Nicole Itano, Nairobi
A Kenyan woman bleeding from a botched abortion is denied medical help by disapproving hospital nurses. It is the kind of incident that translates into high maternal mortality rates in Africa, where reproductive health clinics are losing US funding.
Dr Linus Ettyang was at home in his Nairobi suburb last year when he saw a woman lying under a tree near his house, bleeding profusely from an incomplete abortion or miscarriage. He quickly put the woman in the car and drove her to the nearest hospital, run by missionaries.
But the nursing sisters turned the patient away, saying they didn't treat women suffering from abortion complications. Shocked, Ettyang was forced to take her to another hospital, even though she had lost a great deal of blood and needed emergency care.
Ettyang, program manager for the Nairobi-based Family Planning Association of Kenya, the country's oldest and largest private family planning organisation, says the nursing sisters refused to even let him take her out of the car.
The incident haunts Ettyang. It also represents the kind of reality reflected by the latest dire statistics about women and mortality in Africa.
According to a report released in November by the World Health Organisation, the United Nations Population Fund and UNICEF, women in Africa have the highest maternal mortality rate in the world, with women having a staggering 1-in-16 lifetime chance of dying while pregnant.
In all, the report estimates that 529,000 women die each year while pregnant, 99% in the developing world, particularly Africa and Asia. India has more maternal deaths than any other country, an estimated 136,000 each year, followed by Nigeria and Pakistan. Kenya has the dubious distinction of joining a three-way tie for ninth place with China and war-ravaged Angola. Although African and Asian women have almost equal numbers of maternal deaths, since the population of Africa is much smaller than that of Asia, statistically African women have a much higher chance of dying while pregnant.
In Kenya, unsafe abortion is one of the biggest causes of maternal deaths, accounting for an estimated 30%, and at least half of the hospitalisations in public gynaecology wards. It is, say family planning organisations, an epidemic that is being largely ignored, in Kenya and elsewhere on the continent.
The precise causes of maternal mortality vary from country to country, but across Africa, women's access to contraception, prenatal care, skilled birth physicians and abortion are hampered by poverty and overstretched health systems, say family planning groups. With little control over their reproductive health, many African women are destined to have repeated pregnancies at great risk to their lives and health.
HIV/AIDS has also proven to be a double curse, raising maternal mortality and drawing attention from family planning and reproductive health issues.
Global gag rule
"Family planning and reproductive health is really on a back burner", says Ettyang, whose organisation recently lost US Agency for International Development (USAID) funding because it refused to abide by the restrictions of Washington's revived Mexico City Policy, also known as the "global gag rule", which bars US funding to organisations that perform abortions or inform their patients about abortion or advocate for changing their nation's abortion policies and laws.
The global gag rule was first announced by US President Ronald Reagan in 1984, but was rescinded by President Bill Clinton on January 22, 1993. Incoming president George W. Bush reinstituted the rule on January 22, 2001.
Although abortion is illegal in Kenya — as it is everywhere in Africa except South Africa — and the Family Planning Association of Kenya does not perform abortions, they provide post-abortion care and advocate revising the country's restrictive abortion laws.
When the gag rule was reimposed, the organisation was forced to close three of its 15 clinics due to lack of funding. Two more shut their doors in December. The British family planning organisation Marie Stopes has also closed two Kenya clinics.
Most of the closures have been in Nairobi's slums and in poor rural areas, where family planning had been heavily subsidised. USAID was one of the few donors providing large amounts of aid for family planning and Ettyang and his colleagues have been unable to replace the lost funds.
There are plenty of grants for AIDS education, but few for non-condom contraception programs such as Norplant, a long-term hormonal implant, and the pill — popular options among Kenyan women who use birth control — despite evidence that family planning reduces maternal mortality and generally raises the standard of living for a family.
In comparison with other African countries, South Africa has a low maternal mortality rate, an estimated 230 deaths per 100,000 live births compared with an average of 830 per 100,000 for the continent as a whole, according to the report. Yet proportionately, more mothers die in South Africa than in Asian and Latin American countries of equal wealth.
Women dying of AIDS
Research in South Africa, which has more HIV-positive people than any other country in the world, also indicates the number of pregnant women dying of AIDS is on the rise and is now one of the highest causes of death for pregnant women in the country. AIDS-related deaths now account for at least 17% of maternal fatalities and that percentage is likely to rise in coming years as the epidemic reaches maturity.
Africa's richest country has the luxury of looking at expensive AIDS remedies like antiretroviral drugs, which can prolong the life of HIV-positive people and reduce the chance that they pass on the disease. Most African countries, however, are struggling to provide such basic care as skilled birth attendants and access to family planning services.
Even in Kenya, where family planning programs have helped to cut the birth rate from an average of eight children per woman to 4.5, only 31.5% of women use modern birth-control methods and only 44% of women are aided in labour by trained assistants.
Efforts to reduce maternal mortality are hampered not only by a lack of funds, but also by strong opposition to family planning by conservative forces such as the Catholic Church — which continues to oppose any contraception, even when it is intended to prevent the spread of HIV/AIDS — and the US administration which puts enormous pressure on countries and organisations to oppose abortion.
"There are people here who don't even want to hear the words 'reproductive health'", says Dr Solomon Orero, one of Kenya's strongest advocates of the right to abortion and head of an organisation that trains rural health care providers in post-abortion care. "And that is emanating largely from [the United States], from the Bush administration."
[From Women's eNews. Visit <http://www.womensenews.org/>.]
From Green Left Weekly, January 28, 2004.
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