiting for the drugs to work, she inserted a bent coat hanger into her vagina and scratched the uterus walls until she lost consciousness. Maureen found her, bleeding profusely and unconscious from the drug overdose, the coat hanger still inside her vagina.

Unfortunately, abortion is so stigmatized in Kenya that few clinics or hospitals will treat women who are dying from unsafe abortions. Maureen therefore had to find a car to take Mary to a special clinic 28 km away. It took her 1 hour to find a car and another 1 hour and 30 minutes for the car to maneuver the unlit, damaged roads. By the time Mary was admitted to the clinic, she was almost dead.

KMET is responding to the crisis by training and creating networks of health providers who offer women cheap post-abortive care. KMET has also established a Sisterhood for Change (SFC) center, which educates teenage girls about reproductive health. The girls (many of them mothers, orphans, high-school dropouts and/or commercial sex workers) learn about contraception, sex, pregnancy and HIV/AIDs. The girls then become advocates in their communities and are encouraged to teach others about safe-sex practices, particularly about condom use.

Where does Kiva come in? KMET has an extensive volunteer base of community health workers who visit the homes of HIV/AIDs patients to administer drug treatments and provide food. In gratitude for their help, KMET offers these volunteers low-interest microfinance loans, many of which are funded by Kiva. For more information about KMET, please see: http://www.kmet.co.ke/

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And for the newly-departing Kiva Fellows, I offer a Luo proverb: Ariango misalo kichuo piere piny.

Translation: A real traveler doesn’t stick his buttocks down for any length of time.

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