In Pursuit of Justice

Imagine you go to the hospital or a doctor’s office and receive the treatment that you need to stay healthy. On your way out the door, you are given a bill. And an ultimatum.

If you can’t pay the tab, then you will pay with your freedom.

It sounds like something out of science fiction or some far-fetched post-apocalyptic world.

But it’s not. It’s happening today. To women in Kenya.  

Today, the Center for Reproductive Rights filed a case before the High Court of Kenya against several parties, including Pumwani Maternity Hospital, the country’s largest maternity hospital (located in the capital, Nairobi), Kenya’s attorney general, and its minister for medical services. Our aim is to halt this atrocious practice of arbitrary and illegal detention of women and to ensure that the Kenyan government takes affirmative measures to prevent from happening in the future, in accordance with its constitutional and human rights obligations.

Many women have suffered this kind of degrading treatment—in some cases, after receiving abysmal care from the medical staff. The story of one woman—one of the two that we’re fighting for in the case—illustrates just how awful it can be if a woman is pregnant and poor in Kenya.

When Margaret gave birth to her first child at Pumwani Maternity Hospital, the delivery did not go smoothly. After significant complications, she fell into a week-long coma. What she awoke to, though, was truly a nightmare.

The hospital gave Margaret a bill for its services, but the amount due was more than she and her then-husband had available. So hospital officials refused to let her leave, detaining Margaret for 12 days until her husband scraped together the money to settle their debt.

Hospital officials force these women to live in terrifying conditions through these detentions. Women are jammed into cramped rooms with their newborns and forced to share beds with other women. Guards monitor their activities, but the hospital staff does next to nothing to care for the health needs of women and their babies, left to fend for themselves for everything from food to diapers. 

It got worse for Margaret. Several days after she was released, she began to experience severe pain. Upon returning to the hospital, doctors discovered that the surgeons performing Margaret’s cesarean delivery had sewed a pair of scissors into her stomach. She spent an additional two months in the hospital.

This time, officials chose to not bill her.

Kenya has been failing women, especially the poor, for too long. Government officials still haven’t addressed the affordability of health care for women, even though Kenya has committed to providing affordable health care to all its citizens through its health sector policies and constitutional and human rights obligations.

Pumwani serves a large swath of Nairobi’s population, including many impoverished neighborhoods. Its performance is symptomatic of the government’s failure to honor human rights commitments to protect women’s right to health. Unfortunately, Margaret found herself there again to deliver another child, and this stay was nearly as catastrophic as the first.

Doctors failed to realize that her baby was in a breech position, and left Margaret unattended for two hours as she lay bleeding. The neglect had an impact on both the child and mother—Margaret suffered a ruptured bladder, leading to yet another surgical procedure, while her daughter was born with a swollen neck and legs.

Once again, the hospital fees led to another illegal and unconstitutional detention. This time, hospital staff told Margaret—just days after having surgery—that she wasn’t entitled to a bed. For six days, she slept on the floor without a blanket.

The staff further endangered her health by withholding the cotton cloths Margaret needed to clean her still-healing stitches. And they abused her verbally, one nurse saying, “You are stupid. That is why you are giving birth every other day.”

Naturally, these incidents have traumatized Margaret. “I would not want to go back to Pumwani,” she said. “I would prefer for women to give birth at home if possible, rather than be abused or detained.”

Margaret’s is not an isolated experience. The Center and its Kenyan partner, FIDA Kenya, started documenting this inhumane practice many years ago, culminating in the 2007 release of the groundbreaking report Failure to Deliver: Violations of Women’s Human Rights in Kenyan Health Facilities. Our six-month investigation of Kenya’s health facilities revealed that women seeking maternity services across the country regularly suffer a number of serious human rights violations, including arbitrary detention, verbal attacks, sexual assault, flagrant neglect, and filthy conditions.  

Following this report, the Kenya National Commission of Human Rights undertook a follow-up investigation and confirmed these atrocious practices. But Kenyan health officials have offered little in the way of real reform.

Kenya has failed consistently in its obligations to guarantee women’s health and human rights, across many fronts. All governments have a fundamental duty to guarantee a woman the right to make choices about her health care and to ensure her access to affordable, timely, quality care. And the exercise of those rights cannot be subject to economic barriers. The detention of Kenyan women under those circumstances represents a gross violation of their rights.

This is the first case of its kind before the High Court of Kenya. We have the highest expectations that this court will recognize the injustice that Kenyan women, including the two we represent, have suffered and the responsibilities that all hospitals and government officials have to women across Kenya. Because no one should ever have to make a decision between her health and her freedom.