By Katy Migiro
NAIROBI (TrustLaw) – The forcible detention of patients over unpaid bills and physical and verbal abuse in the delivery room are among the human rights violations that the Center for Reproductive Rights (CRR), one of the U.S.’s most powerful advocacy organizations, plans to address from its first regional office in Africa, which opened here earlier this week.
“There are terrible accounts from all over the region of women who have been detained with their babies, sometimes on locked wards. They cry out for medical assistance and sometimes they don’t get it and their babies die,” Elisa Slattery, regional director for Africa in CRR’s International Legal Program and head of the new Nairobi office told TrustLaw.
“Everyone knows that it happens but it is not necessarily seen as a rights violation or as having a really concrete effect on whether or not women seek services.”
One of the most inhumane examples, cited by CRR in a 2007 report with Kenya’s Federation of Women Lawyers, Failure to Deliver is the detention of women whose babies have died.
“At night I stay awake [and] hear babies suckling or crying,” said one woman in Nairobi’s Pumwani Maternity Hospital, Kenya’s largest public maternity hospital.“The milk then flows from my breasts… I wish mine was alive.”
The main strategy for reducing Kenya’s high maternal death rate – 488 maternal deaths per 100,000 live births – is to encourage women to seek skilled delivery assistance, instead of giving birth at home.
But unsanitary conditions in some hospitals and widespread abuses of patients by staff members documented in CRR reports deter women from seeking lifesaving medical care.
Women delivered on hospital beds covered with blood and bodily fluids of the women who had delivered before them and babies were wiped with soiled bed sheets after delivery, CRR found. During labour, they were pinched, slapped, beaten and verbally abused by medical staff.
“They were told to stop pretending to be in pain, to continue suffering because they were responsible for their pregnancy, to go ahead and die if they wanted to die, and not to complain because the nurses were not the ones who impregnated them,” the report noted.
Discrimination against HIV positive women is even worse, CRR found in its 2008 report At Risk: RightsViolations of HIV-Positive Women in Kenyan Health Facilities.
“You see, in many cases, HIV positive women being told they shouldn’t have access to contraceptive services because they shouldn’t be having sex without condoms, even if that is not an option,” said Slattery.
CRR also will be lobbying to ensure the implementation of women’s constitutional right to abortion in cases where their life or health is at risk, which was affirmed in the new constitution adopted in 2010. According to the World Health Organisation, this definition includes mental health.
“A lot of people still aren’t familiar with the content of the language or what it means,” Slattery said.
She said she came across dozens of horrific stories while researching CRR’s 2010 report In Harm’s Way: The Impact of Kenya’s Restrictive Abortion Law.
“For young women and poor women, most of them were turning to unsafe [abortion] methods, either to a quack or drinking Omo [washing powder] or blooming agent [fabric dye], throwing themselves down stairs, inserting pens, terrible, terrible things,” she recalled.
In Kenya, abortion, outside cases where it has been determined that the mother’s health is at risk, is a crime that brings a 14-year jail sentence. As a result, women are often afraid to seek post-abortion care services, even though the government has a stated commitment to post-abortion care.
Slattery described one woman who sought help at a Nairobi clinic.
“They [the staff] could smell her coming. There were flies following her. She had gone somewhere for an illegal procedure and there was a pen lodged in her uterus,” she said.
Last year, a woman who had been arrested on suspicion of carrying out an abortion died in remand.
While increased funding for health care is critical to improving women’s access to safe reproductive health services, Slattery pointed out that some reforms could be implemented for free.
“You don’t need money to treat a patient with respect,” she said. “One of the main reasons that women don’t go to the hospital to give birth is they fear being mistreated and abused.
“It’s the combination of having an equipped facility but then also making sure that people feel they will get attention, not deliver alone on a hospital bed or be delivered by another patient, which is something that has been happening at Pumwani [Hospital] for decades now.”
When governments do not respond to dialogue, CRR uses litigation to press for women’s rights to be upheld.
For example, in Peru a 17-year-old girl was forced to carry her pregnancy to term, even though doctors told her the foetus was severely deformed and would die soon after birth. Doctors refused to perform the procedure, even though abortion was legal under these circumstances.
After being breastfed for four days, the baby girl died. Her teenage mother fell into a severe depression.
CRR took the case to the United Nations Human Rights Committee, which found that her suffering was foreseeable and amounted to cruel, degrading and inhumane treatment.
Aside from lobbying for implementation of its existing recommendations, CRR is also gathering evidence on the sterilization of HIV-positive women without their knowledge or under coercion “in the throes of delivery”. In addition, it is investigating coercive pregnancy testing in schools and the expulsion of pregnant school girls across Africa.
Along with Kenya, priority countries for the Nairobi office are Nigeria, Tanzania and Uganda. New York-based CRR also has a regional office in Bogota, Colombia and plans to open a regional office in Asia later this year.