A small medical clinic on a narrow, unpaved road in Nairobi’s Embakasi neighbourhood is one of the few medical facilities where low-income women in the area can access safe abortion services.
The clinic is run by Reproductive Health Network Kenya (RHNK), a consortium of healthcare facilities providing abortion services.
The network is led by Nelly Munyasia, a trained nurse, who estimates that about three RHNK providers face harassment every month for providing abortions. This can involve police raids on clinics – sometimes accompanied by journalists, as well as arrests of healthcare workers and confiscation of medical records.
Munyasia says her job entails protecting healthcare providers who do “stigmatised” work and who are willing to be arrested.
“Everyday they are like, ‘As long as I’m going to save that life, let me save the life, and let me get arrested. I will go to court and deal with the aftermath.’”
There have been cases of Kenyan politicians inspired by “western, anti-reproductive rights, faith communities” who have entered medical clinics in Kenya providing abortion services, seized the patient register and broadcast the names of women and girls seeking abortions, says Dr JE Musoba Kitui, regional director for Ipas Africa Alliance, which trains medical workers to provide safe abortions.
Legal uncertainty and confusion over when, or even if, abortion is permitted leaves healthcare providers exposed to the risk of police raids, prosecution and public harassment. This deters many medical facilities, particularly in overpoliced and impoverished Kenyan neighbourhoods, from providing abortion services.
This gap in abortion services is exacerbated by the refusal of Catholic-run hospitals – which represent about 30 per cent of Kenya’s hospitals – to provide abortions, and pushes many women and girls to resort to dangerous backstreet abortion or to keep high-risk and unwanted pregnancies.
A report co-published by Kenya’s ministry of health estimated that 792,000 induced abortions occurred in Kenya between April 2023 and May 2024.
Nearly half of these abortions are estimated by the African Population and Health Research Centre to have been backstreet abortions, a leading cause of maternal death in Kenya.
“Those are the stories we see every day,” says Munyasia. “Some come with ruptured uterus bleeding almost to death, or severely infected and in pain, and sometimes unconscious because of septicaemia.”
Under Kenya’s 2010 constitution, medical professionals are allowed to provide abortions where there is a danger to the life or health of a pregnant woman. Subsequent court decisions interpreted this to include abortions in cases of rape and incest, and for “health” to include mental health. Nevertheless, there is a “myth on the street” that abortion is illegal in Kenya, rather than restricted, says Kitui.
The legal uncertainty is, in part, created by a colonial-era penal code that continues to criminalise abortion in Kenya, and which the country’s high court has previously ruled should be repealed due to inconsistencies with the constitution.
A recent legal case has created further confusion for Kenya’s medical workers. The “Malindi” case involved a 17-year-old student who went to an RHNK medical facility, where a doctor determined she had miscarried and provided emergency care by removing the foetal remains.
While the student was still recovering, she and the doctor were arrested. Later, police stormed the clinic, confiscating the teenager’s medical records.
Kenya’s high court ruled these arrests were illegal and that abortion was a fundamental right under the constitution. This decision was appealed by the attorney general and the Kenya Christian Professional Forum (KCPF).
Over the last decade, conservative Christian groups – including the KCPF, the Kenya Conference of Catholic Bishops and the Kenya Catholic Doctors’ Association – have been active in supporting and joining litigation concerning abortion rights and LGBTQ+ issues.
Kenya’s court of appeal issued a ruling in the Malindi case in April that rejected abortion as a fundamental right. In its decision, the court implied that the conflict between Kenya’s constitution and penal code should be resolved by allowing police to arrest medical workers and women allegedly procuring abortions, following which those arrested could then raise a defence in court that the abortion was necessary.
“That cannot be a legal position that Kenya ought to have in this day and age,” says Prudence Mutiso, a lawyer at the Centre for Reproductive Rights in Nairobi, which is involved in a pending appeal of the case to the supreme court.
“Healthcare workers are the ones who have been carrying a huge burden when it comes to criminalisation of abortion,” says Erick Mundia, a lawyer with Ipas.
He says healthcare workers providing abortions are often burdened with the cost of paying for defence lawyers, as well as time spent appearing as witnesses in cases.
“We try as much as possible to create a legal support network for healthcare workers,” he says.
Anti-abortion activists in Kenya are now increasingly well resourced and active in civil society and government advisory groups.
In 2024, the Institute for Journalism and Social Change published an analysis of how US anti-rights groups had increased their total annual spending in Africa by about 50 per cent between 2019 and 2022.
US president Donald Trump, who relies heavily on the Christian evangelical vote, supported efforts to globalise the reach of the US anti-abortion movement by establishing the Geneva Consensus Declaration at the end of his first presidency and rejoining it at the start of his second.
The global anti-abortion initiative operates from an office in the US department of health in Washington. As has been the practice for Republican presidents for the past four decades, Trump also banned overseas US funding for groups that provide or promote abortion.
After dismantling the US aid and development agency, USAid, the Trump administration is now channelling aid to African states through bilateral deals rather than aid agencies.
In 2025, the White House agreed a five-year deal to provide the Kenyan government with $1.6 billion for frontline healthcare workers, medical supplies and the accelerated digitisation of the healthcare system.
The digitisation is connected to a separate deal whereby Kenya would provide the US with large sets of what the US state department refers to as “aggregated, de-identified” health data.
The US says the data-sharing agreement will help it respond to infectious diseases and develop vaccines.
Critics have described the deal as “digital colonialism” that will benefit US AI and pharmaceutical companies at the cost of developing nations. A suspension of the deal due to constitutional and privacy concerns was lifted by Kenya’s court of appeal in October, pending a full decision by the court.
Kitui is concerned that direct US funding for healthcare workers will impact public health workers’ ability and willingness to provide abortions. He says the digitisation of the public health system could allow doctors providing abortion services and women receiving them to be more easily tracked and targeted with criminal charges.
“Digitisation of data is celebrated as a breakthrough,” says Kitui. “But I think that patient-doctor confidentiality is one of the biggest concerns doctors have.”
He says many doctors are sympathetic to women who come to them after rape or incest and who do not want to continue their pregnancy, and that digitisation in the current legal landscape will discourage public doctors from offering abortions.
“They’re going to commit suicide or risk going out there [to procure an illegal abortion], and you offer services to them because they need those services,” says Kitui.
“But now, if you do that in the public health system, the system will track you. So many doctors will just tell the woman: ‘No, I’m sorry, I can’t help you.’”
Source: The Irish Times · Hannah McCarthy
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