It is 6pm in Nairobi’s Kibera estate and 18-year-old * Saida has just come home from school.

Her four-year-old daughter goes to greet her, running between buckets lining the corridors of their compound. The two hug at the door after which Saida gracefully adjusts her hijab. She reaches out of her school bag and gives the daughter a packet of biscuits.

“I regret everything,” she starts, recounting the night she had an abortion. “I have never felt the kind of pain I did on that day. It is still etched in my mind. It was not as painful as when I gave birth to my child at 14 years. My back and my waist were in so much pain it felt like they were pulling apart.”

Saida had an abortion in September 2020 when schools were out of session due to the Covid-19 pandemic. This was barely a month before the government announced that schools would reopen in October 2020 for learners in grade Four, Class Eight and Form Four.

“Then, I was too young and could not bear the thought of burdening my mother with a child. I had to terminate the pregnancy. I was sitting the Kenya Certificate of Secondary Education examination the following year.”

She remembers bleeding more than she did when she gave birth. “I was in pain. I was four months pregnant. As a Muslim, I knew I had sinned, but I did not have a choice. I see myself as a murderer to date,” she tells HealthyNation.

The lockdown 

On March 15, 2020 President Uhuru Kenyatta announced the indefinite closure of schools and other learning institutions due to the pandemic. Kenya had then reported 16 coronavirus cases. The move was aimed at curbing the spread of the virus in schools.

Saida became one of the thousands of adolescent girls who were at risk of teenage pregnancies during the long break that lasted nine months.

As a teenage mother, Saida depended on her mother who lost her job during the pandemic. Therefore, she ran back to the arms of the man who made her pregnant leading to the birth of her daughter, who is now four years old.

For the first time, she relied on handouts from her boyfriend to feed her three siblings, her daughter and her ailing mother.

Sadly, she got pregnant again. Abandoned a second time, she opted for an abortion.

“My friend took me to a woman in the estate who helps young girls to terminate pregnancies using some bitter herbs. My mother is still not aware of what I did. I ran away from home for two weeks. I had defied my religion a second time and sinned again,” she gasps out the last statement between tears.

Her daughter joins us on the couch, Saida puts her on her lap and continues with the conversation.

“I did not want to get another child after this one,” she says, pointing to her daughter. “I did not want to drop out of school. During the nationwide curfew, in the dark and in pain I wrapped everything that was expelled after taking the herbs and threw it away.”

According to findings from the Presidential Policy and Strategy Unit Study on Impact of Covid-19 on Adolescents, when schools reopened in January 2021, 16 per cent of girls and eight per cent of boys did not return. This was mainly because of lack of school fees and unintended pregnancies. The numbers translated to approximately 125,000 boys and 250,000 girls who did not re-enroll when school reopened.  Among 15-19-year-olds four per cent are pregnant or recently had a baby - Over 100,000 adolescent pregnancies

Two per cent of 15-19-year-olds were married when schools reopened following the extended closure in 2020, translating to approximately 160,000 early marriages.

Botched abortion

The daughter of Coletta, not her real name, is one such case. Her 14-year-old daughter * Sandra died after a botched abortion. Like Saida, Sandra got pregnant when schools were closed due to the pandemic.

“I work as a cleaner. I had gone to work and had just started soaking clothes at the house where I was working on that day when my phone rang. The caller told me I was urgently needed at Madiaba in Kawangware. I was hesitant because I did not know the caller, so I did not go. The caller was persistent and told me if I do not make it on time, my daughter will bleed to death,” she recalls the events of that day.

The message sprung her to action and left for Madiaba. What she saw haunts her to date.

“There were four girls in a room. One opened the door for me. Two were mopping blood on the floor. None of the faces looked familiar. On looking closely, I realised the girl lying on the floor soaked in blood was my daughter. The girl on her right, said she tried pulling out the knitting from her vagina and the bleeding became worse. Her stomach was swollen and she was crying,” she recalls.

Coletta remembers the empty house had cardboards on the floor, which she assumed were used as sleeping mats by the girls.

The 30-minute journey from Kawangware to Kenyatta National Hospital from a private clinic was a nightmare for the mother, who was racing against time to save her daughter’s life.

Three hours of runs by nurses could not save her life. A nurse emerged from the ward with blood spattered on her scrubs and informed her that her daughter had died. By the time they got to KNH it was too late to save her.

“She told me that she had used needles to try and terminate her pregnancy and her stomach was swollen because they could not remove everything. She bled to death,” says the mother. 

Sandra’s story resonates with that of JMM who died in June 2018. Her death was the beginning of a story and a fight for reinstatement of the post abortion care guidelines abolished by the Health ministry in December 2013. 

On December 2019, the Center for Reproductive Rights, Federation of Women lawyers, Fida and other community rights group won a landmark case against the government. The groups were challenging the withdrawal of the Standards and Guidelines for Reducing Morbidity and Mortality from Unsafe Abortion in Kenya.

The groups filed the case on behalf of the adolescent (JMM). The case was presided by a five-judge bench at the High Court. The court found that the Director of Medical Services and the Health ministry had violated the rights of Kenyan women and girls by arbitrarily withdrawing the guidelines, creating uncertainty as to the status of legal abortion and discouraging medical providers from performing abortions for fear of criminal prosecution. The government was ordered to reinstate the guidelines.

“That was victory for Kenyan women and girls. JMM’s case was a window into the plight of many other women and girls who have no place to turn, and no access to information or reproductive health services. With e implementation of this court order, health providers can offer clinical abortion and post-abortion care services without the fear of being prosecuted. And it is a step in the right direction toward improving maternal health outcomes for our country,” says Evelyne Opondo, the centre’s senior regional director for Africa. 

JMM got pregnant after she was forced into sex by an older man in 2014. With Sh1,500, she procured an abortion drug with the help of a friend.  When the foetus was not expelled, JMM returned to the pharmacy and the ‘doctor’ proceeded to insert a metal-like cold object into her vagina and once again told JMM to go home as the foetus would be out by that evening. That evening, JMM started vomiting and experiencing severe stomach pains accompanied by heavy bleeding that led to a domino of medical complications that later took her life.

To date the government is yet to state the progress in terms of reinstatement the guidelines.

“With regards to sexual and reproductive rights in Kenya, we have made some progress in terms of the laws and policies although there is still a lag in terms of implementations in our Constitution and the policies, but we are seeing a disconnect. We are still seeing some deaths in the country and disabilities related to maternal health.”

On October 13, 2020 Health Cabinet Secretary Mutahi Kagwe appeared before the National Assembly Health Committee to respond on the steps the ministry had taken following petition No 266 of 2015 on reissuing of the standards and guidelines for reducing morbidity and mortality from unsafe abortions in Kenya. He was also to respond to questions on the inclusion of a training curriculum.

“The Director of Medical Services upon receiving complaints and concerns, established that these guidelines and training material developed thereof, created ambiguity and covertly enabled healthcare workers without proficiency of training to determine that a pregnancy poses harm to the mother to meet the constitutional threshold of terminating a pregnancy. As a result, there was indiscriminate termination of pregnancies through acts of omission with attendant increase in morbidity and mortality,” said the CS.

However, there have been concerns over the continued number of deaths being reported due to complications arising from unsafe abortions especially among young girls and women due to lack of the guidelines.

“The laws and policies are not in sync. There are a lot of contradictions. While there are certain laws that provide for care and access to health services, there are those that claw back and retract the access and right to that care,” says Ms Opondo. 

According to the ruling in 2019, the court declared that women and girls had the right to the highest attainable standard of health, which includes its broadest interpretation, to include mental and social well-being as well as physical, the right to non-discrimination, the right to life and other rights.

“When an adolescent has been raped and the medical profession has determined she cannot keep the pregnancy because it is affecting their mental health, this adolescent is allowed by law to terminate the pregnancy. But beyond that where there are adolescents that have received the necessary support from the healthcare system, parents, church and teachers and end up with unsafe abortions,” says Ms Opondo.

“When they come back with knitting needles stuck inside them, they have damaged organs they are dying. We must provide adequate medical care and this is called post-abortion care. This care will help such adolescents live meaningful and dignified lives.

According to a study done the Health ministry and the African Population and Health Research Center, the cost of treating complications arising from unsafe abortion in public facilities in Kenya was Sh432.7 million.