Julia Nyaberi's* "clinic" in Majengo, a slum in Kenya's capital, Nairobi, caters to one type of client only - pregnant women seeking abortions.
Young women writhe in pain on the floor of the poorly lit house; the neighbours all know what happens here and have become immune to the moans and wails.
"They come to me and each pays me 50 shillings [US$0.70]," Nyaberi told IRIN/PlusNews. "Most of them are sex workers who operate here in Majengo and have conceived by mistake."
She uses a concoction of herbs to induce abortion, and admits there have been fatalities. "Even qualified drivers at times cause accidents; I do not do this job to kill anyone, but at times some are unlucky and go together with the child they came to abort," she said.
Diana Awuor*, 21, is a sex worker in Majengo, and fell pregnant after unprotected sex with a regular client.
"Not that I have sex without a condom every day but there are some regular clients you can excuse at times and I think that is how I became pregnant," she said. "We cannot do our work while pregnant because nobody will want you, so I have to abort to stay in business, and also, I don't want a baby."
Ministry of Health statistics put the number of Kenyan girls and women who have abortions every year at 300,000; abortion remains illegal so many of these take place in back-street clinics like Nyaberi's. According to the International Planned Parenthood Federation, unsafe abortions account for between 30 and 50 percent of maternal deaths in Kenya.
"One person attending to up to even five women without sterilizing whatever instruments are being used can spread HIV," said Jacky Abuor, a counsellor at the faith-based Kenyan NGO, Crisis Pregnancy Ministries, which works with young women dealing with unwanted pregnancies.
The legalization debate
A recent study by the local NGO, Centre for the Study of Adolescence (CSA), found that four in 10 Kenyan girls had sex before the age of 19, many with multiple partners and often in exchange for gifts such as mobile phone airtime or food. Along with the predictable public outcry, the report re-ignited the legalization debate.
Women's rights groups have long urged the government to legalize abortion to prevent the high number of maternal deaths from unsafe procedures. A Reproductive Health and Rights Bill proposing that "safe and accessible abortion-related care" be enshrined in the constitution as a reproductive right was tabled in Parliament in 2008 by the Federation of Women Lawyers and the Coalition On Violence Against Women; MPs have yet to vote on the issue.
The country's anti-abortion movement has powerful backers, from religious leaders to politicians, such as Vice-President Kalonzo Musyoka.
"When you say four out of 10 girls have engaged in sex, how do we keep the remaining six from being lured into early sex? The window lies in counselling and education," said Anne Muisyo, “Abstinence and worth the wait” programme coordinator at Crisis Pregnancy Ministries.
"Sex education at the early stages of life and especially targeting young people can significantly turn the tide and prevent new cases of HIV," Paul Mitei, head of gynaecology in western Kenya's Nyanza Provincial Hospital.
|More on sex education:|
|More sex education equals less HIV and teen pregnancy|
|From the classroom to the bedroom|
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Kenya's Ministry of Education has an HIV/AIDS prevention and sex education curriculum that focuses on upper-primary and secondary school, but no specific time is set aside for this during the school day, leaving teachers and school heads to fit in the subject at their discretion.
Speaking at a recent meeting in Nairobi, Kenya's director of public health, Shanaaz Sharif, admitted that opposition from parents, religious groups and some civil society bodies had led to a "censored sex education campaign" in schools.
Agnes Odawa, in charge of guidance and counselling at the education ministry, told IRIN/PlusNews the government had plans to introduce a more detailed sex education package as part of the school curriculum.
Responding to the CSA's findings, the head of the National AIDS Control Council, Alloys Orago, said the government was also looking into the promotion of condom use among teenagers.
Currently the government's HIV prevention programme for teens revolves around the promotion of abstinence, with a nationwide media campaign urging young people to "chill", or abstain, from early sex.
"Many young girls and even boys in rural areas and poor settings do not really know about contraception; those of them who use the condom only know it as a means of preventing HIV," said Mitei. "There is a need to promote condoms to young people both as an HIV preventive measure and birth control measure."
* not her real name
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions
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