Seventeen-year-old Sharon Okello still writhes in agony from the surgery that removed one of her Fallopian tubes.
The bleeding has eased, but the pain has not and she fills her one-room house in the Kibera slum in Nairobi with faint cries on the days it decides to swell up inside her.
“I got pregnant, but my boyfriend ran away and my mother was supporting my elder sister through school by herself.
“She couldn’t afford to take on another mouth to feed, so I felt like I had no choice.”
Okello came to the decision by herself, taking a cocktail of pills recommended by a friend.
A day later she collapsed at the door of the house she shared with her mother, blood streaming down her legs.
She survived after an emergency operation, but she was one of the lucky ones.
Around 21 000 Kenyan women are hospitalised every year because of complications from unsafe abortions.
An estimated 2 600 die, according to Kenya’s obstetrical and gynaecological society, from procedures carried out by untrained “professionals” in back alleys and people’s homes — well away from proper health facilities where women can be reported to the police and jailed for up to 14 years if convicted of terminating a pregnancy.
Many are reported by neighbours. Some women are reported to have bled to death in police cells.
It is, says Muhtoni Ndungu of the reproductive health and rights alliance, a problem that affects only the poor.
When you least expect it
People from all backgrounds — young and old — can fall pregnant when they least expect to, she says, but it is only those with no money who are left to deal with the worst consequences of using herbs, detergents and drug cocktails to end their pregnancies.
Coat hangers and other wire are often used. Another method involves blowing tobacco into a straw inserted into the woman’s uterus.
“Rich people can afford abortions by travelling to South Africa or elsewhere, but the poor cannot.
“This is a class issue.
“Wealthy women know where to go, making it legal for the rich, but not the poor.”
The abortion issue is heating up in Kenya.
The new Constitution, introduced last year, permits women to procure an abortion if their life is in danger.
But according to anti-abortion campaigners, the provision that allows for this was just a means of allowing abortions-on-demand in through the back door.
“This is just the first step, which means we have to step up our campaign against proponents of abortion who are better funded than us,” says Richard Kakeeto, a lawyer with Human Life International Kenya.
Two weeks ago the Kenya Medical Association held a two-day meeting to discuss the implications of the 2010 Constitution for maternal health.
The meeting was addressed by Sir David Steel, the man behind Britain’s 1967 Abortion Act, raising concerns among many Kenyans that abortions-on-demand are on the way.
“Those who want abortions say: ‘What other option do women in desperate situations have?’ But this is the wrong question. We need to ask what is driving women to have abortions in the first place.
“Abortion in this country is a social issue and we need to form policies to address this. Give me jobs so that women are not too poor to have children and hospitals to support them so when someone gets pregnant she does not feel like she’s being condemned to hell.”
Ndungu agrees, but says another problem is that sex is a taboo subject in Kenya, with no comprehensive sex education offered in schools.
“More than 40% of births in Kenya are unplanned and one in four married women has an unmet need for contraceptives. Yet women are ostracised if they have children out of wedlock. So the fact that women are getting abortions should not surprise us.”
It’s certainly no surprise to Professor Joseph Karanja, a gynaecologist at Kenyatta National Hospital in Nairobi, the maternal health ward of which receives about 20 admissions every day.
He says 10 of the 20 or so admissions are related to complications from unsafe abortions.
“I have been here since I was a student and it has been like this the whole way through.
“Women will seek abortions, no matter what the safety issues.”