Cover photo: Melvine Ouyo and Kephine Atieno in front of Venoma Clinic in Malindi, Kenya
This story contains sensitive information regarding unsafe abortion and gynecological emergency.
Just a few miles from the Indian Ocean, in the coastal Kenyan city of Malindi, Kephine Atieno sits at Venoma Clinic. She established the private clinic eight years ago following an almost-decade-long career with Marie Stopes Kenya. Venoma, much like Kephine, does not try to hide itself from the community; it is situated just off the main road in clear view, with its white walls and blue trim standing out clearly.
With the sounds of tuk-tuks whizzing by the clinic, Melvine Ouyo and I sit down with Kephine to talk about the services she provides. Kephine began providing abortion services when she started working with Marie Stopes Kenya in 2001. “I have a passion for what I do,” she says. “Safe abortion was a key service at Marie Stopes Kenya.” She explained that she could provide 15 or more abortions every day in Mombasa (Kenya’s second largest city, after Nairobi). Today, Kephine still provides abortion services to the patients who walk through her door at Venoma.
“When a girl leaves the facility, she smiles. When she came in, she was unsure, because the stigma is that abortion means you will die.” Kephine has never lost a patient.
While Kephine still works closely with Marie Stopes Kenya for service provision and provider trainings, she does not receive funding from her former employer. “I’m a hustler,” she says when asked how she receives her funding, “and I pay from my own pocket.” While medication abortion costs 4,000ksh ($40 USD) and surgical abortion costs 5,000ksh ($50 USD), no client will be turned away for lack of ability to pay. “I’ve done services for 1,500ksh ($15 USD) for a 16-year-old girl who was at school.” Kephine will take whatever contribution a patient can give.
Venoma has never received USAID funding, but has partners that do and that have signed the Global Gag Rule. Patients Kephine and her colleagues once were able to reach with their contraceptive outreach and youth engagement partnership programs are no longer receiving services. “The gag rule has caused us a lot of pain because we are no longer able to do the activities we used to, and it’s making medical costs go up.”
“First, Trump is very mean and self-centered. He is not for the girl child. The president needs to be told that the girl is the future leader of tomorrow, and we don’t expect all the girls to get married at that tender age, a cause for poverty. We can fight the gag rule.”
Many women in the community seek contraceptive supplies at Venoma, the most common one being Depo-Provera (injection). But in recent years, Kephine and many providers are experiencing stock outs of Depo-Provera, a common theme we’ve seen when speaking with providers in Kenya. “What does [a patient] do when she comes to [get] her next shot but we don’t have it? Other options are more expensive.” She explains that in the last year, she has been given much less stock. “Whatever is left goes to government facilities,” limiting access in private facilities that serve rural communities. Decreased U.S. funding for international family planning, removal of funding to UNFPA, and the Global Gag Rule have exacerbated this stock out.
Kephine says the cost of abortion medication is going up, causing “under-dosing,” where unsafe or unregulated providers are not giving patients enough of the drug. In cases like this, abortions fail and ultimately lead to increased need for post-abortion care. With Mariprist, a combination pack of mifepristone and misoprostol, now on the market, Kephine is hopeful that this practice of under-dosing comes to an end.
“The culture and environment is very hostile,” Kephine explains of her community’s view on her work. “They should understand that sexual and reproductive health is comprehensive, even for the men!” Abortion stigma is exemplified in a story she shares with us about a married mother of three children who was pregnant with another man’s child. An unsafe provider gave her fake abortion pills, which caused her to hemorrhage. When she was found bleeding on the floor of her home, she was brought to the public hospital nearby. The medical providers there refused to treat the patient, and she died at the hospital.
When asked what can be done to break down the stigma and shame so that this incident is not repeated, Kephine’s message is clear: “The pro-choice movement is growing, we just need to speak out loud.”
When we #Fight4HER, we fight for the brave healthcare professionals like Kephine, who provide safe abortion regardless of the consequences they may face. We fight for the patients like those who walk through Venoma’s door, who deserve quality reproductive health care. As we continue the #Fight4HER, we look forward to lifting the voices of unwavering providers like Kephine in our work.