(The following feature is part of the package of stories from Reuters correspondents around the world ahead of U.N. projections that the world's population will reach seven billion on Oct. 31)
By Katy Migiro
NAIROBI, Oct 25 (TrustLaw) - "I was bleeding like hell. I knew that I was going to die," Emily said, recalling how she sat naked on a plastic basin, haemorrhaging blood for two weeks after paying 10 for an abortion in Nairobi’s Mathare slum.
"It is the most painful thing I have ever experienced in my life. Even giving birth is not as painful as doing abortion."
One reason the world’s population is soaring -- to 7 billion, by U.N. calculations, on Oct. 31 -- is because many poor women have little control over their bodies or their fertility.
One place where that is most apparent is in Kenya, where high rates of sexual violence, limited access to family planning and poverty mean 43 per cent of pregnancies are unwanted.
The majority of these women and girls have no choice but to give birth because abortion in most cases is technically illegal, although enforcement of laws around abortion are ambiguous, leading to one standard for the rich and another for the poor and uneducated.
As a result, at least 2,600 Kenyan women die in public hospitals each year after having botched backstreet abortions. Many more die at home without seeking medical care. And another 21,000 are admitted for treatment of abortion-related complications.
When Emily, 28, found out she was pregnant in 2009, her boyfriend denied it was his child and left her. She was jobless and already had a seven-year-old daughter, Ashley, to care for. Emily’s friends advised her to terminate the pregnancy.
"I have seen what my girls have gone through with abortion. I was very afraid," she said, adding how she found a 20-year-old friend dead alongside a note explaining how she had drunk a bottle of bleach hoping to cause a miscarriage.
After two months debating what to do, Emily borrowed $ 10 from friends -- the equivalent of two months’ rent -- and sought treatment from a well-known local abortionist.
The elderly woman inserted a plastic tube into Emily’s vagina and told her to sit for several hours on a bucket until she heard a pop.
"I felt something hot from my stomach coming out. She gave me some medicine and I went home," Emily said, sitting in a friend’s one-room corrugated iron shack off a muddy alley.
After a week of bleeding, Emily’s friends brought her more medicine from the abortionist but it didn’t help. Eventually, they carried her to a nearby clinic where she was given an injection that stopped the haemorrhaging.
Her ex-boyfriend beat her when he found out about the abortion.
"He told me that I am a murderer, that I killed his baby," Emily said.
WOMEN DIE IN POLICE CUSTODY
Kenya is a deeply religious Christian country and the church is vocal in its condemnation of abortion.
The implementation of the law, which prohibits abortion except in cases where the mother’s life is in danger, is ambiguous, however.
The penal code says women who abort illegally can be jailed for seven years. But wealthier and more educated women take advantage of "medical guidelines", which allow terminations in the interests of a woman’s physical or mental health but require the signatures of multiple doctors.
"In Kenya, we don’t know whether to procure an abortion is legal or illegal. We are just in between," said one doctor who performs abortions.
Public hospitals rarely provide the service but it is easily available in private practices, such as the prestigious Nairobi Hospital where women pay around $1,000 for a termination.
International charity Marie Stopes performs abortions in clinics for $25 to $60, which is still unaffordable for the majority of Kenyans.
"If we were to charge a lower price, we would be overwhelmed," said a doctor working for Marie Stopes.
NEEDLES AND STICKS
Women and teenage girls who are poor often have no option but to turn to quacks in backstreet hovels.
"They use bicycle spokes, knitting needles ... putting sticks, pens through the cervix," said Joseph Karanja, an obstetrician-gynaecologist who works at Kenyatta National Hospital in Nairobi.
Other painful, often lethal, methods include drinking detergent or overdosing on malaria pills.
The hospital’s acute gynaecology ward receives five women each day seeking post-abortion care. It has 30 beds, sometimes shared between up to 70 women.
Women often delay seeking treatment until they are very sick due to fear, lack of money or emotional turmoil.
"They come at the point of death," said Karanja, who estimates one or two women die from post-abortion complications at the hospital each month.
"They stay at home scared because they are afraid they will be arrested. So the uterus goes rotting inside. They get a very bad kind of infection called septic shock, where there is tissue damage, kidney damage, and then they finally die."
Unsafe abortions account for 35 percent of maternal deaths in Kenya, versus the global average of 13 percent.
"We are losing many people through the botched and backstreet abortions," said the Marie Stopes doctor.
"If we legalise it, we shall find that the number of deaths will go down or maybe there won’t be any deaths at all."
For Karanja, the problem is the divide between Kenya’s rich and poor.
"The high and mighty don’t have a problem. In those ivory tower hospitals, these services are available as a routine," he said.
"These services should be provided in all public health facilities because that is where ordinary people go." (Editing by Sonya Hepinstall)