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Standards Are Not Enough: Policy Implementation Remains Central

Image : TradeMark EA

By Melvine P. Ouyo

In 2013, Kenya’s Ministry of Health made the devastating decision to withdraw the Standards and Guidelines for Reducing Morbidity and Mortality from Unsafe Abortion. This caused a huge influx in untrained back street abortions, immense suffering, and the loss of countless lives. After six years of irreversible damage from this decision, Kenya’s High Court issued a clear ruling this summer: the government had violated the rights of Kenyan women and girls by withdrawing the Standards and Guidelines. It was a revolutionary moment for Kenyan communities.

The worldwide movement to give women freedom to choices first culminated at the 1994 International Conference on Population and Development in Cairo, Egypt. The conference brought diverse views of human rights, population, sexual and reproductive health, gender equality and sustainable development. It marked a global consensus that placed human dignity and human rights—including the right to plan a family—at the heart of development.

Despite this global declaration, communities in Kenya have continued to suffer in silence as they’re denied access to critical reproductive health care. In fact, 362 in 100,000 live births in Kenya result in death from pregnancy-related preventable causes. Many Kenyan women are denied the power to choose who they want to marry and when, and when and how many children to have. As a result, many women give birth to children they don’t have the resources to raise, compromising their physical, social and economic well-being. 

The High Court’s ruling this summer is a step in the right direction, but the Ministry of Health’s 2013 decision to withdraw the Standards and Guidelines has caused years of irreparable consequences, and more policy implementation is needed for Kenyan families to have access to the health services they deserve. Communities have faced abortion service denial, clinic closures, unplanned pregnancies and births due to contraceptive stock outs, school dropouts, long-term health complications, and loss of lives from botched procedures. Teen pregnancies have also increased at an alarming rate. 


This year after graduating from the Kennedy School of Government at Harvard University, I returned to Kenya and have had the opportunity to interview patients and community members about how both domestic and international policies, such as Kenya’s Standards and Guidelines and United States’ Global Gag Rule, have impacted communities.

Multiple people I interviewed shared how these policies have led to an increase in back street abortions with deadly complications. “I vividly remember the chronology of events and emergency referrals of that girl, a minor, who suffered kidney complications after an unsafe abortion.” said an NGO worker. “She was moved from Kisii level 5 hospital to Tenwek hospital, but the girl still died.” 

As a result of the Global Gag Rule, which cut funding for medical supplies, health care, and contraception in our country and around the world, healthcare providers have been forced to turn away women seeking abortions. Many women turn to back street procedures by “quacks,” leading an alarming numbers of patients seeking emergency post-abortion care in several counties. 

Post-abortion care has also never been a method of family planning in Kenya. Even medics who have the skill to offer this essential care have been blocked from offering trainings. “Women have been told they can only access post-abortion care at the health facilities. An explanation to why they only seek emergency care when the procedures complicate,” explained Ann (pseudo name), a service provider and supervisor. 

I also had the opportunity to speak with many young people who shared heartbreaking stories about the stigma associated with reproductive health and lack of adequate health care services and resources in their communities. Fred (pseudo name), 18, was filled with sorrow as he explained what happened to his classmate, Eveline (pseudo name), 14. “She was innocently lured into unprotected sex at a disco matanga (funeral disco). She got pregnant and acquired HIV. She was forced to drop out of school and has since been rejected by her parents. She keeps moving with her son from one relative to another for shelter.” 

“Efforts to guarantee contraceptive commodity security have always been challenged with pro-life opposition from within and without,” explained Clinton (pseudo name), a director of a reproductive health organization. “As we speak, this country is experiencing stock out (absence) of Depo injection, yet this is the most preferred contraceptive for most Kenyan women.” 

These experiences are unacceptable, and we must speak up. While reproductive health organizations struggle with funding cuts for international family planning at the hands of the United States, it’s high time we reflected as a country on our valued economic and social development. 

As we approach “The Nairobi Summit” in November, Kenya will prepare to host governments and advocates in a discussion that includes the International Conference on Population and Development plans of action. It is imperative that during these conversations we think beyond the pro-choice, pro-life rhetoric. Instead, we must focus on Kenyan women and youth empowerment and their contribution to this country’s economic development. The Standards and Guidelines will yield minimal results if sexual and reproductive health and rights policies, including age-appropriate sexuality education, are not fully implemented.

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