DR. JEAN W. KAGIA

CONSULTANT OBSTETRICIAN/GYNAECOLOGIST

CHAIRPERSON PROTECTING LIFE MOVEMENT –KENYA

31^st OCTOBER 2007

HOUSE COMMITTEE OF FOREIGN AFFAIRS

THE MEXICO CITY POLICY- IMPACT ON FAMILY PLANNING AND REPRODUCTIVE HEALTH –Focusing on the African woman

Hon. Chairman, Hon members of the committee, I am very honored to have this rare opportunity to address you on this important subject.

I am a consultant Obstetrician Gynaecologist who was born in rural Kenya and trained in Kenya for both undergraduate and postgraduate. I have worked as a doctor in both public and private sectors for the last 31 years and as a gynaecologist for the last 26 years. In my career I have treated very many women who have had complications from pregnancy and childbirth including women who have suffered physical and psychological injury from abortions. I realized that the indirect causes of maternal mortality include ignorance, poverty, lack of economic empowerment, inadequate health care services in terms of materials and manpower. After seeing their suffering I decided to dedicate my time and resources in getting involved in programs that reduce maternal mortality. This service I give free of charge.

I am one of founder and board members of Institute of Family Medicine which trains doctors for a postgraduate degree in Family Medicine so as to improve health services in rural areas. I am the National Coordinator of an American based emergency obstetric care program called Advanced Life Support in Obstetrics. I am also the chairperson of the Protecting Life Movement of Kenya which educates the public on what abortion is, possible complications of abortion and alternatives to abortion, through public meetings and the media. Our organization also partners with organizations that teach skills in both behavior formation and behavior change for the youth.

Although figures point to high maternal mortality rates due to abortion in Kenya, the actual magnitude of the problem is not known. All the figures are hospital based including the latest that were carried out by IPAS in 2005. I wish to state that by imposing the Mexico City Policy the effect on Family planning in Kenya has not been adversely affected because there are other sources and facilities that have continued to offer the service. The IPAS study in 2005 seems to indicate that not only has the abortion situation not gotten worse, but may have improved considering the differences in the national population. In 1982 Aggarwal and Mati found that 62% of admissions due to abortion were induced or likely to be induced (1) as compared to 44% in 2005 by IPAS (2). Out of the 7deaths reported by the IPAS study, 6 were due to use of the manual vacuum aspirator (MVA) in mid trimester abortion by trained medical personnel, showing that abortion is not safe even in the hands of trained health personnel(3).

The Protecting Life Movement is currently seeking funds so that we can carry out a national ‘Knowledge, Attitude and Practices of Abortion’ survey that will give us reliable information of the magnitude of abortion. We would like this survey to be done by the Department of Community Health at the University of Nairobi, so that there is no potential conflict of interest or bias involved. Our hope is to take the results of this survey to create a prevention program that includes education and behavior change programs that build on the successful HIV/AIDS behaviour change programs already taking place in Kenya. We will also look for other ways to prevent abortion that respect women and recognize the right to life of the unborn child. After an appropriate period we would want to do a second survey to determine the success of the prevention program and to change it if necessary, so that we can create the most effective abortion- prevention strategy.

The NGOs that have been affected by the Mexico City Policy do not seem to be conversant with the social, cultural and religious practices of the African woman. In order to attempt to reduce maternal mortality, one has to propose remedies that do not conflict with her social-cultural and religious practices; otherwise they will be met with a lot of resistance. Remedies need to take into account the realities and faith of the African woman and not focus only on family planning (when she is not assured of the survival of her children or if she does not have consent from the husband) or abortion (which not only risk her health and the life of the unborn baby but would also make her go against her faith and conscience).

This is confirmed by ‘Opinion polls’ in Kenya regarding legalization of abortion. Even though abortions occur, the number of people – including women – who said ‘NO’ to legal abortion were 81% in 2003, 86% in 2004 (Steadman Research Group) and 85% in 2007 (SMS text message survey by a media house). I have to ask why Congress wants to fund organizations that work against the will of the majority of the people of democratic countries.

In considering the solution of the abortion issue one has to remember some very important facts:

1. An Unplanned pregnancy is a social problem and not a medical one.

2. By treating a social problem medically complications do occur even under the best medical conditions both in developed and developing countries.

3. Abortion whether legal or illegal kills babies (wiping out future generations), injures and sometimes kills the mothers.

What the African woman needs is:

1 .Education so that she can understand issues particularly those pertaining to reproduction.

2. Economic empowerment to be able to reach health facilities.

3. Provision of accessible, affordable and good quality health care services, including emergency obstetric ones.

4. Prevention of unplanned pregnancies through behavior change programs and family planning services whether they artificial or natural.

5. Transport to health care service.

Enforcing the Mexico City Policy has NOT adversely affected the over all health of the Kenyan women because:

1. 60% of family Planning services are provided by the government up to health center level. 30% is by Faith based health facilities and the rest by private hospitals, clinics and NGOs. This means that the effect of the closed clinics is almost negligible [4]

2. Our two medical schools produce over 350 doctors per year and these are deployed in rural areas thereby improving the healthcare services [5]. The first group of family physicians graduates at the end of this year.

3. Prevention of unplanned pregnancies among the youth is being successfully addressed through behavior formation and behavior change programs such as Life Skills, Worth The Wait, Why Wait, Cross roads, True Love Waits, Wholistic Caring and Counseling Services and Inter Varsity Peer Counseling Association and many more.

4. Free Primary school education which is empowering the girl child.

5. Improving economy (6% growth within the last 4 years).

6. Free ante and post natal care, family planning and delivery services by the government. Free delivery services are given in health centers and dispensaries where most of the poor women are.

In conclusion, the promotion of and effort to legalise abortion in Africa is a foreign agenda and a form of recolonisation. The Mexico City Policy together with the government, public, private and some NGOs are going to lower maternal mortality within the African social, cultural and religious setup. I would plead with you to support those local programs that are run by people who respect African babies and women within the context of African culture, faith and real-life situation.

Thank you.

Ref:

1 .Aggarwal VP, Mati JGK.Epidemiology of induced abortion in Kenya.J Obst Gyn East Cent Afric 1982; 1:54-7

2. A national Assessment of the magnitude and consequences of unsafe abortion in Kenya page 15 by IPAS 2005

3. A National Assessment of magnitude and consequences of unsafe abortion in Kenya page 18 by IPAS 2005

4. Division of Reproductive health and CHAK 2007

5. Dean of Medical School University of Nairobi