Nairobi — Every day, Ward 1D of Kenyatta National Hospital receives between six and eight cases of botched abortions.

In a month, the ward deals with an average of 250 cases of failed abortions involving women who are rushed to the hospital after attempts to end pregnancies backfire.

The national statistics are more startling.

About 316,560 abortions occur in the country annually. Out of these, an estimated 20,893 women are hospitalised with abortion-related complications.

Despite general outrage over the practice, thousands of women in the country still risk their lives to end unplanned or unwanted pregnancies.

According to a recent report by Ipas, an international reproductive health organisation working in conjunction with the Ministry of Health, Kenya Medical Association and Fida-Kenya, abortion is increasingly becoming a major challenge to the provision of reproductive health services.

Religious leaders

Although religious leaders and moralists have condemned the act, it continues with impunity.

"It is a problem that cannot be wished away. No matter how much public outcry there is against abortion, the fact is that many women continue procuring it in the back streets and we are left to clean-up the mess of quacks which most of the time may be too late," says Prof Joseph Karanja, an obstetrician gynaecologist and lecturer at the University of Nairobi.

Prof Karanja asks Kenyans to stop burying their heads in the sand and squarely face the prevailing "abortion crisis".

"We should deal with the issue of abortion the same way we are dealing with HIV/Aids.

Necessary mechanisms

"In the beginning Aids was highly stigmatised. But now people are talking about it openly and the necessary mechanisms have been put in place.

"We have seen a change. Why then can't we rise above the stigma on abortion in the same way?" asked the lecturer.

"Abortion affects all in society including the rich, poor, educated, young, old and even the clergy. We should have a sober approach on this issue."

Recently, Health assistant minister Enoch Kibunguchy, himself a gynaecologist, declared having safely procured abortions and called for sanity in the abortion debate.

"I told a forum of gynaecologists in Nyeri recently that as a doctor, I have performed abortions and so have many of the doctors in attendance. I said 'may the first innocent doctor who has not done it cast the first stone' and they concurred because they understand how desperate the situation is. It is time that we looked at abortion soberly," said Dr Kibunguchy.

The high cost of contraceptives and poor access fuelled by religious leaders' condemnation of their use, has left many sexually-active women in a dilemma on how to deal with unwanted pregnancies.

More children

Contrary to popular belief that it is mainly young school-going girls who procure abortion, statistics reveal that older women - including married ones - often find themselves with unplanned pregnancies and engage in the practice.

They include those whose husbands no longer need more children and older women presumably past child-bearing age who could "embarrass" their families with a pregnancies.

Mothers in rural areas who cannot access or afford contraception find themselves in the same dilemma.

In Kenya, abortion is legally restricted to cases where a woman's life is considered to be in danger due to pregnancy.

The law criminalises anybody who procures an abortion in unsafe circumstances.

However, under the Health ministry, the law allows post-abortion care services for women who have developed complications while trying to terminate a pregnancy.

Studies conducted in various district hospitals in the country reveal increasing desperation among women who often use crude tools to procure abortions.

Some cases result in the removal of uteruses, blockage of fallopian tubes or severe haemorrhage, and death.

"When a woman is desperate to procure an abortion, she will not care about the qualifications of the person who offers to perform it or even consider the fact that she might lose her life in the process.

"That is how desperate women are in this situation," says Dr Solomon Orero, a gynaecologist based in Southern Sudan.

According to a 2006 survey on unsafe abortions by the Population Reference Bureau, an estimated 46 million abortions are performed yearly worldwide

Of these, 19 million are procured in unsafe conditions by people who lack the necessary skills.

Developing world

The report also states that 529,000 girls and women die from pregnancy-related complications each year, almost all of them in the developing world.

About 68,000 of these deaths are due to unsafe abortions.

But even more critical is the need for accessibility and availability of reproductive health services such as contraceptives to prevent unplanned pregnancies. The Health ministry has also not come up a comprehensive reproductive health budget.

"The reproductive health budget has been decimally low. More efforts need to be put in this area if we are to save our women," said Dr Kibunguchy.

The Global Gag Rule by the US on organisations that fund reproductive health projects has worsened the situation. It has led to closure of hundreds of reproductive health clinics across Africa.