| Author: Saskia Hüsken | Function: Senior Technical Advisor

Covid-19: The resilience of safe abortion providers in Kenya

Wherever you are located in Kenya, you will find one of the 587 RHNK health care providers, who are trained and supported by Reproductive Health Network Kenya (RHNK). These providers are committed to offering quality reproductive health services, including safe abortion, to their clients. They provide these crucial services to all who need them, without judgement, and all while operating in an environment of deeply ingrained stigma and taboos. The global Covid-19 pandemic is now challenging these providers in entirely new ways, yet they continue to find a way to ensure safety and choice remain at the centre of reproductive health care.

Saving lives with safe abortions

RHNK’s ambition is to contribute to the reduction of maternal morbidity and mortality among Kenyan women and girls. Unsafe abortions, a highly stigmatized topic, cause an estimated 7 women to die every day in Kenya. RHNK knows that providing services and safe products through its providers is essential to saving women’s lives as a result of unsafe abortions. They also engage local leaders, community health workers, pharmacists, and youth peer providers in order to break the silence and mobilize communities, in an effort to increase awareness of reproductive health and safe abortion services.

The Covid-19 crisis and lock-down in Kenya, has forced RHNK to expand on their already existing online solutions to train, monitor and coach providers in its network. It has already been a part of RHNK’s approach for several years, especially in view of the increasingly constrained space for providing abortion information and services. RHNK uses WhatsApp to reach its network of service providers via their mobile phones, for continuous engagement, learning and peer-consultation.

RHNK has built my clientele through advocacy and sending referrals to my clinic, and provided commodities to support service delivery. They have been offering mentorship and links with my cluster by creating a WhatsApp group. This enables us to connect and share best practices and offers us strength to deliver SRHR services without fear.

 
Kephine
RHNK Provider, Coastal Kenya

The platform also serves as a support group to address stigma and to share about countering opposition that providers often face while delivering abortion care to women who need it. RHNK offers pro-bono legal support to its providers through the Centre for Reproductive Rights (CRR) as and when providers are faced with harassment from police or others opposing abortion, such as anti-choice groups.

RHNK has provided our clinic with commodities, which has increased service delivery, especially safe abortion services. RHNK also offers pro bono legal services, which I directly benefited from in the recent past, after being harassed by law enforcers.

 
Elizabeth
RHNK Provider, Central Kenya

Safeguarding services during the crisis

When Covid-19 measures were put in place in Kenya at the end of March, the government prioritised Covid-19 preparedness and care. As in other countries, providers were afraid that safe abortion services and other reproductive health care would be considered less essential. RHNK seized the opportunity of their strong collaboration with the Ministry of Health by providing technical contributions to the development of the national Guidelines for continuity of reproductive, maternal, newborn and family planning care and services during Covid-19. These Guidelines now include a section on Post Abortion Care, safeguarding that these services can continue during this crisis.

At the same time, Covid-19 has disrupted much of RHNK’s work, as they are no longer able to conduct physical activities such as trainings, advocacy meetings, community dialogues and support sessions with their providers. Covid-19 also fills providers with fear of contracting the virus, and like in other countries, Personal Protective Equipment (PPE) has been lacking. Support from Planned Parenthood Global and Rutgers ensured that RHNK could distribute minimum packs of PPE and other products to its providers. Driven by the firm belief that every Kenyan has the right to health care, RHNK staff and providers never ceased to deliver services to their clients and even in these unprecedented times.

There is an increasing turnout of female clients seeking family planning services because their spouses are working from home. Our concern is that with the growing demand for this service, soon there will be shortage of family planning commodities, which will increase reported cases of unwanted pregnancies.

 
Libulele
RHNK Provider, Western Kenya

Covid-19 Action Plan

RHNK responded quickly to the Covid-19 crisis with innovative solutions, including firstly  mapping out the current and potential impacts of the crisis. Their response was guided through a Covid-19 Action Plan, which centres on protecting their providers, monitoring disease prevalence, measuring the impact on SRHR service delivery, and tracking the need for PPE and safe abortion and contraceptive commodities in their clinics.

From social media outreach, it became clear young people needed correct information, including referral systems for women and girls to access safe abortion and contraceptive services. As part of this, a group of RHNK youth advocates created messages and art work for a new campaign dubbed, Nena Na Binti (= speak up). A toll-free number was created and the campaign was launched on 1 May. After running for only a few weeks, awareness of the hotline is already growing, and an increasing number of girls and young women have already been counselled and referred to quality services at a nearby provider.

RHNK supports the self-management of abortion and telemedicine, and, where we are able, we will deliver abortion pills to girls and women. We are also using WhatsApp to discuss SRHR challenges faced by health care providers and young people due to Covid-19 and the government measures to prevent the disease in Kenya.

 
Branda Boit
RHNK Programmes Manager

I am proud that as a front line provider, I have not closed my clinic and kept working during the emergence of Covid-19. I am happy to have developed a good working referral system and good connections with higher level hospitals, so there is continuity of service delivery to my clients. I am able to offer comprehensive SRHR services to my clients, including safe abortion, and I am impacting their future positively.

 
Libulele
RHNK, Western Kenya

Despite Covid-19 and the many challenges faced in Kenya, it is the RHNK providers who continue to provide life-saving services, and who inspire us to continue ensuring that women and girls can decide over their own bodies, including access to quality care, services and products.

It is Her health and Her choice, and it should be a Safe Choice.

This article was developed together with Nelly Munyasia, Executive Director at Reproductive Health Network Kenya (RNHK). We highly appreciate the RHNK team and quoted providers's contributions. RNHK partners with Rutgers in the She Makes Her Safe Choice programme, which aims to improve access to safe abortion methods and services.

Saskia Hüsken Senior Technical Advisor

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