Innovating Safe Abortion Access for Women with Disabilities

A young, queer Kenyan woman living with a disability faced a harrowing challenge when she discovered she was pregnant. Sally, a 23-year-old, struggled to access safe abortion services in a country where unsafe abortion is a major cause of maternal health issues and deaths.  In Kenya, according to the African Population and Research Centre, the rate of unintended pregnancies increased from 34% in 2014 to 42% in 2020, and unsafe abortions account for up to 14% of pregnancies, leading to approximately 2,600 deaths annually. With a maternal mortality ratio of 362 per 100,000, women aged 25-39 face a significant portion of these deaths and severe complications, with up to 17% potentially linked to induced abortion. 

Breaking Barriers in Unsafe Conditions  

In Kenya, abortion is heavily restricted, leading many women to seek unsafe methods from unqualified providers or through dangerous home remedies. Sally’s situation was compounded by her economic dependence on her father and a lack of family support. “I’ve been grappling with significant emotional pain and a lack of support from my family, particularly from my father, who disowned me when I was 11 years old. I found myself in a constant struggle to get their approval but only ended up disappointed with low self-esteem as they neither acknowledged me nor supported me in any way. I got involved with a man who gave me financial assistance to support my siblings and I,” Sally recounted.  

She further explains, “I got pregnant. I had not planned for the pregnancy, and I felt that I was not ready to carry it through. Moreover, the man denied the pregnancy. Being a lesbian brought its own set of challenges because I could not tell my friends in the community because I feared that they would ostracize me. I really did not know what to do.” 

Women Spaces Africa’s Innovative Response  

Amid her struggles, Sally reached out for help: “I finally found the courage to tell a friend who introduced me to Celine, a disability champion from Women Spaces Africa who lived near my village. Celine asked me a set of questions. She needed to know when was the first day of my last menstrual cycle and unfortunately, I could not remember. She said she could give me abortion pills and I could have the abortion at home without anyone involved but since I am not sure of the exact dates of my last cycle, Celine had to refer me to a doctor. She offered to accompany me during and after the procedure. She kept her word, and I got an abortion for free.”  

Women Spaces Africa (WSA) is a feminist, disability led non-governmental organization that is working towards achieving sexual and reproductive health rights for girls and women with disabilities. Through support from the OPTions Initiative, WSA works to eliminate the barriers facing girls and women with disabilities in accessing to safe abortion by putting pills in their hands alongside the needed information and guidance and making direct referrals to affordable abortion providers whenever it is necessary.  

Many sexual and reproductive health interventions do not include girls and women with disabilities, and those that do fail to offer disability friendly services. This intervention is responding to the unmet need for safe abortion among girls and women with disabilities by delivering pills directly and providing referrals to affordable providers. Their innovation includes a safe, judgement-free abortion accompaniment service for women with disabilities in Nairobi’s informal settlements. Trained disability champions offer support, administer pills, and facilitate referrals to trained abortion providers who offer disability-friendly services at subsidized costs. 

Phylis Mbeke, the Executive Director at WSA emphasizes that the self-care model for girls and women with disabilities is crucial as this addresses their accessibility needs while accessing abortion services.  According to the World Health Organization, self-care interventions have the potential to increase choice, where they are accessible and affordable, and they can also provide more opportunities for individuals to make informed decisions regarding their health and health care. Consequently, self-care interventions represent a significant push towards new and greater self-efficacy, autonomy and engagement in health for self-carers and caregivers. 

As a result of this innovation, 298 women with disabilities have been supported to have safe abortions both through direct provision of pills and referrals to abortion service providers. In addition to that, 39 public health facilities have been trained on the World Health Organization abortion protocols and disability friendly abortion service provision. They have displayed positive attitude towards women with disability and their right to abortion. Some of the providers offer subsidized rates while others offer free abortion services to girls and women with disabilities as a result of the intervention.  

The innovation will be scaling up to reach a wider number of girls and women with disabilities with continued focus in Nairobi and a new area in Mombasa. WSA is bringing in women led disability organizations to adopt the innovation.  

A follow up on Sally after the abortion revealed that she is positive and happy and has since set up a small hair salon. “It has been two months since I had an abortion and I feel relieved. I still have long conversations with Celine, who remains a steady and understanding presence. I also find solace in journaling and creating art. I am determined to make my life better and become independent financially. With support from Celine and Women Spaces Africa, I have started engaging as an advocate for reproductive health rights and LBTQ+ issues by sharing my story to help other girls and women with disabilities to feel less alone in their abortion journey,” shared Sally.  

Sally points out that, “for individuals with disabilities, the right to choose abortion is not just about personal freedom; it’s about ensuring that every individual has the opportunity to live a life that aligns with their own capacity and aspirations. Women with disabilities should be able to access acceptable standards of abortion services at an affordable cost, without judgement”.

 

Learn more about the innovator here.

This story is shared by Women Spaces Africa.

Names of individuals in the story have been changed to protect their privacy.