A Comprehensive Reproductive
Health Act for Kenya?
Rationale, Components and
Implementation
Prof Japheth Mati
Mua Hills, Machakos
KMA and Maternal Health
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Maternal health issues ought to feature among the top
health priorities in KMA agenda (see below).
Among the top four leading causes of death among
women, Maternal Conditions rank second only to
HIV/AIDS, but are at the top of causes of Disability
Adjusted Live Years (DALY) lost
It is appropriate that this conference has the theme: “The
lives and Health of Women in Kenya are Worth Preserving:
In Harmony with the New Constitution”.
and Disease Burden in Women Ages
15-44
(Source: Global Disease Burden Project, 2006)
CAUSES OF
DEATH
% of Total
deaths
CAUSES OF
DALY LOST
% of Total
DALYs
HIV/AIDS
25.5
Maternal
Conditions
13.2
Maternal
Conditions
13.5
HIV/AIDS
12.4
Cancer
7.9
Unipolar
Depressive
Disorders
11.2
Tuberculosis
6.4
Cancer
3.5
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My given topic is: “Is it Time for a
Comprehensive Reproductive Health Act
for Kenya? Rationale, Components and
Implementation”
Right to Reproductive
Health
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Art 43 (1) of the Constitution of Kenya
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Every person has the right—
(a) to the highest attainable standard of health,
which includes the right to health care services,
including reproductive health care;
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Government’s obligations
upon promulgation of the
Constitution
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Guarantee and protect right to health including RH
services for women and men
Women and men have access to quality RH services
Women have freedom to decide if, when and how often to
reproduce
Women survive pregnancy and child birth
Factors that contribute to maternal morbidity and mortality
are addressed
Laws, policies and guidelines are in place to guarantee
quality health care services.
The Right to RH implies
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Guaranteed access to adequate RH care for
all including poor and marginalised groups
Addressing underlying determinants of
health- water, food, clean environment etc.,
as provided for in Art. 43 (1) (b-f) are
KMA & partners have crucial role to
play in implementing health
provisions in the Constitution
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The Constitution of Kenya provides opportunities for
enhancing health, including RH and rights
The Constitution addresses key factors that are
fundamental to improving RH indicators- equality, equity,
dignity and freedom from discrimination.
The Constitution in Art. 26(4) has established under certain
specified conditions, the entity of legal abortion.
KMA, professional societies, and partners can play central
roles especially in ensuring laws, policies and guidelines
do reflect provisions in the Constitution for effective
implementation of quality RH services
Evidence-based interventions for
reduction of maternal deaths
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Strengthening/ building efficient health
infrastructure & human resources. (MMR is the
best proxy of a functional health system)
Prioritising most effective approaches to deliver
key interventions
Scaling up interventions that are known to work
Ensuring interventions reach those who need them
most
Apply high-impact interventions to address lead
causes of maternal death
Examples of high-impact
interventions
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Prevent unplanned pregnancy- access to efficient
FP services
Prevent unsafe abortion- access to safe abortion
services
Ensure skilled care throughout continuum of
pregnancy, childbirth and postpartum period
(define new role of TBA)
Prevent PPH through active management of 3rd
stage of labour (AMTSL)
Family planning saves lives
Ensuring access to efficient FP services:
 Reduces unwanted births- reducing risk of
maternal deaths,
 Reduces unwanted pregnancies- reducing risk of
unsafe abortion- reduce maternal death by 35%
 Birth spacing can reduce maternal morbidity and
mortality. Birth spacing of 3-5 years associated
with lower risk of APH, PE, PRM, puerperal
endometritis and maternal death (Systematic
reviews and meta-analyses).
Right to life
Article 26
Article 26:
(1) Every person has the right to life.
(2) The life of a person begins at conception.
(3) A person shall not be deprived of life intentionally, except to the extent
authorised by this Constitution or other written law.
(4) Abortion is not permitted unless, in the opinion of a
trained health professional, there is need for emergency
treatment, or the life or health of the mother is in danger, or
if permitted by any other written law.
Art 26(4)
Effectively recognises the entity of legal abortion in
Kenya, though under certain specified conditions
Arising from Art 26(4) a number
of clarifications and definitions
are needed, including:
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Who is a trained health professional?
What legal issues arise from ‘Task shifting’ implied
above?
What constitutes danger to life or health of the
mother?
At what stage is emergency treatment mandatory?
What definition of ‘health’ is implied- is it WHO’s?
(i.e. “a state of complete physical, mental and social
well-being…..)
etc. etc.
Who among these is implied in “trained
health professional”?
Obstetrician Gynaecologist?
Registered medical practitioner?
Registered Clinical Officer?
Registered Nurse?
Registered Midwife?
Any health worker trained to competency?
All of the above?
Safe abortion services
WHO definition of ‘safe abortion’ includes:
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Provided by trained health workers
Using proper equipment
Using correct techniques, in
Functional well equipped health
infrastructure, and
Supported by policies and regulations
Conditions for providing ‘safe
abortion’ services within the law
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Requirements of Article 26(4) are met
Conditions for WHO definition of ‘safe abortion’
are satisfied
Under such scenario TOP is a legal safe medical
procedure. TOP outside above conditions, it is
“Unsafe abortion”.
Denial of abortion services to women
who are legally entitled to them
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What is the legal position of Conscientious
Objection?
What are the legal obligations of doctors invoking
Conscientious Objection?
What are legal responsibilities of such providers to
women who seek abortion services?
Other considerations in a
comprehensive RH Act
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Access to services – physical access e.g.
specified maximum distance to nearest health
facility in all counties
Minimum RH services that must be available
in health facilities
Minimum standards of quality of RH services
Norms and standards of HR, equipment and
supplies
Other considerations -cont’d
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Basic (minimum) RH conditions that
must be catered for at various KEPH
levels
Accreditation and inspection of health
facilities (public and private)
Training and roles of RH service
providers including ‘task shifting’
Conclusions
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The Constitution of Kenya provides
opportunities for enhancing health, including
RH and rights
The Constitution of Kenya addresses key
factors crucial to reduction of maternal
mortality- equality, equity, dignity and
freedom from discrimination.
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The Constitution of Kenya in Art. 26(4) has
established the entity of legal abortion, under
certain specified conditions
Conclusions
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There are several areas that require legal
clarification in order to avoid unwarranted
access barriers to services that are now
legally sanctioned.
KMA, professional societies, and partners can
play key roles especially in ensuring laws,
policies and guidelines do reflect provisions in
the Constitution for effective implementation
of quality RH services