Women’s reproductive health and rights; are we heading in the right direction?



If you have been reading the news then you will know that the Pope Francis talked about how people should not breed like rabbits. This has created a heated debate about whether he is condoning the use of contraceptives or not. The church, especially the Catholic Church, has always been vocal on the issue of reproductive health. The Church’s stand has always been that Catholics should not use contraceptives but use natural family planning methods. This sometimes puts a woman in a difficult position because she is torn between what is best for her health and what her spiritual leaders tells her.

Scenario 1.
A lady finds out that her husband is cheating. She wants to leave but the church does not condone divorce and neither does it condone using of contraceptives. So if she continues sleeping with her husband she may get one of the common sexually transmitted diseases and she might even get HIV.

Scenario 2.
A woman who is married and has 5 children wants to start using contraceptives. Her last pregnancy was problematic and she almost died. Her doctor told her that she shouldn’t have any more children because it will put her life at risk She is a devoted Christian but she feels that the methods the church advocates for are not working for her. When she suggests the issue to her husband he says that they have to follow the teachings of the church.

But it is not only the church that impacts the reproductive health of a woman—it is culture too. In many African cultures women were circumcised. Through education and advocacy many of those tribes have now stopped the practice. But others still continue even though governments have passed laws that ban this. Females as young as 10 are still undergoing forced circumcision. This affects their reproductive health as these girls can develop infections and some even die from infections or blood loss. Many of the girls who undergo circumcisions, especially the extreme FGM procedures, are unable to enjoy sex and also have difficulty giving birth.

It is strange that a woman’s reproductive health is usually dictated by everybody except her. Her family, culture and religion all have a say in what she can do with her body, but she is just a bystander with limited options in potentially life or death situations.

Another such situation is when a woman faces a pregnancy that puts her life or health at risk. For example, she may face an ectopic pregnancy, in which the embryo implants outside of the uterus, potentially causing life-threatening blood loss.

In Kenya, there has been some progress towards ensuring in this situation that a woman can actually protect her health and life: the 2010 Constitution provides that a woman can get a safe abortion if her life or health is in danger.

Yet a recent series of actions by the Ministry of Health has effectively stripped her of that option, once again making her a bystander when it comes to life or death decisions about her reproductive health.

As part of the implementation of the 2010 constitution the Ministry of Health developed standards and guidelines for reducing morbidity and mortality from unsafe abortion. They were adopted then withdrawn in unclear circumstances. In Feb 2014 the Director of Medical Services issued a memo to all health workers stating that the constitution of Kenya 2010 is clear that abortion on demand is illegal. The memo did not clarify under which grounds abortion is legal. This has meant that medical professionals can not carry out safe abortions even if it is to save a woman’s life. The memo also stated that there is no need for training health workers on safe abortion care All trainings were to be stopped and failure to comply could lead to legal and professional recourse.

This puts the lives of women who need an abortion for medical or emergency reasons at risk because no medical professional would want to risk the legal ramifications to carry out such an abortion.

Why is The Ministry of Health saying that there is no need for training on safe abortion care when there is a ward at the Kenyatta National Hospital filled with women seeking post abortion care for botched abortions? Why is it possible for a woman to get post abortion care but not for her to get a safe abortion to save her life in a case of an ectopic pregnancy? Something is very wrong.

Whether you are pro-life (those who do not support abortion) or pro-choice (those who support a woman’s right to choose), you will have your standard on whether and when it is right or wrong to have an abortion. The law however is clear: the Constitution of Kenya in article 43 (1) says that every person has the right – (a) to the highest attainable standard of health, which includes the right to health care services, including reproductive health care;
Article 26 (4) right to life says “abortion is not permitted unless, 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.

Women have come a long way in terms of reproductive health care. But there is still a long way to go. Women are stakeholders in the health of women; actually, they are the primary stakeholder on the issue. But as long as their reproductive health issues are dictated by other people—whether culture, religion, or government—they will never truly be safe, healthy, or free.

We should give women the freedom to make choices to protect their own well-being and that could ultimately save their lives.There is an interesting article you should read. It is called issues in reproductive health by Dr. Mahmoud Fathalla. This is a UN paper on reproductive health. It is an eye opener on what is happening around the world. He says

“Being a woman has implications for health. Health needs of women can be broadly classified under four categories (Fathalla, 1997). First, women have specific health needs related to the sexual and reproductive function. Second, women have an elaborate reproductive system that is vulnerable to dysfunction or disease, even before it is put to function or after it has been put out of function. Third, women are subject to the same diseases of other body systems that can affect men. The disease patterns often differ from those of men because of genetic constitution, hormonal environment or gender-evolved lifestyle behavior. Diseases of other body systems or their treatments may interact with conditions of the reproductive system or function. Fourth, because women are women, they are subject to social diseases which impact on their physical, mental or social health. Examples include female genital mutilation, sexual abuse and domestic violence.”

You can join in on the conversation on women’s reproductive health on social media. The hashtag is #keepWanjikusafe.

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