Kenya’s Cycle of Birth And Death

Eldoret Kwamboka Moraa, a third-year student at Egerton University in Rift Valley Province, has become the unwitting poster girl for contradictions that swirl around Kenya’s convoluted medical regime. This September, the 23-year-old student of Agricultural Engineering separated from her boyfriend of two years. Later, when she discovered she was pregnant, Moraa decided to get an abortion. But there was a hurdle.

Since Kenya’s independence in 1963, successive regimes have declined to accede women the right to abortion. In fact, if found culpable, the victim and the individual abetting the offence, are individually liable to a jail term of not less than four years without the option of a fine. “The law is punitive and archaic. It only serves the interests of a few, particularly, male chauvinists. Lately, religious moralists, too, have joined the brigade. Fortunately, the system is not fooling proof: the same medical institutions that are funded by the taxpayers’ money offer the service. The right of what to do with a pregnancy intrinsically belongs to a woman and there can be no other way,” she says.

Coincidentally, Moraa, now a national celebrity within the ranks of lobbyists from the free-choice movement, has earned abomination from the conservatives for daring to go public with what is pervasively considered a moral conundrum. When the Attorney General Amos Wako heard the brazen Moraa – she had held a national press conference – he directed the police to arrest and persecute ‘ the criminal’.

But a new report in the ‘Journal of Obstetrics and Gynecology for East and Central Africa’ exposed the hypocrisy and irreverence of the government, leading Wako to rescind his order. ‘Epidemiology of Induced Abortion in Nairobi, Kenya’ has revealed that 316,560 abortions occur in the country annually of which, an estimated 20,893 women are hospitalised with abortion-related complications.

For women who go ahead with a pregnancy out of their free will or because of the absence of safe abortion facilities, there is an even greater threat at the end of the road. The same 36-page report has brought to light a far deadlier reality: bleeding after birth is responsible for killing thousands of women in Kenya. The reasons for this range from unsafe abortions to negligent doctors.

Consultant obstetrician and gynaecologist, Dr Jean Kagia says that bleeding after birth, medically referred to as post-partum haemorrhage (PPH), is more of a cause of death amongst women in Kenya than the ‘illegal’ abortions. “If you look at the statistics, you will discover that about 28 per cent of the deaths amongst pregnant women occur as a result of induced abortions, while the remaining would be classified as having been triggered by ‘natural causes’. Without early intervention, a woman with severe PPH can bleed to death within three to four hours,” she says.

The national Maternal Mortality Rate (MMR) is estimated to be between 414 and 590 deaths per 100,000 live births, annually. Generally women who have had multiple pregnancies are five times more vulnerable to bleeding to death. It is said that on an average, a woman in the rural areas gives birth to five to eight children. This, of course, then puts them at maximum risk of suffering from PPH.

According to a Kenya Medical Association (KMA) report titled, ‘The Forgotten Woman and a Service Deferred’ (April 2007), an estimated 3,500 women succumb to PPH of whom 65 per cent or 2,275 are to be found living in rural Kenya. The remaining are mostly from the inner and poorer suburbs of urban centres.

According to the report, ‘…population remains the biggest obstacle [in rural Kenya] to obtaining an equitable distribution of wealth. This is because households have a tendency of ignoring all forms of contraceptives resulting in either higher birth rates or at worst death.’

Another major reason for the occurrence of PPH is medical negligence. According to Prof. Zipporah Ngumi, Dean, School of Medicine, University of Nairobi, the abysmal national patient-doctor ratio – 10,000: 1 – and the poor remuneration doctors receive – a newly qualified doctor earns a monthly stipend of US$ 1,125 – are reasons for such negligence and neglect.

“Kenyan doctors are an over-worked lot, which explains why after been awarded with their practicing certificates many opt to migrate to western countries. Those who choose to remain here go into private practice. In the end money is always a major factor. With the large number of patients, a doctor may unfortunately overlook a lingering medical condition (such as the number of and the spacing between existing children) that could trigger PPH,” says Ngumi.

Commenting on the Moraa issue the Dean is not shocked. She confirms that abortions are common place in both public and private run hospitals. “You cannot police this operation because of the clause of patient and doctor confidentiality. The operation takes only a couple of minutes. How can one monitor what a doctor and the patient are up to in a locked enclosure?”

(Courtesy: Women’s Feature Service)