The deadly consequences of curbing reproductive rights

It’s a hot mid-August morning, and Lydia Wambui’s bright green overalls are soaked. She’s standing knee-deep in Nairobi River, using a metal rod to catch rubbish lazily flowing down its murky waters.

“Sewage, bottle-tops, needles – people chuck everything in here,” she says, wiping sweat off her forehead before adding: “We also keep finding babies.”

Two months earlier, the 37-year-old volunteer spotted a blue plastic bag amongst the garbage. She immediately felt anxious: “You have to open it even though you fear what you’ll find.”

FLOATING BABIES

Inside was what she believed to be a recently aborted foetus, several syringes and blood-stained cotton wool. “I’m a mum, I have two kids,” she explains. “It hurts.”

In one 350-metre section, nine foetuses and newborns have been found this year by Wambui’s clean-up team, Komb Green Solutions. After police said the parents could not be identified, the team buried the babies – including two sets of twins – in a makeshift grave.

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Two weeks ago, more than 6,000 people attended the International Conference on Population and Development (ICPD) in Nairobi, a global summit on sexual and reproductive health.

The original event, 25 years ago, kick-started the global movement to recognise reproductive rights as human rights. This time, speakers touted huge gains in global access to contraception, health services and a reduction in maternal deaths.

Yet, the Nairobi riverbanks tell a story of unfinished business. On the first morning of the summit, the Komb Green Solutions team found their ninth body: a baby boy floating down Nairobi River.

EMPTY PROMISES

“Progress is slow,” explains Angela Nguku, Executive Director at the White Ribbon Alliance, when asked about the impact of the ICPD’s goals on Kenyan women. “The government makes a lot of promises but doesn’t deliver.”

Abortions are illegal in Kenya, unless a woman’s life or health is in danger. Safe procedures at clinics cost roughly Sh20,000 (£150, one third of the average monthly salary), whereas unsafe abortions are roughly a tenth of that price. If you can pay, you often risk your life on a concoction of chemicals. If you can’t, you can quickly become desperate.

Every day, 320 women are hospitalised – and seven die – as a result of dangerous ‘quack’ abortion in Kenya, says Marie Stopes, the international family planning charity.

“Women and children are still dying,” says Nguku. “Why do we bury our heads in the sand?”

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This year, Nairobi Governor Mike Sonko asked police chiefs and county officials to investigate the “worrying trend” of bodies found in the river. He has accused hospitals of illegally dumping foetuses and babies. Yet little has changed, says Fredrick Okinda, Komb Green’s chairman, and the issue isn’t exactly new. It’s not just the city’s rivers: babies are also found tucked into dustbins, dropped down pit latrines (long drops) or discarded by roadsides.

BIGGER PROBLEM

“If you live in Kenya, you’ll have heard many stories about abandoned babies,” explains Nelly Bosire, a Nairobi-based obstetrician-gynaecologist. “But the problem is bigger than it should be – and bigger than we are talking about.”

Young women from the poorest communities are most impacted, says Bosire. Cases frequently occur around informal settlements, where contraception is difficult to access. In Africa’s biggest slum, Kibra (formerly referred to as Kibera), 50 per cent of 15-to 25-year-old women are pregnant at any one time.

Dorothy, a 27-year-old pastor, spends much of her free time wandering the streets of Nairobi’s sprawling shanty-towns. By August of this year, she had stumbled on 12 abandoned infants. Some were just several hours old, clenched fists revealing them struggling between life and death. Of those she rescued this year, eight died and four lived.

“Blood is the one consistent thing,” she says. “It’s almost like the mum is still around, like she’s not quite left yet.”

LOST COUNT

Dorothy, who requested that her name be changed to protect her identity, used to keep a tally of the total but gave up several years ago. “It was demoralising,” she says, shaking her head. “Now I just count per year. When the year ends, I peel off the paper, throw it away and move on.”

Nationally, there is no centralised data system to keep track of the total, and official data is difficult to source.

“For police located near the river, [an abandoned infant] is so common it’s not an incident to report,” says Muteru Njama, the Managing Trustee of Change Trust, an organisation that deals with adoption and children's rights in Kenya. He estimates roughly 7 to ten are discovered each week. “But it doesn’t even make the news.”

Pamela Dochieng, a Marie Stopes midwife, says she receives an abandoned newborn every three to four days in their Kibra clinic. Dorothy, meanwhile, believes the number of abandoned babies is rising.

“No one really knows the true scale of what’s happening,” adds Njama.

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SURVIVAL SEX

Five years ago, 23-year-old Mercy Atieno dropped out of school. Her family was in financial trouble, so she turned to ‘survival sex’ with local men in exchange for money. After receiving the wrong abortion medicine from a local quack doctor in Kibra, she became seriously ill.

“I bled so much,” she says, tears filling her eyes. “I felt like my stomach was being cut into pieces. I got better but everyone knew – my neighbours, my family – and I felt like dying. I wanted people to know me for something impressive, not the lady who nearly died from an abortion.”

This was Atieno's fifth abortion in two years. Yet she’s not alone: almost half a million abortions were conducted in Kenya in 2012 – the most recent data available – with one in four women and girls suffering complications.

Women are petrified, says Tabitha Tsaoyo of Kelin, a legal NGO in Kenya.

“Firstly, contraception is often scarce. Young girls are then being forced to carry pregnancies to term because they’re scared of going through an unsafe abortion and dying. Desperation leads to dumping,” she says, before sighing heavily. "We’re giving them no other choice.”

POLICE EXTORTION

What’s more, confusion around the law has led to uncertainty over when the procedure is allowed. Police use this grey area to frequently target both women and health providers in slums.

“Police want money,” explains Tsaoyo. “They will put you on a bond for about Sh50,000  (£375). Then they’ll say: ‘we can drop this case if you pay us.’”

According to the Annual Crime Report, between 2010 and 2018 there were 348 cases reported to police for ‘procuring abortion’ – the offence that both women seeking abortions and medics are typically charged with. Abandoning your baby can fall under two categories – ‘infanticide’ or ‘concealing birth’ – of which 108 cases were recorded last year.

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Just 40-minutes north of Nairobi lies The Nest children's home. Away from the city’s hectic hustle, a quiet calm washes over the lush green trees. Edna Ouma, a 29-year-old social worker, shows us around their ‘Baby Village’ – an airy, red-bricked building dedicated to caring for abandoned infants. Twenty-one babies currently lie fast asleep inside. It’s nap time.

DROPPED OFF, NEVER PICKED

Their capacity is 25, but sometimes they take in more. Today, half the children belong to imprisoned mothers (this is home’s main focus), while the other half were dropped off by the police, a ‘Good Samaritan’ or simply left outside their large green gates.

In some respects, these babies are the lucky ones. Or luckier. If no family has been traced after six months, The Nest receives a letter from the police and they can begin contacting adoption agencies. Kenya's Children’s Department also makes a provision for mothers to give their babies up for adoption if they so wish. The system, however, is not widely publicised.

Similarly, Nairobi-based gynaecologist Dr Jean Kagia set up rescue centres – known as ‘kiotas’ or ‘nests’ in Swahili – for young pregnant girls. She describes herself as pro-life, viewing abortion as a social not medical problem and, according to Bosire, is “plugging the gap” for vulnerable women.

LEFT WITH NO CHOICE

“It’s tricky,” begins Ouma. “The reasons vary, but the mothers I’ve spoken to often say they didn’t want to do it. They needed to work to feed their family. Maybe they dropped their baby off in daycare, but didn’t make enough money that day and they were afraid to come back. Women find they’re left with no other option.”

Each case is different, says Ouma, but The Nest is keen on counselling women and helps with employment opportunities so “they do not need to repeat the same thing again.”

The issue is undoubtedly an economic one. As Sofia Rajab-Leteipan, a human rights lawyer based in Nairobi puts it: “poor women are being targeted.” But she, and many experts believe the problem is much bigger than that. “Looking at abortion in isolation isn’t going to help anyone. The entire system is failing women.”

Access to health services is key, she says, but it’s more than just the range of services available. Cost, a woman's knowledge of contraception and her ability to make decisions about accessing it all need to be addressed. “If there are barriers on all these things, women will become pregnant, they will have unwanted and unplanned pregnancies, which will result in unsafe abortion and dumped babies,” she explains. “It’s a chain.”

REDUCED FUNDING

What’s more, the US has dramatically reduced funding for maternal health and family planning in Kenya under President Donald Trump's administration. The total dropped from £32 ($41m) in 2017 to £6.8 ($8.8m) just one year later. 

Family Health Options Kenya (FHOK), the country’s first and largest reproductive health organisation, lost roughly $2.2 million in response to the Trump administration’s passing of the “global gag” rule in 2017. FHOK has now closed two clinics, eliminated all free outreach services, and laid off 18 staff members.

Only 2 per cent of their services were abortion-related, according to FHOK’s Amos Simpano.

“Dumped babies are just the tip of the iceberg,” says Elizabeth A. Bukusi, a Kenyan doctor who is also a research professor at the University of Washington in Obstetrics, Gynaecology and Global Health. “Do these young women even have enough bus fare to get to a healthcare facility?”

Back at the river, life has been disrupted once again. In what’s fast becoming a disturbing routine, the Komb Green Solutions team found the latest body, swaddled in a paper bag, and buried him with the others. The deaths are, unsurprisingly, beginning to take a toll.

Lydia was off that day, but she heard what happened. “It’s so sad,” she says quietly. “We really can’t go on.”

CREDIT: This story was a collaboration between The Daily Nation, The Fuller Project for International Reporting, and The Daily Telegraph.