Women die silently, invisibly from pregnancy

Last week’s call by the United Nations Population Fund (UNFPA) to governments to increase spending on reproductive health may prove to be hard for Kenya to implement. Kenya has no budgetary allocation for reproductive health.

During celebrations to mark the World Health Day last week, Thoraya Ahmed Obaid, executive director of the UNFPA, said providing family planning will reduce maternal mortality by 25%.

“As contraceptive use rises, maternal and newborn deaths decline,” she said in a statement.

Concerns are, however, mounting that without state commitment to provide family planning in Kenya, maternal mortality may continue to rise.

“The budget we have for reproductive health is meant for meeting, for example, salaries for staff of the department. We have no specific budgetary fund to procure contraceptives. This is serious because it means more women may continue dying from pregnancy,” said Dr Josephine Kibaru, head of reproductive health services at the health ministry.

She said: “We get contraceptives from donors. But we have been advocating for a budget to purchase contraceptives. We have constantly been lobbying the treasury. This year, we are expecting a budget line for family planning.”

Kenya’s contraceptive prevalence rate is only 39%, according to the 2003 Kenya Demographic and Health Survey (KDHS).

Campaigners blame the unmet need for safe and effective contraception for Kenya’s high maternal mortality. With no contraception, there will be more pregnancy as well as a high risk of death at childbirth, they say.

The KDHS shows that the country’s maternal mortality ratio is 414 deaths to 100 000 live births, way above the United Nations Millennium Development Goal of 147 deaths per 100 000 live births by 2015.

Of the half a million maternal deaths each year, 95% occur in Africa and Asia, according to the UNFPA. In sub-Saharan Africa, a woman faces a one in 16 risk of dying during pregnancy or childbirth, compared with one in 3 800 for a woman in the developed world, the UNFPA says.

Health activists say the unmet need for effective contraception, resulting in unwanted pregnancies, has been the reason for women and girls seeking abortions.

Of the estimated 211-million pregnancies that occur every year, about 46-million end in induced abortion, of which only about 60% are carried out under safe conditions, according to the UN World Health Organisation (WHO). The rest are performed by unskilled people or in an environment lacking the minimum medical standards, or both, the UN health agency says.

In Kenya, as in most countries in Africa, abortion is illegal and is only permitted when a woman’s life is at risk.

About 300 000 abortions are performed each year in the East African country, resulting in the hospitalisation of an estimated 20 000 women and girls with abortion-related complications, according to the 2004 report A National Assessment of the Magnitude and Consequences of Unsafe Abortion in Kenya.

Conducted by the Kenya Medical Association, the ministry of health and the Federation of Women Lawyers’ Kenya chapter, together with the International Projects Assistance Services (Ipas), a global body advocating reproductive health rights for women, the study shows that 800 abortions are carried out every day, with a death rate of 2 600 every year.

As a result, health activists and practitioners blame the international community for ignoring women’s health.

“The world only responds to crises which are visible; for example, a crash or an explosion. But every minute when a woman dies, it is nothing because she is dying silently and invisibly, and it is viewed as a problem for her family. She is left to die and she just becomes part of statistics.

“The issue of women dying from unmet health needs is a much bigger disaster. If the international community responds to disasters, including floods, why can’t it react to women dying?” said Dr Josephine Moyo, of Ipas.

She accused the international community of reneging on its commitment to the International Conference on Population and Development (ICPD) and the Fourth World Conference on Women (FWCW), both of which addressed the issue of unsafe abortion.

Held in Cairo, Egypt, in 1994, 179 countries at the ICPD recognised unsafe abortion as a major public health issue and emphasised the importance of preventing it through scaling up family-planning services and ensuring safe abortion in cases where it is permitted.

In 1995, during the FWCW held in Beijing, China, governments agreed to consider reviewing laws that branded abortion illegal.—IPS

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