An Ethical Response to Reducing Maternal Mortality in Kenya

The leading cause of maternal death in Kenya is haemorrhage, contributing to 25% of maternal deaths followed by complications caused by disease such as malaria, anaemia, HIV and AIDS and other indirect causes at 20%. Sepsis is responsible for 15% of maternal deaths while hypertension diseases are responsible for 12% of maternal deaths in Kenya. Obstructed labour is responsible for 8 % of deaths while induced abortion is responsible for 13% of maternal deaths.

Maternal-mortality
Picture Source: PWRDF Photostream on Flickr

Last week, a report on the incidences and complications of unsafe abortion in Kenya was released; a collaboration of NGOs and some institutions, the report is tailored to justify abortion and increased access to contraception as a humanitarian gesture. The report was done in consultation with professionals/informants who support abortion and is not representative of all Kenyans. Certainly, women with post-abortion complications may be given post-abortion care but post-abortion care should not be the pseudonym for abortion services. It also opens our eyes to the fact that some foreign clinics are procuring abortions outside the limits of the Kenyan constitution. Contrary to the report, women who ‘fear’ contraceptives in Kenya do so for health reasons and some  space births using natural family planning which works effectively and in tandem with women’s reproductive systems as opposed to hormonal contraception which overloads women with synthetic hormones that are harmful to their reproductive and overall health. Calling for increased access to contraception as the solution to end the need for abortion does not take into consideration that contraception is not 100% effective and is subject to failure as many women get pregnant while using it.

Haemorrhage the Leading Cause of Maternal Deaths in Kenya

Abortion is not a leading cause of maternal mortality in Kenya as purported by the report. The maternal mortality rate in Kenya lies at 360 maternal deaths per 100,000 live births [1]. One in three women in Kenya dies while giving birth. The leading cause of maternal deaths in Kenya is haemorrhage, contributing to 25% of maternal deaths followed by complications caused by disease such as malaria, anaemia, HIV and AIDS and other indirect causes at 20%. Sepsis is responsible for 15% of maternal deaths while hypertension diseases are responsible for 12% of maternal deaths in Kenya. Obstructed labour is responsible for 8 % of deaths while induced abortion is responsible for 13% of maternal deaths [2]. Maternal deaths caused by abortion are induced by human persons and can be reduced to 0 % by merely stopping all abortions. More questionable are the methods used to procure abortions ‘safely’. They are dangerous and even if carried out by professionals the mother still stands at great risk. What women need is not to be forced to abort their children; they need support when in crisis. There is a need to increase the number of crisis pregnancy centres available; much so, the government needs to be committed to social and economic justice for women. Both parents should assume responsibility for their children rather than leaving women to carry the burden of pregnancy alone. If policy makers can focus on addressing the leading causes of maternal deaths in Kenya, a lot of progress would be made in achieving MDG 5. As the millennium development goals come to a close and we focus on a post 2015 development agenda, ensuring that women get the care needed before pregnancy, during delivery and post-partum is key in reducing maternal deaths in Kenya and in the larger developing world. This can be achieved by improving infrastructure so as to make hospitals easily accessible as well as increasing the number of hospitals in various localities. Much so, ensuring that the needed facilities are easily available will go a long way in reducing maternal deaths in Kenya. Recently, the Kenyan president made maternity services free for all expectant women, a big step in reducing maternal mortality. Over half of all Kenyan babies are delivered at home and another way to reduce maternal deaths is to train women in communities in midwifery so that skilled birth attendants are easily available for women in localities. There has been a marked decrease in maternal deaths between 1999 and 2010 and this was not attributable to an increase in abortion related services. This was attributed to improvement in health systems, accessibility of health facilities as well as an increase in the number of women attended to by skilled birth attendants [3].

Violating Kenyan Law

The report on the “Incidences and Complications of Unsafe Abortion in Kenya” is erroneous and contravenes the Public Benefit Organisation Act which seeks to safeguard the sanctity of human life as enshrined in the Kenyan constitution. When we have foreign funded NGOs teaming up with Kenyan institutions to attack the sanctity of human life then the will of the Kenyan people is not respected. Non Governmental Organisations in Kenya are required to comply with a new set of rules. They are referred to as “Public Benefit Organisations” and are required to operate in public interest. . Part III article 27 (1) (Ethical principles and aspirations) of the Public Benefit Organizations Act, sets out principles that guide public benefit organisations (NGOs). In the pursuit of their aims, objectives and activities, public benefit organization should be guided by the following principles and aspirations:

  • Commitment to the sanctity of human life and to a peaceful and non-violent orientation in all its activities;
  • Promotion of democracy, human rights, the rule of law, good governance as well as justice for all the people of Kenya;
  • Respect for the equality, rights and dignity of all people;
  • Promotion of social justice to ensure balanced economic development;
  • Rejection of partisan political, ethnic, cultural, racial or religious intolerance and all other forms of discrimination;
  • Commitment to the promotion of gender equality and social inclusion at all levels;
  • Rejection of research efforts, programmes projects and other activities which are directly or indirectly aimed at developing methods of torture, or other forms of techniques that violate and subvert people’s human rights;
  • Identifying and reporting any breach or violation of the provisions of this Act to the Authority.

The report done by Ipas, the Guttmacher Institute and the African Population and Health Research Center is in violation of the Public Benefit organizations Act that seeks to protect Kenyans from foreign influenced policies that are not beneficial to them now and in the long run. It is a violation that cannot be ignored. While population and reproductive health is listed as category of operation in the Public Benefit Organisation Act, it certainly doesn’t include abortion. Population and reproductive health activities should respect the sanctity of human life. Population and reproductive health includes: treatment of infertility, diseases like fibroids, dysmenorrhoea, cancers of the reproductive tract and safe and ethical methods of spacing children. Rather than recommend solutions that are harmful to Kenyan women, the focus should be on the implementation of alternative reproductive health care solutions such as those espoused by the Paul VI institute which offers fertility care that is safe and healthy for women. Making abortion ‘safe’ will not solve the reproductive health problems faced by Kenyan women.


[1] Maternal and Child deaths In Kenya: Inching Forward, Sometimes Backward. Available at: http://www.internewskenya.org/dataportal/categorylist/15
[2] Maternal Mortality Rate Ratio (Modeled Estimate Per 100, 000 Live Births). Available at:  http://data.worldbank.org/indicator/SH.STA.MMRT
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