I’m going to kick off this entry by directing your attention to the disclaimer on the left sidebar of the page: this is just me talking. Not the Peace Corps, not the US government. To say our topic today tends to be slightly controversial is to say our Coastal rainy season can be slightly damp. But it’s an incredibly salient and worthwhile discussion, regardless of where you stand politically – as you will see in the coming paragraphs. Furthermore, after writing about birth control access, early marriage, and the inevitability of motherhood in Kenya, I should at least say *something.*

I recently had a conversation with a health professional in which they talked about a case that had recently come into the clinic. (Forgive the use of “they” referring to one person; I mourn for the lack of a commonly-understood gender-neutral singular pronoun in English.) The patient, a young woman, had been bleeding for days, and while she told the health professional she’d miscarried, she quietly informed a patient aid that she’d had an abortion. Abortion is illegal in Kenya. This Constitutional position is widely supported by most citizens, to the point where some argued against the ratification of the Constitution on the basis that it provided an exception for the life of the mother. Thus, after being told about the true origin of the bleeding, the patient aid in turn told the HP.

Following some prolonged questioning, the patient tearfully confessed that her husband had forbidden her from using family planning, an order not uncommonly backed up with physical violence or even promises of death. (Yes, I’ve met women genuinely afraid their husbands would beat them to death for disobeying these sorts of directives.) When the patient became pregnant, she realized they couldn’t afford to support an expansion of the family, so she had a “bush abortion,” wherein an herbalist/witchdoctor gave her pills of some kind that resulted in a termination. (The majority if women I’ve talked to about this subject – after denying they’d EVER EVER EVER do such a thing themselves – admit these services are pretty easy to get, and most “know someone who knows someone” who has direct access.) But days later, the woman was still bleeding, and had developed a fever. “Like something still remained inside,” she later said. She was fearful of dying. The HP wrestled with their conscience about whether the woman should be treated, and ultimately did so – which they sort of regret – before turning the patient’s information over to the police. They hoped they had “taught her a lesson,” you see. Taken a stand against immorality and sinful, lazy women.

And (potentially) deprived children of their mother, and a woman of her freedom, for attempting to do best by the family she already had instead of adding another mouth she could not feed.

This sentiment of “making immoral women face their choices” is one I hear fairly often, and something that has even come back into political play in the United States, nearly 40 years after the landmark Roe V. Wade ruling stopped the bloodshed and butchery that killed killed hundreds and maimed thousands of women every year. (Perhaps the name Geraldine Santoro rings a bell?) Ironically, it was also the subject of a conversation I had literally the day after I discovered that the reproductive rights and family planning access research foundation The Guttmacher Institute released its data on abortion access and maternal death in Kenya specifically. It’s a worthwhile – if heartbreaking – read, and posting a link to it is half the reason for this post today:

Guttmacher Institute: Unintended Pregnancy and Abortion Factsheet – Kenya (Released May 2012)

Did you know …?

– East Africa has one of the highest incidences of unsafe abortion in the world, with an estimated 2.4 milllion performed in the year 2008 alone.

– Abortion in Kenya is illegal under the Constitution in all but a rare set of circumstances, making it tricky to track, but some studies estimate the annual rate of unsafe abortion in Kenya to be over 300,000.

– 13,000 deaths result annually in East Africa from unsafe abortions; one in five maternal deaths are due to unsafe abortion in the region as a whole. More specifically, a pilot study in the Nakuru area of Kenya alone found that about 25% of maternal deaths are the result of unsafe abortions. As many as 60% of gynecological emergencies and related hospital admissions are due to the same.

– Women who seek treatment following an abortion often have long waits before they are able to be assessed by trained medical professionals. Basic training could remedy this. [ANECDOTAL NOTE: In my experience, there’s a LOT of misinformation about this, even among healthcare providers. Post-abortion data is recorded and submitted to the government, and some providers believe this means the identities of the women must also be submitted to the government or police. Some providers are resistant to getting training because they think it would mandate they provide abortions, or because they believe treating women who have “brought this on themselves” is unethical. This is not from the Guttmacher report, but is germane information I’ve gained during my work in public health.]

– One in four married women has an unmet desire for contraceptives. Only 12-17% of rural poor women use modern methods of family planning.

– As a result, the average Kenyan woman has one more child than she wants. The average rural Kenyan has two more than she wants.

There’s a lot more, but these are some of the highlights. Seriously, go read it.

The other half of my reasoning for this entry it to recommend a pair of books to supplement your summer reading. As the abortion debate in the US heats up, we need to better educate ourselves about the political, social, and medical realities of what a world without access to safe, legal abortion looks like. Regardless of your take on the issue, I STRONGLY encourage you to read the two following books, both of which are available on Kindle (as well as old-fashioned paper versions):

A Life of Passion: Margaret Sanger A biography of Margaret Sanger, whose experiences as a nurse led her to be a crusader for birth control access and reproductive choices for all women. You may know her best as the founder of the American healthcare provider and education giant, Planned Parenthood. She was viewed as deeply immoral and arrested numerous times in her life for the controversial position that – in her own words – “Children should be (1) Conceived in love; (2) Born of the mother’s conscious desire; (3) And only begotten under conditions which render possible the heritage of health. Therefore we hold that every woman must possess the power and freedom to prevent conception except when these conditions can be satisfied.” Some of her positions remain controversial today, for good reason, but this book provides a fair and contextual reading of all of it – both the parts that are pleasant, and those that are less so.

When Abortion Was a Crime: Women, Medicine, and the Law in the United States, 1867-1973 An exhaustively researched piece about the state of life in America before Roe v. Wade, from doctors’ crusade against abortion as a tool to disempower midwives onwards. Fascinating, and heartbreaking, stuff.

You need to read them, but I can also basically summarize what they say in two basic points:

1) Studies show that access to accurate reproductive information and a variety of forms of birth control do not “encourage” sex (adolescent sex, pre-marital sex, gay sex, any kind of sex) any more than carrying an umbrella “encourages” rain. This is a vitally important first line of defense in the fight to promote lifelong reproductive health and lower the overall rate of abortion as well as other negative outcomes like STIs. (Just look at Europe.)

2) Access to safe, legal abortion, or at the very least, access to post-abortion medical care doesn’t “cause” more abortions. Women will have abortions, regardless of whether its relatively safety. They have done so for literally milennia The results are simply more women who survive, rather than bleeding to death in the wilderness (I wasn’t kidding about “bush abortions”) or succumbing to infections silently in their homes.

I wonder what happened to the woman who came to the clinic with unremitting bleeding, where she is now, if the police followed up or took action, if her husband took action – and if so, did she survive it? I think about her and the hundreds of thousands of women like her every year. It is for them as much as ourselves that reproductive activism and awareness of access rights is as critical for my generation as it is for that of my mother and grandmothers. It is for them that we must continue to fight the good fight.

I hope she’s ok.

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