A Comprehensive Reproductive Health Act for Kenya?

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A Comprehensive Reproductive Health Act for Kenya?

• Rationale, Components and Implementation
• Prof Japheth Mati
• Mua Hills, Machakos

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KMA and Maternal Health

• 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.

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Top Four Leading Causes of Death 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

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Right to Reproductive Health

• Art 43 (1) of the Constitution of Kenya
• 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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Governments obligations upon promulgation of the
Constitution

• 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.

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The Right to RH implies

• 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

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KMA partners have crucial role to play in
implementing health provisions in the
Constitution

• 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

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Evidence-based interventions for reduction of
maternal deaths

• 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

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Examples of high-impact interventions-

• 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)

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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).

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Right to life

• Article 26

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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.

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Art 26(4)

• Effectively recognises the entity of legal
  abortion in Kenya, though under certain specified
  conditions

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Arising from Art 26(4) a number of clarifications
and definitions are needed, including

• 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
  WHOs? (i.e. a state of complete physical,
  mental and social well-being..)
• etc. etc.

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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?

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Safe abortion services

• WHO definition of safe abortion includes
• Provided by trained health workers
• Using proper equipment
• Using correct techniques, in
• Functional well equipped health infrastructure,
  and
• Supported by policies and regulations

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Conditions for providing safe abortion services
within the law

• 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.

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Denial of abortion services to women who are
legally entitled to them

• 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?

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Other considerations in a comprehensive RH Act

• 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

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Other considerations -contd

• 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

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Conclusions

• 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.
• The Constitution of Kenya in Art. 26(4) has
  established the entity of legal abortion, under
  certain specified conditions

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Conclusions

• 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

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thank you!