This past week was spent in the Ipas Africa Alliance Kisumu office, and I’m glad it was, because I got to meet with a few staff who generously shared their experiences with me. There was also more cake to be eaten in celebration of several more staff birthdays, and anyone who knows me knows I’m always ready for cake!
Seriously, though. I am so humbled to even know these folks. They are warriors on the front lines the struggle to defend and uplift the humanity of women and girls. They are helping to end preventable suffering and to move reproductive justice from a slogan to a reality.
I think one of the things that moved me the most during my getting-to-know-you sessions with Alliance staff was their personal connections to unsafe abortion, often a driving force behind their deep commitment to this issue. An unsafe abortion is defined by the World Health Organization (WHO) as a procedure for terminating a pregnancy which is provided by a person who has not been trained or in an environment which is lacking minimal medical standards, or both (World Health Organization, 2017). Although abortion is permitted under Article 26 of the Kenyan Constitution in cases where the life or health of the pregnant woman is at risk, stigma, a lack of provider training, and misinformation about the law continue to be a barrier to women’s and girls’ access to safe abortion care.
Staff told me of cousins who died after seeking unsafe abortions, of quacks who forced their “patients” to have sex with them as payment before providing an abortion using painful and dangerous methods, causing the woman to become severely ill. They told me of their work as a medical provider in a high-volume referral hospital, where they cared for hundreds of women who were septic after an unsafe abortion. One of these cases involved providing medical care for a 10-year old rape victim with sticks pushed up into her cervix. From a medical and human rights standpoint, these cases are intolerable- and among anyone who has looked at the evidence, it’s clear they are preventable.
When provided using current technology and in a hygienic environment, abortion is one of the safest procedures in existence today- that goes for both medication abortion and manual vacuum aspiration (Grimes, Benson, Singh, 2006). In the U.S., for instance, women and their communities have no collective memory of the bad old days, when women frequently suffered disability, injury or death from unsafe abortion (Grimes, 2006). In areas where the procedure is restricted, unsafe abortion remains a primary cause of hospital admissions due to pregnancy-related complications. However, in countries or regions where women have easier access to medication used to induce an abortion safely, such as misoprostol, there is evidence that the severity of injury and mortality associated with unsafe abortion is reduced (Hyman, Blanchard, Coeytaux, Grossman, Texeira, 2013). This is still not the case in Kenya, where many women are forced to rely on herbs, quinine, detergent and even metal rods and wires inserted by the woman or another untrained person into her uterus though her vagina, compromising her health, her dignity and too often, her life (Marlow, Wamugi, Yegon, Fetters, Wanaswa, Msipa-Ndebele, 2014).
Thankfully, there is change on the horizon in Kenya and throughout the region, and much of that change is thanks to the work of Kenyan leaders, like Suzanne, who told me about her work to sensitize policy-makers to the need to increase funding for women’s and girls’ access to contraceptives, as well as young people’s access to information about their sexual and reproductive health. Despite being a lawyer, she told me how she’ll walk into a room of local political leaders, often all of whom are men, and often be presumed incompetent. Men will cut her off, tell her to fetch their tea, or behave in other inappropriate ways. She stays focused though. She says, “I have the information about this issue and they don’t. I have to be firm, clear and sometimes repetitive. I tell them, ‘I know what I mean to say, thank you.’ I remind myself, ‘you’ve got this.’ ”
Things are also changing because of staff like Mori and Sitati, who have spent hundreds of hours in the field, sensitizing providers, parents, teachers, police chiefs and even faith leaders on the issue of unsafe abortion and the stigma and silence around this and related issues, like sexual violence, that put the lives of women and girls at risk. Sitati told me that he’s used to people being defensive about the topic, and when they asked what he did, he wasn’t always open to sharing. He finally decided, “I have to tell them- it’s too important.” He told me he lets them express their judgement and then asks them to have more compassion for the women in their communities. He tells them, “you can think what you think, feel what you feel, but you cannot know because it has not happened to you, to your family.”
They told me about their work to personalize the issue for community members, who may have been convinced by some conservative leaders that human rights and safe abortion are “Western” concepts. Mori says, “It’s about personalizing that abortion experience for them- helping them see what is happening in their community. We create a dialogue- we talk about that human rights violation that happened, and this reduces the stigma, making way for access to services.” Suzanne shared, “I help them see- we are all moving toward the same goal- improving the health and saving the lives of women in our country.”
Their courageous optimism is warranted. Both Sitati and Mori told me about the transformative power of their collaborations with community members tired of watching girls suffer and sometimes die from unsafe abortion. The compassion they’ve helped foster in these communities has a dramatic and tangible impact on the health and lives of women and girls. There are now faith leaders in rural Kenya that will identify young women in need of support and offer them referrals for contraception or safe abortion care. Mori explains his passion for this issue in the following way, “I have a wife. I have sisters. Women I care about. This could be them. If my wife were raped, I wouldn’t want her to suffer more. Every woman is my wife, my sister, my friend.”
Spoken like a true warrior in the global struggle for reproductive justice.