Backstreet abortions fuel a deadly crisis for teens in Kenya's slums

At just 17, Nelly Anyango* faced a life-changing challenge. Living in Nairobi’s Kibera slums, unemployed and vulnerable, she found herself unexpectedly pregnant and unprepared for the future.

The pregnancy stemmed from a relationship shaped by pressure and unmet promises. “He told me he would only give me money if we had sex. I really needed the money, so I gave in. But he refused to use protection, claiming he was allergic to condoms,” Anyango recalls. Like many young girls in informal settlements, Anyango had never received adequate education on reproductive health. She was unaware of any options for preventing pregnancy or protecting herself.

Five months later, she realised she was pregnant. When she told the man, he vanished. Left alone and desperate, Anyango turned to her mother for help, only to be advised to terminate the pregnancy.

“I was scared. I’d heard stories of girls getting very sick. But my mother insisted it was the only solution,” Anyango says.

Her mother took her to a local traditional healer. Inside a small, dark house, an elderly woman examined her and estimated the pregnancy was two months along. She offered a bitter herbal concoction to induce an abortion. “We were told to go home and wait for the effects. It felt like she didn’t want me to die in her house,” Anyango recalls.

That night, Anyango began experiencing severe pain and heavy bleeding. “It started slowly, then it got worse. I sat on a bucket, and it wouldn’t stop. This continued for five days before it got worse.”

Eventually, the bleeding became too much. While trying to get help, she collapsed. Her neighbours, alarmed by the noise, found her unconscious.

“In that moment, I thought I was going to die. I imagined people saying, ‘She’s the girl who died after an abortion.’” Dr Moses Obimbo, a Nairobi-based gynaecologist, frequently treats adolescents suffering from complications after unsafe abortions. “Most come in with incomplete abortions, the pregnancy tissue remains inside, causing excessive bleeding,” he explains.

These patients often present with high fever, rapid heart rate, severe abdominal pain, and foul-smelling discharge, signs of infection or internal haemorrhaging. Once admitted, doctors must assess the patient’s condition, remove retained tissue, and administer antibiotics.

Dr Obimbo warns that some girls arrive with life-threatening injuries to their uterus, bladder, or pelvis, often after attempting to self-induce abortions using crude instruments. “Some of them admit to inserting objects. This can lead to peritonitis, and many don’t survive,” he says.

Infections can also cause pelvic inflammatory disease, which may lead to infertility. After providing treatment, Dr Obimbo and his team offer counselling and guidance on family planning to prevent further cases.

However, unsafe abortions are now taking new forms. Increasingly, women and girls turn to online hotlines to seek abortion advice and support.

Aunty Jane*, a counsellor at one such hotline, explains the appeal. “They come to us because it’s private, fast, and non-judgmental. Hospitals ask many questions. We just help,” she says. Jane says most girls call when they’re already in crisis. “Some are raped. Some are just desperate. But the stigma is so strong that they hide instead of getting help,” she adds. She believes the healthcare system needs to become more empathetic. “We need to train health workers not to stigmatise these girls. Many are traumatised, they don’t need more judgement.”

Legal grey areas 

While Anyango survived her ordeal, her case raises serious concerns about the access, or lack thereof, to safe, legal abortion services in Kenya, especially for poor and vulnerable girls.

A survey of chemists in Kibera and Mukuru Kwa Njenga revealed that abortion pills cost between Sh500 and Sh2,500, a significant amount for many girls, but still more accessible than formal medical procedures.

For many girls and women living in informal settlements, even the cost of basic medication is not affordable. However, some are still able to raise enough money to access it. While several women remain torn between seeking healthcare and bowing to societal pressure, Kenya’s abortion laws remain unclear. The Ministry of Health operates under the guidelines of the Constitution, which prohibits abortion except under specific circumstances. These, include cases where a trained health professional determines there is a need for emergency treatment, or when the life or health of the mother is at risk.

Additionally, the Maputo Protocol obliges signatory states to take appropriate measures to protect women’s reproductive rights by authorising medical abortion in cases of sexual assault, rape, incest, or where the continuation of pregnancy endangers the physical or mental health of the mother, or where the life of the mother or foetus is at risk.

Nyokabi Njogu, a reproductive health advocate, argues that although Kenya is guided by both the Constitution and the ratified Maputo Protocol, administrative and legal barriers still persist.

“The law does allow for abortion in the mentioned circumstances, but first we need to accept that abortion is a healthcare intervention,” Nyokabi asserts.

“The challenge is that, despite having a progressive Constitution, administrative obstacles remain. For instance, the Constitution highlights only the health of the mother and not of the child,” she adds.

Njogu refers to a landmark High Court judgement from June 2019, which clarified the constitutional grounds under which abortion is legally permitted.

The case centred on the lack of access to lawful and safe abortion services, particularly for women and girls who became pregnant as a result of rape or defilement. The judgement reinstated key guidelines, standards, and training tools to support healthcare professionals in offering safe abortion services within constitutionally allowed circumstances.

However, a contradiction remains between the Constitution and the Penal Code, which still criminalises most forms of abortion. This legal inconsistency hinders access to safe and legal abortion services. “A healthcare worker can be arrested, and parts of the Penal Code are often used to harass them, even for stocking medications that are normally used to induce labour. The Penal Code must catch up with the Constitution,” says Njogu.

She emphasises the importance of recognising abortion as an essential healthcare service for women.