They rushed her to the reception. As a single mother to a 1-year-old daughter, Aisha immigrated to Kenya alone from Uganda. She had resorted to sex work to care for her child and she had become pregnant.
“If a woman in Africa wants to have an abortion, you can’t tell everyone,” said Fauziah, who told the story with the proviso that only her first name be used for privacy reasons. “She felt like getting pregnant, we would call her inconsiderate and irresponsible. She didn’t tell any of us. So she did it all by herself.”
They later found out that Aisha had visited one of the unlicensed pharmacists in the slums who are known for swindling poor women in exchange for bogus abortion services. He sold Aisha a pack of pills and she took them that day. Fauziah doesn’t know what her friend was taking, but women say they’ve been given quinine pills that are ineffective, or even large packs of birth control pills that can cause vaginal bleeding. The practice is so widespread that the nurses noticed what was happening, Fauziah said, and made no effort to hide their disdain.
She asked the nurses to take Aisha in, but it was already too late – she died on the hospital floor in a pool of her own blood.
“The thing has never [left] my mind,” said Fauziah.
This is what an unsafe abortion can look like in Kenya, a traditionally conservative country that has long restricted access to reproductive care. Many women and girls resort to desperate measures—using knitting needles, drinking bleach, taking unfamiliar pills, or taking traditional herbs—to terminate their pregnancy.
Although Kenya has gradually liberalized its abortion laws in recent years, activists fear a tipping point Roe v. calf by the US Supreme Court could set back their progress. But they are determined to continue their fight and draw inspiration from Latin America, where three countries expanded abortion rights in the last year.
“I think the wave that started in Mexico, in Argentina, in Colombia, is catching fire in Africa,” said Tabitha Griffith Saoyo, a Kenyan lawyer working to expand reproductive rights. “[T]Here is room for Africa to lead by showing that abortion is an African issue, not a Western concept, and that we stand ready to protect our women.”
Access to abortion varies widely around the world. In most European countries, Australia and Canada, as well as Russia and China, abortion is possible on request with different pregnancy limits. Within sub-Saharan Africa, Kenya occupies a middle ground; Abortion is banned in Madagascar, the Republic of the Congo and Sierra Leone, among others, while South Africa, Mozambique and Benin are among a handful of countries that allow abortions on demand.
Pregnancy is a deadly gamble in Sierra Leone
Kenya’s original abortion laws were outlined in its colonial-era penal code, which imposed harsh penalties on any woman who terminated a pregnancy and any doctor who assisted her, except in rare cases where the woman’s life was in danger.
Unsafe abortions became one of the leading causes of death and injury for Kenyan women and girls. A 2013 study conducted by Kenya’s Ministry of Health in collaboration with healthcare organizations and civil society found a rate of 30 abortions for every 100 births. More than 157,000 women sought help this year for symptoms related to unsafe abortion attempts, and 37 percent of them experienced serious complications such as high fever, sepsis, shock or organ failure.
“We’ve seen all sorts of grotesque cases,” said Anne Kihara, a practicing obstetrician and president of the African Federation of Obstetricians and Gynecologists. “Women who had their wombs removed, infections, the instruments used, the gross things we had to remove.”
Kenya’s 2010 constitution clearly states that life begins at conception. Abortion is not permitted unless a health professional deems it necessary to protect the woman’s “life or health” or “where permitted by another written law,” a clause opening the door for left open future legislation on reproductive rights. The 2017 Health Act broadened the definition of “health” from the absence of disease to include physical, mental and social well-being.
In 2019, a landmark court ruling gave victims of sexual violence the right to abortion. In another case decided this year, a judge ruled that abortion is a fundamental constitutional right – specifically citing important points of roe – but the decision is being appealed.
For now, on-demand abortion remains illegal, and unsafe abortions are still common. The latest data from 2017 shows a maternal mortality rate of 342 deaths per 100,000 live births in Kenya. In comparison, the United States, which has the highest maternal mortality rate among developed countries, had 17 deaths per 100,000 live births in 2018.
Abortion rights advocates talk about the impact of the tipping here Roe v. calf extend far beyond the United States. “The fact that it’s happening in the United States doesn’t matter,” said Angela Akol, country director for Kenya of Ipas Africa Alliance, a global reproductive rights organization. “What matters is the importance that the United States plays in foreign policy, especially health policy.”
Many Kenyan reproductive health programs are heavily dependent on US government grants and suffered significant financial losses when the Trump administration reinstated and expanded the “global gag rule” in 2017. These organizations fear that more anti-abortion policies and funding cuts may be on the horizon.
Advocates also fear the ruling will embolden international anti-abortion groups, which have long meddled in African politics.
One of these groups is CitizenGO, an ultra-conservative petition mill from Spain. It has already launched a successful campaign to temporarily halt the passage of Kenya’s Reproductive Health Care Act 2019, and its campaign manager for Africa is part of the group appealing this year’s court decision making abortion a constitutional right.
“We will start to see the opposition groups lobby and poke holes in some of the progressive policies and laws that we have in the country,” said Nelly Munyasia, executive director of the Reproductive Health Network Kenya, a coalition of health experts. “And they’re definitely going to want to quote them Roe v. calf Decision.”
Global data from the United Nations shows that restricting access to abortions doesn’t make it less common, but it makes it more dangerous. The UN calculates that 45 percent of abortions worldwide are unsafe.
“Women who are desperate to have an abortion will definitely get it,” Ipas’ Akol said. “Because of the restrictive environment, people are going underground and doing all sorts of things to get an abortion. They die.”
Saoyo, the Kenyan lawyer, said she and other advocates will continue to fight for abortion rights. “There’s still room to fight back as a movement,” she said. “This is the time for Africa and Latin America to lead the way.”