“Why let her fall into danger?”- Ending preventable suffering from unsafe abortion is our global mandate at Ipas. Will you join us?

As I contemplate the fact that I only have about four weeks left here in Kenya, I find myself in the strange position of simultaneously missing Kenya and home. When the end of an experience that you know you’ll surely never have again starts to appear on the horizon, it fills you with a strange kind of premature sadness and longing. Also, WHERE in Sanford, North Carolina am I going to find ugali and sukuma wiki?! The green fields and forests of Western Kenya, the sunsets on Lake Victoria, the delicious-but-cute goats wondering about… I’ve really come to love Kenya in these past weeks, and I deeply respect the difficult, world-changing work of my colleagues here. My eyes are getting teary as I write this!

This week, I traveled along as Ipas Africa Alliance staff visited several towns in Trans-Nzoia County, including Endebess, a town near Mt. Elgon National Park where people work on a large, corporate-owned plantation, typically receiving only maize and milk in exchange for their labor. The people that live there have very little access to healthcare or formal education, and when Ipas partners with the Kenyan first-lady, Margaret Kenyatta’s Beyond Zero mobile clinics, it’s not rare for hundreds of women to line-up to receive contraception. The scenario left me with great respect for Ipas’ work to collaborate with existing government structures and programs to reach women and girls in the most remote areas of the world with contraception and safe abortion care. It also made me wonder about the role that colonization has played in stagnating development, and wondering why so-called pro-life groups weren’t also working in these areas to join Beyond Zero in eliminating preventable death and suffering due to a lack of healthcare and opportunities. Apparently, they are too busy working to criminalize abortion worldwide. 😦

One of the staff members that I traveled with this week is Nancy Aloo, a nurse and health systems advisor for Ipas. Nancy is religious, and our travels in the field usually started with a prayer for traveling mercies, which was a great relief as speeding matatus and boda-bodas flew by my window. I asked her what got her into this work, and she shared that she was curious about how unsafe abortion could be addressed, having worked for USAID in the past, which prohibits its’ funding from responding to the death and suffering related to unsafe abortion in the developing world. These Helms’ Amendment restrictions on the use of funds for safe abortion care, generally even in cases of incest, rape, or life-threatening pregnancies, have serious consequences in countries that receive foreign-aid, often preventing implementation of a country’s own laws on the matter of abortion- see more on this imperialist foolishness (for, that is what it is) here.

Nancy shared with me that abortion was talked about as being against her religion and “something that will kill you” when she was growing up. She accepted these messages until she started college, when saw middle-class Kenyan classmates having safe abortions and surviving. Then, her clinical work began,  and she started finding herself working in emergency rooms caring for large numbers of poor women who didn’t have access to the safer abortion methods that her classmates did. She came to the conclusion that, “Even if some religious people say that abortion is not permitted, women still have them. When a woman here decides she is going to end a pregnancy, she’s going to do it. We can either make sure she does it safely, or let her fall into danger. Why not make it safe?” As Nancy and other members of religious groups in Kenya have come to realize, allowing women who are disproportionately poor and have limited access to contraception to suffer and sometimes die unnecessarily is not in line with their beliefs. Many of us with Nancy’s logic- why not stop this needless suffering altogether?

This week, an article was published in The Washington Post regarding the likelihood that, if made illegal in the U.S., abortion might not necessarily be unsafe for large numbers of U.S. women, as many more women are now able to order misoprostol online and end a pregnancy safely at home. This is true, and could be used by anti-choice groups to argue that abortion need not be institutionalized. However, as I reflect on the disparities poor women face, like the women Nancy encountered during her days of clinical nursing practice, and the low-income women I used to work with in the U.S., a deep unease settles in my chest. Yes, women like me- the most privileged, literate women with the resources and knowledge needed to look-up online, pay for and order misoprostol regimens necessary to induce an abortion, will rarely, if ever, suffer death or injury as a result of the procedure being driven underground. However, it is a global reality that the poorest women remain most at risk for resorting to unsafe methods of terminating a pregnancy. With an anti-choice majority on the U.S. Supreme Court, the future of clinic and hospital-based abortion access in the U.S. is at risk like no other time in recent history, and the criminalization of women who have abortions, while devastating, would not be the only potential risk of overturning Roe vs. Wade.

Consider the film, Jackson, a documentary that highlights the struggle of Mississippi’s last remaining abortion clinic in a state with 38 Crisis Pregnancy Centers (CPCs). CPCs are heavily-funded by anti-choice groups and aim to coerce women considering abortion into giving birth, no matter the emotional and economic impact of this coercion on the women they target. In one scene, April, the young woman featured in the film, who is clearly unsure about her decision to continue an unplanned pregnancy while struggling to provide for her four children, talks about growing up poor in rural Mississippi and drinking Clorox after realizing she was pregnant as a teenager in an attempt to end her pregnancy. This scene has stayed with me. April drank bleach to end her pregnancy in the U.S., not in Kenya, or other countries where access to misoprostol is cost-prohibitive to large numbers of poor women. Can you imagine the desperation and fear that April must have felt to drive her to such lengths?

No, if abortion is criminalized in the United States, large numbers of women might not fall ill or die, but we must admit to ourselves (which the Post article does not) that those made most vulnerable by inequality, racism and a lack of opportunity are likely to suffer damage to their health and potentially lose their lives. As Nancy wisely said from experience, when a woman has decided to end a pregnancy, she’ll find a way. Are we willing to accept the suffering of those least likely to find the safest ways? Are you?

Nancy Aloo, Health Systems Advisor for the Ipas Africa Alliance, speaking to a group of Community Health Volunteers in Trans-Nzoia County, Kenya about the importance of their work to link women and girls with their right to contraception and safe abortion care.