Death by backstreet abortion

When I met Mary a year ago, she had two weeks to her wedding but was admitted to the hospital. The wedding was planned to coincide with Valentine’s Day but given her medical condition, the wedding was hanging in the balance. “Doctor, we have planned this wedding for two years,” said Mary. “Invitation cards have gone out… it just has to happen.”

The worry was that the time she needed to recover from an operation as major as the one she had just had was unpredictable, and so it was not possible for me to tell whether she would make the wedding. Mary had just had a hysterectomy as a result of a botched backstreet abortion.

“I do not regret the abortion, it was the best thing for me at this point,” she reflected. “But I regret losing my uterus. It is painful. I just do not know how to handle it” she added, tears rolling down her cheeks.

Mary’s story was sad. Thugs attacked her house, raped her, and carried away all her electronics. It was a difficult experience for her. She chose to tell her fiancé about the robbery but left out the rape bit. She was afraid that this would put him off at a time when they needed to be most intimate.

Unfortunately, Mary conceived as a result of the rape. “I stopped thinking. It became urgent for me to abort,” she confessed. She confided in a close friend who introduced her to a traditional birth attendant known to do abortions.

“The consultation was done in her house and asked for Sh8, 000 before doing the procedure on me. I quickly gave it to her,” said Mary. The traditional birth attendant then took Mary to her bedroom and inserted metals in her private parts repeatedly until she started bleeding. She was then told to go to her house and reassured that the pregnancy had come out. “I have never felt such pain in my life,” Mary said of the experience.

The bleeding went on for a week and the pain worsened. Mary felt weak and developed a fever. Her friends carried her to the hospital where she was found to have a badly damaged and infected uterus. She was transfused with blood, put on intravenous antibiotics, and operated on to remove the damaged uterus.

Mary is one of many women in Kenya who resort to backstreet abortions to terminate unwanted pregnancies. It is estimated that 465, 000 such abortions happen in Kenya every year. A number of women die and many more suffer acute and long-term injuries.

Asked why she resorted to backstreet abortion, Mary said if her community got to know she had aborted, she would have been banished. She wanted the most private and confidential provider to keep the secret, and the traditional birth attendant appeared to be the one. “You know you cannot just walk into a hospital and request for an abortion, the doctor can even call the police to arrest you,” she said.

In general, abortion services have not been available in health facilities in Kenya. This is despite the fact that the Constitution of Kenya now allows a trained health professional to counsel a woman asking for abortion and determine if such a request is lawful, and provide it. Article 26 of the Bill of Rights allows abortion for health reasons, in emergency situations, and to save a life. It is therefore no longer expected that a health worker will mistreat a woman who walks into a health facility asking for an abortion. Instead, such women are supposed to be treated respectfully, counseled in a private room, and given safe options including the possibility of giving the baby up for adoption. Where the health worker is convinced that the pregnancy is not healthy for the woman, safe abortion is to be provided. This ensures that desperate women do not go the dangerous quack route.

“So tell me, doctor, my fiancé is traveling and will be arriving here tomorrow. How do I tell him that I was raped and conceived and aborted and lost my uterus?” Mary asked, crying, “How I wish I had died in theatre during the operation.” She was seemingly losing it. Intensive counseling was needed.

The next day I passed by the ward to check on Mary but found an empty bed. I asked the nurse where she was, the nurse did not answer me; instead, she fetched Mary’s file. Mary had died the previous night. She developed breathing problems, was put on oxygen, and resuscitated but deteriorated and stopped breathing. A diagnosis of pulmonary embolism was made; a blood clot had gone into her lungs and blocked blood from flowing, causing her to stop breathing. This was a complication of the prolonged illness and the big operation to remove the uterus.

Mary’s story was a grim reminder that unsafe abortions can kill. If ever you come across a person with an unwanted pregnancy, tell them to go to a health facility for help. Taking the right step makes the difference between life and death.