How Covid-19 fanned the flames of unsafe abortions

One morning in September, Ashura Mciteka was sitting at home when her daughter burst through the door. “Come and see,” cried 10-year-old Ella, tugging her mother’s hand. Together they retraced Ella’s steps along a rocky, uneven pathway in their low-income neighbourhood in Nairobi, to where the young girl had been playing.

The pair spotted it easily; a tangle of lifeless limbs in a muddy puddle.

As a trained health volunteer, 38-year-old Mciteka is frequently called to make home visits, treat common illnesses and arrange hospital referrals for her neighbours. She immediately knew what she was looking at; a recently aborted foetus.

“I’m also a mother, so I know,” she explains over the phone one month later, her voice low.

Over the last six months, across Dandora, an array of apartment blocks and informal settlements next to one of the largest unregulated landfill sites in Africa, Mciteka has directly dealt with or heard of at least 30 abandoned foetuses or new-born babies.

Rubbish collector

Five of these were found in the same tip minutes from her home, discovered by someone in her community – a rubbish collector, local resident and even her own young child.

 In 2019, she knew of 10 cases, she says.

“Even when I’m not around, I get a call,” Mciteka says. “I say: okay, I’m far but let me see what I can do.”

In Kenya, the issue of abandoned new-borns is not new. Last year, The Telegraph and Daily Nation reported on a volunteer clean-up team, Komb Green Solutions, who had uncovered nine foetuses and babies in as many months while clearing a section of the Nairobi River of plastic, sewage and needles. The river is just one place the babies are found; news of infants discovered in dustbins or discarded by the roadside hits headlines with unsettling frequency. But without a national centralised data system to keep track of the total, many cases go unreported.

Work by women like Mciteka offers a small window into the scale of the problem. In Kenya, abortion is illegal unless a woman’s life or health is in danger and almost two-thirds of pregnancies among adolescent women aged 15-19 are unintended each year, according to the Guttmacher Institute. The pandemic, like everything else, is making an already concerning situation worse, say service providers in direct contact with women on the ground.

Aborted foetuses

Following a flurry of reported cases in June and July, Nairobi Governor Mike Sonko told journalists in Kenya that the issue of aborted foetuses and abandoned babies is beginning to “resurface again” and urged women to seek help from authorities.

The 70-plus members of the Komb Green Solutions team have also noted an up-tick since the outbreak of Covid-19. They’ve stumbled on 34 cases so far - 13 of which they've found since May, according to Christopher Wairimu, the group’s secretary.

“Some of them were breathing,” adds Debra Ogollah, a 26-year-old volunteer, “but unfortunately, they only lived some seconds.”

The team continues to bury the new-borns they find – including eight sets of twins found over the course of one year – in an ever-growing makeshift grave nestled next to the river (local police have given them permission to do so, say the Komb team).

Several hours north of the capital, reports of the same issue are occurring across Nyeri County in central Kenya. In September, John Waruru, local assistant chief, rescued a new-born from a bush near the banks of Gura River – the umbilical cord was still attached. On this occasion, the baby girl survived.

“I’m hearing of stories weekly,” says Nelly Munyasia, Head of Reproductive Health Network Kenya (RHNK), a web of over 500 trained health professionals providing health services. “Initially, it was just in Nairobi, but it seems to be spreading pretty fast across the country.”

Like many countries around the world, Kenya closed schools in March to help stem the spread of the virus. The move left some 18 million students with little to do for more than six months and restrictions on movement meant accessing contraceptives and reproductive health information became harder.

The collapse of global medical supply chains earlier this year, meanwhile, is still causing knock-on delays and shortages for some clinics in Kenya. Several service providers in Munyasia’s network are reporting difficulty in accessing long-term contraceptive methods – such as hormonal implants and intrauterine devices (IUDs).

In Kenya, high rates of teenage pregnancy have long been an issue yet since mid-March, healthcare providers have repeatedly raised concerns about a spike during the pandemic. Although comprehensive national data about the impact of Covid-19 is not yet available – and statistics can be patchy at best – community health organisations in informal settlements say, anecdotally, teenage pregnancies are soaring. And in the first seven months of 2020, the Ministry of Health noted a 35 per cent increase in the number of sexual and gender-based violence cases compared to the same period the previous year, particularly among girls aged 10-17 years.,

Backstreet quacks

The Ministry of Health did not respond to the Telegraph’s request for comment. During a September visit to Kibra, an informal settlement, one of the ministry officials, Dr Mercy Mwangangi, acknowledged that “the same barriers that restrict sexual and reproductive health care during the most normal of circumstances still exist and are often magnified during the (coronavirus) crisis.”

Nearly 90 per cent of Kenyans live on less than £4 (Ksh500) a day, and the cost of a safe abortion procedure, roughly £150 (Ksh2,200), is out of reach for many women. Unsafe abortions are cheaper, but typically involve visiting backstreet quacks who prescribe a concoction of dangerous – and sometimes lethal chemicals. There is little support or aftercare, and young women are frequently left to fend for themselves.

Back in Dandora, Mciteka quietly covered the aborted foetus with an old cloth. She informed the local chief, who in turn called the police. When a foetus or new-born is found, there is no official process – sometimes the local chief or police help, but often it falls to community members like Mciteka to arrange a burial (it’s a different situation altogether if the child is still alive).

The heaviness is taking its toll, says Mciteka. For several weeks after finding the foetus, Mciteka’s daughter, Ella, didn’t leave their home. She only wanted to play inside. Since then, things have improved – she’s ventured past the front door but doesn’t wander far. As a mother, it’s painful for Mciteka to watch something so dark close to home – but it’s also part of the reason she can’t quit.

This story is a partnership between the Telegraph, Kenya’s Daily Nation and The Fuller Project, a global non-profit newsroom reporting on issues that affect women.

Louise Donovan is a correspondent with The Fuller Project, a global non-profit newsroom reporting on issues that affect women. Nasibo Kabale is a health reporter with the Daily Nation.