I first met Jessica in February last year (2011), when I was writing a piece on female sex workers and condom use (Jessica’s story).
The last time I met her, Jessica -a mother of four living with HIV in Rongai, Kenya – was supplementing the money she made as a hairdresser by selling sex in the local pubs and chang’aa dens. At the time, she was pregnant and had been enrolled on a prevention of mother to child transmission (PMTCT) programme in the hope that her child would be born without HIV.
Last week I visited Jessica again. She tells me shortly after our first meeting she had aborted the baby she had been carrying then. She is now pregnant again. Jessica says this cycle of pregnancy and abortion is something she feels trapped in.
Jessica recalls: “I had my first abortion sometime back, and then I was six months pregnant. I was taken to an old woman who operates as a traditional birth attendant and she gave me some herb that grows along riverbanks, which she asked me to slip inside my private parts. I did as required and within five hours the foetus came out and I continued with life as usual.”
In Kenya elective abortion is illegal, heavily stigmatized and responsible for the deaths of thousands of women every year. According to the World Health Organization (WHO) 67,000 women die annually due to unsafe abortions while another five million end up temporarily or permanently disabled. Many of these are schoolgirls, teenagers and female sex workers.
Jessica’s had her second abortion when she was eight months pregnant. She says she has never had an abortion in her first trimester “because it is risky and one can easily die”. Again, her abortion was carried out using traditional medicine.
“This time I almost died because the child refused to come out. For three days, I was in excruciating pain and my body had swollen so much. A friend gave me some concoction from another TBA to drink and on the fourth day the child was expelled from my body. It was a girl and she had died in my stomach as a result of the herb that I had inserted in myself. She had started to decompose, which caused me to swell.
“The third time I went to hospital – and this time I was five months pregnant. I had every intention of keeping my baby but I opted for an abortion when my boyfriend left me. I had lied to him that the pregnancy was his although in reality it was not because he had never, ever touched me without a condom.
“With him out of my life and with four children to take care of the only thing I could do was abort because how would I otherwise feed my children?
“Since my boyfriend left, I quit my salon work and currently I am a full time sex worker who is struggling to make ends meet. I survive on ‘shots’ – that is what we call casual sex by the roadside with strangers.”
“We walk in the streets looking for a client and when you sense or see a potential client you communicate in gestures and when they respond we go to the nearest corner and finish our business. In a day you can get three to five ‘shots’. Sometimes it [business] is so bad, like yesterday, I only had one shot. Today I received one very early in the morning but the day is still young; who knows I may get some more.”
Clients will pay more for unprotected sex and despite the local drop-in centre’s efforts to educate Jessica and her colleagues on the dangers of unsafe sex the lure has been too great. Now Jessica is pregnant again and facing the daunting prospect of another illegal abortion. She also knows the harms involved with being HIV positive and having unprotected sex but says that, were it not for the problems she is facing, she would not do what she is doing.
Abortion in Kenya is not permitted unless there is a medical emergency which requires treatment or if the life of the mother is in danger. The law expresses that any person who “intentionally or through omission” prevents a child from being born alive is deemed to have unlawfully killed that child and is liable to life imprisonment.
Does the Kenyan law impose compulsory motherhood on expectant mothers by criminalizing abortion? How many Jessicas are out there, risking death to terminate unwanted pregnancies and transmitting HIV in the course of trying to make ends meet?
By making abortion illegal, the law makes abortions unavailable to women, many of whom may find themselves unable to cope with the child they are expecting. What is the way forward?