Elisa Slattery Center for Reproductive Rights In Harms Way: The Impact of Kenyas Restrictive Abortion Law

importance of an enabling legal environment and human rights to the fulfillment of SRHR and the MDGs Need for a rights protective environment to prevent violations such as: Delays or denial of treatment Verbal and physical abuse User fees as barriers/Detention for inability to pay medical bills HIV testing without counseling or consent Lack of confidentiality Coercive or forced sterilization Practical and symbolic effect of laws and policies –Restrictive/discriminatory laws and policies Restricting or banning access to abortion Restricting access to contraception (de facto ban in Manila, bans on EC) Mandatory HIV testing and disclosure/criminalization of HIV transmission –Laws which lack clarity –Failure to implement positive laws and policies

Prior Abortion law: Explicit life exception: Interpreted to include a mental and physical health exception Interpreted to include exception for rape Lack of clarity surrounding the law results in most providers and women believing it to be entirely illegal. Law after Introduction of new Constitution Health Statistics: Over 21,000 women are admitted to public hospitals annually with complications from abortion. More than 40% of these women are suffering complications from unsafe abortion. Unsafe abortion represents 30-40% of Kenyas maternal deaths. The risk of dying after abortion is alarmingly high in Kenya, compared to global and regional estimates. legal and health context on abortion in Kenya

Sarahs story

rights violations leading to unwanted pregnancy and unsafe abortion Poverty –Survival sex: the media has reported that girls as young as 10 are having sex to help feed their families and buy basic commodities Lack of Access to Contraceptives –Frequent and pervasive stockouts of contraceptives in public facilities poor women either have to wait until they [contraceptives] are supplied to [public] hospitals or get pregnant. (public sector nurse) –Lack of access to EC, in particular -- We dont just give it out. Clients have to tell you what happened and explain grounds for needing EC. If we give too much EC it may end up being abused. (provider) Sexual Violence –Kenya has high rates of sexual violence, with some statistics stating that a woman is raped in Kenya every thirty minutes. Denial of the Right to Education –Girls are often expelled from school when pregnancy discovered. –Over 13,000 schoolgirls drop out of school each year due to unintended pregnancies. Lack of Access to sexuality education

Insertion of objects: catheters, crochet or knitting needles, sticks, pipes, coils or wires, herbs, pens. Ingesting dangerous substances or overdosing on medication: bleach or a bluing product concentrated tea soapy water or detergent overdose on malaria pills, cytotec or misoprosotol Herbs from an herbalist. painful and dangerous methods used to terminate an unwanted pregnancy

toll of unsafe abortion An estimated 220,000 children worldwide lose their mothers to abortion-related deaths These children are less likely to receive healthcare and social care and are more likely to die Difficult to estimate cost to healthcare system but cost is high particularly b/c women wait till complications are severe out of fear of legal and social repercussions: –Diverts scarce resources to easily preventable health issue –Study of one Kenyan provincial hospital found abortion to be the most common acute gynaecological ailment and requiring the longest hospital stays –More than half of patients with abortion complications were younger than 20

barriers to safe abortion Women lack information about the law or where to access a safe abortion Prohibitive Cost –Safe abortion in private clinics in Nairobi can cost up to $ ; average income is less than $2/day. –Because its illegal there are people that are overcharging the patients and extorting money from patients. (CO Nairobi) –Deters or delays women; higher rates of second trimester abortions with greater risks of complications Fear of Arrest –Arrests and prosecution are common, particularly in informal settlements, such as Kibera –Turned in to police by community, family members –Would rather go to herbalists where they can have abortion in secret

barriers to safe abortion Providers as Barriers: –Misinformation about the law –Personal beliefs/attitudes resulting in intentional denials or delays in receiving an abortion. Few Avenues for Redress: no clear disciplinary rules addressing denials of legal abortion; no credible enforcement agency Lack of trained providers and equipment –Only doctors are comprehensively trained, of which there are approximately 5,000 in Kenya, with most located in urban centers –Very few health care providers (less than 300) are trained in providing second trimester abortions

barriers toquality post-abortion care Fear of arrest/social condemnation and of cost Structural Delays: Lack of trained providers, supplies, equipment –A 2004 Kenyan Service Provision Assessment Survey found that only 16% of Kenyan public health facilities had a vacuum aspirator and only 14% have a D&C kit. Negative Provider Attitudes –Many believe women should suffer for the crime that they committed, including withholding pain relief –Patients may deliberately be kept waiting for more than 2 days after arriving in the facility –Verbal abuse: You had sex, you had your excitement, now youre crying, who will help you? We will just leave you to die. Bribes in Government Facilities –In order to receive services or locate a trained provider A clinical officer says to the woman: if you dont pay this, well leave you to die. They leave you there but [the women] always pay in the end.

repercussions of discrimination and coercion in healthcare settings Discrimination and coercion in the healthcare setting violate rights and undermine public health initiatives. For example: Undermine family planning efforts Deters institutional births, undermining maternal mortality and PMTCT programs. Interferes with adherence to treatment programs and can otherwise deter individuals from seeking necessary treatment and care.

Whether services are being provided How theyre being provided Are they being provided in the same way to all womendiscrimination against young women, marginalized groups Is there accountability and redress for violations? One number doesnt tell the whole storyuniversal access to treatment in Chile but host of violations against HIV+ women Need for vigilance in terms of safeguarding womens rights across the board Constitutional review processes are one example of this Accountability in how governments provide services and within healthcare facilities Good laws and policies are necessary but not sufficient Training providers to reduce stigma and discrimination considerations

prevent, address, redress Accountability strategies Fact-findingneed for eyes and ears on the ground: document violations, understand whats happening to women when they need and seek RH services –Abuses in healthcare settings, including against HIV+ women –Failure to provide or subsidize contraceptives (Philippines, Slovakia) –Restrictive abortion laws Advocacy Litigation –Coercive sterilization of HIV+ womenChile –Maternal mortality –Abuses in healthcare facilities

thorny issues punitive attitudes towards womens sexuality problems with data collection on stigmatized issues productive engagement with healthcare providers globalized opposition –Spread of fetal rights discourse

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