Dr John Nyamu is the Director of the Reproductive and Maternal Health Consortium in Kenya and is a passionate advocate of women’s sexual and reproductive health and rights.
In 2004, Dr Nyamu and two RHS clinic nurses were arrested and charged with providing illegal abortions. After more than a year in detention, Dr Nyamu and the two nurses were acquitted.
The media attention that surrounded their arrests and trial galvanized the community of doctors, lawyers, and activists working on reproductive health issues in Kenya to come together and launch a campaign that led to the provisions on abortion and reproductive health in the 2010 Constitution.
Dr Nyamu is the Leading Safe Choices Best Practice Champion in Kenya.
Here we talk to Dr Nyamu about abortion care in Kenya.
What drew you to working in abortion care in Kenya?
I work in both postabortion care and safe abortion services. I am a trained Gynaecologist and I felt that it is my duty to save women's lives and alleviate their suffering.
21.6 million women experience an unsafe abortion worldwide each year; 18.5 million of these occur in developing countries; 47 000 women die from complications of unsafe abortion each year. Deaths due to unsafe abortion remain close to 13% of all maternal deaths. Could you tell us a little bit about the situation in Kenya?
In 2010, Kenya passed a new constitution that expands the right to abortion. However, many doctors in public health facilities are unaware or misinformed about this, and refuse to perform abortive procedures.
Unsafe abortion, often caused by inserting knitting needles into the cervix, drinking bleach or overdosing on medical drugs, accounts for 30-35 percent of maternal deaths in Kenya, versus the global average of 13 percent. In Kenya approximately 465,000 unsafe abortions occur every year with 75% presenting with moderate to severe complications resulting in 1200 maternal deaths.
A report by the Ministry of Health in Kenya in 2013 indicated high rates of complications from unsafe abortion that amount to 120,000 women being treated for post abortion care complications. Despite these alarming indicators, women in Kenya continue to face critical challenges due to the lethargic approach in the realization of reproductive rights in the country.
While safe abortions have been available in the private sector for over thirty years, poor women have been seeking illegal and unsafe abortions, which often result in the injury and death of pregnant women.
What do you feel are important factors in reducing the number of deaths caused by unsafe abortions in Kenya?
Factors to reduce maternal deaths from unsafe abortion include a reasonable health budget for availability of contraceptives; a conducive environment for women's access to safe abortion - both legal and service delivery; effective management of postabortion clients; and promotion of postabortion family planning to avoid a future unintended pregnancy.
What role can health care providers play in ensuring women receive high quality sexual and reproductive health care in your country?
Provide services without discrimination in facilities with adequate supplies.
Why did you decide to become the RCOG Best Practice Champion and adapt the Best Practice Papers in Comprehensive Postabortion Care?
So that my country can start proper management of unsafe abortion clients without stigma as the ministry will produce guidelines and make the process official and available in all government and private facilities.
This interview has been condensed and edited.