Kenya approves new guidance for provision of safe abortion care

Monday, October 22, 2012

In 2010, Kenyans voted to pass a new Constitution that allows abortion if “in the opinion of a trained health professional, there is need for emergency treatment, or the life or health of the mother is in danger, or if permitted by any other written law.” Now, after years of evidence-gathering and intense stakeholder discussions, the law will be implemented through carefully crafted standards and guidelines to reduce deaths and injuries from unsafe abortion.


On October 17, the guidelines were launched officially. Dr. Francis Kimani, director of medical services, said: “As you are aware, the core function of the Ministry of Medical Services under the new constitution is to give policy guidelines, setting standards and capacity building in provision of health care…the Ministry of Medical Services has recently come up with Standards and Guidelines for reducing mortality and morbidity from unsafe abortion in Kenya. These guidelines are now available and I call upon all caregivers to acquaint themselves with the guidelines and use them as working tools for the benefit of patients.”


Maternal mortality is high in Kenya and unsafe abortion a major cause for women’s deaths. In fact, Eastern Africa has the highest rates of maternal deaths from unsafe abortion. The preface to the new guidelines recognizes the preventable nature of unsafe abortion and its contribution to maternal mortality in Kenya: “The Ministry believes that the problem of unsafe abortion is multifaceted – it has legal, religious, gender, rights and public health dimensions among others. As such, multi-sectorial involvement is important in solving it because each sector has something special to offer.”


Dr. Joachim Osur, Ipas Africa Alliance program director, worked from the outset with partners, policymakers and health officials in development of the guidelines. The new guidelines are a “very comprehensive tool,” he notes. “We truly used the scientific evidence, including recommendations from the World Health Organization, to define health and interpret the constitutional provisions for abortion.” The guidelines define several health providers—including medical officers, clinical officers, nurses and midwives—who, having completed required training, can perform safe abortions in facilities meeting the criteria set forth in the guidelines.


The guidance is based on the overarching premise that all Kenyans—including young people and adolescents—have the right to freely decide the timing, number and spacing of children and that everyone will have equitable access to reproductive and sexual health information, education and services. In Article 43 of the Bill of Rights, the Kenyan Constitution has elevated health, including reproductive health, to a human right that must be protected. The standards and guidelines are developed with this in mind. Reproductive health, including legal abortion, should not be seen as a fringe benefit but as a human right that should not be violated, notes Osur.


“It took more than a year to agree on this document,” says Dr. Osur. “But all stakeholders agreed that it had to be scientific and lawful; we had to put emotions aside in what at times was a heated debate and just use facts.”


One important gain, he says, is that the new document has outlined the use of safe technologies such as medical abortion (including mifepristone and misoprostol combination) and MVA.

Dr. Osur shares his hopes for the future in Kenya: “If we work together we can reduce mortality and morbidity from unsafe abortion. We know the problem and the new guidelines will help us solve it.”