A Morality Tale
Sonia is a 32-year-old nurse in a hospital located in the northern part of Kenya.
“It will stay with me for the rest of my life, I am sure. She was only 16 and she came to the hospital for an abortion. I sent her away. Abortion is illegal in Kenya, or so I believed at the time. A few days later we heard that she died from complications of an unsafe abortion. I feel an overwhelming guilt—I am even thinking about leaving the profession. I was panicking. I did not think straight: how could I otherwise have sent away a young girl in need of help?”
How many times have we heard this story all over Africa? More to the point: How many times are we going to hear this story again?
It should not be many more times. Under the new Kenyan Constitution, women have the right to access safe and legal abortion when, in the opinion of a trained health professional, the pregnancy presents a danger to their mental or physical health. Abortion ended up in the constitution as a result of a balancing act by the drafting committee assigned to constitutional reform. Since the right to life (and life is defined as beginning at conception) is mentioned in the constitution itself, the committee felt that the right to a safe and legal abortion should also be explicitly stated.
The Catholic hierarchy played an important role throughout the constitutional review process.
Paula is a reproductive health and rights activist in Nairobi.
“The Catholic church is an impressive lobbying machine. They turned the whole constitutional review process into a debate on reproductive health and rights. Lots of damage has been done in the form of widespread disinformation on all the usual issues. They are also formidable organizers: they have an audience with the president, and they rallied all the evangelicals behind their agenda. All Catholic MPs were summoned to do what the church saw fit; all other Members of Parliament received at least one phone call.”
When it comes to abortion, the hierarchy intimidates, charms, rewards and punishes at all levels. “There are those amongst us who want to kill our children,” it thunders from the pulpit Sunday after Sunday. And it works.
Linda is a health professional who provides abortions.
“I am not going anymore, to church I mean. I really had the feeling that I was sorted out and under attack. The priest was saying things about murdering children looking straight at me and the whole audience looked at who he was looking at. It gave me the creeps. It also makes me think about the number of Catholic nuns we had at the clinic for an abortion—after all, how dare they accuse me.
The church manages to make everybody believe that abortion was and is completely illegal.
The government should publish guidelines or an explanation of the new situation but they do not do that. So I am sure that in the entire county where I work we are the only place where you can get a safe abortion. Government hospitals are too confused to provide services when they are needed while the other ones are Catholic and there, abortions are out of the question.”
There is more that the government of Kenya does not do. Catholic health facilities do not provide family planning, for instance. Consider that Catholic schools all over Africa are supposed to follow the official curriculum developed by the nation’s Ministry of Education. Along the same lines, hospitals, Catholic or not, should be licensed to implement the health policy put in place by the Ministry of Health, family planning being part and parcel of that policy. In Kenya, the health policy is not uniformly enforced. The Catholic hierarchy preaches its dogmas on reproductive health and then Catholic-run hospitals enforce them on all clients, both Catholics and non-Catholics.
[If we live to see the day when the silence is broken on the sexual abuse of Catholic nuns by the clergy, the current tidal wave of sexual abuse scandals will look like child’s play in comparison.]
Irene is a 45-year-old single mother who sells second-hand clothes on the Nairobi Market.
“My husband left me when my daughter was three. Later I got pregnant again and I did not want the pregnancy. I did what everybody did at that time, I found some miso2, took it, and went to the hospital as soon as the bleeding started. They were horrible; they left me waiting in emergency for a long time, bleeding and all. They said loudly so that everybody around could hear it: ‘You can have a little more of the pain you caused your baby before we help you.’ And they called the police, but they said they could do nothing with me.”
When it comes to abortion, the hierarchy intimidates, charms, rewards and punishes at all levels.
Western healthcare, including reproductive healthcare, came to Kenya with the missionaries. It was informed by the moral teachings of the hierarchy on sex, marriage and family. These concepts were developed over centuries in a Western context that was completely alien to African realities. And they were imposed with force. Indigenous habits, rituals and ceremonies that dealt with African sexual and family life were driven underground, mainly because the Catholic hierarchy considered them part of the competition—an African religion.
But the good was tossed out with the bad. Many of these traditions functioned as some sort of initiation or rite of passage into adulthood and sexually active life. Whether these moral systems or rituals had the potential to modernize, to respond to a call for gender equality, to remain meaningful to people in the 21st century we will never know: Practices that are rendered semi-illegal tend to freeze in a rigid stupor and can no longer be changed or even discussed. They can be worshipped, though, and they are, by what has become to be known as African traditionalists.
As yet, Africa has had no Alfred Kinsey or Masters and Johnson to examine sexuality scientifically, no feminists like sex educator Shere Hite or author and literary critic Camille Paglia. Common arguments against women’s rights may be flimsy, but there is a lack of hard-hitting opponents in a position to dismantle them.
Catholic Healthcare in Kenya
Archbishop Boniface Lele of Nairobi said in a speech before the Catholic Health Commission of Kenya in 2011 that there are 446 Catholic health institutions in the country, including
– Health facilities,
– Community health programs and
– Medical training institutions.
They offer services such as curative, preventive and rehabilitative care, surgery and specialist care, as well as HIV & AIDS care.
These Catholic-run entities may be managed at the local level by the Kenya Episcopal Conference, which operates 53 hospitals, or run by international NGOs like Catholic Relief Services, which partners with the Kenyan government in its HIV & AIDS programs and other community health initiatives.
Rev. Vincent Wambugu, general secretary of the Kenya Conference of Catholic Bishops, gave somewhat different numbers, estimating that the Catholic church in Kenya operates almost 30 percent of all healthcare facilities—including 54 hospitals, 83 health centers and 311 dispensaries.
Source: African Population and Health Research Center, Ministry of Health, Kenya, Ipas, and Guttmacher Institute, “Incidence and Complications of Unsafe Abortion in Kenya: Key Findings of a National Study,” 2013.
Carry is 35, a never-married single mother and headmistress of a girls’ secondary school.
“Where, I would like to know, am I going to look for a role model or guidance if I do not like the answers of both the missionaries and the African traditionalists? More important, where are my students supposed to look for any sort of moral code that is not based upon hatred of women, or the desire to control every aspect of women’s lives?”
In his book The Church and Development in Africa: Aid and development from the perspective of Catholic social ethics, Fr. Stan Chu Ilo states that within Catholic healthcare, services provided to Africans “should be subject to solidarity instead of the object of patronizing charity.” This is not a superfluous observation because patronizing charity is exactly the expression that comes to mind when considering the state of Catholic healthcare in Africa.
More important is the sublime act of hypocrisy involved with the manner in which both Pope Benedict and Ilo analyze and criticize development policy (from the International Monetary Fund to the Millennium Development Goals). This approach is top-down, has no time for cultural and historical realities in Africa and imposes unworkable concepts on a population rendered dependent. One of Ilo’s theses is that “neoliberal globalization has brought destruction to Africa.” As true as this may be (and it is), exactly the same can be said of the civilization/evangelization project of the Catholic hierarchy in Africa.
It strikes me as intellectually dishonest that Pope Benedict’s 2009 encyclical “Charity in Truth” describes a development agenda that might work: one that is grassroots-oriented and locally designed, with ownership where it belongs and an emphasis on the empowerment of women. But what empowerment agenda is feasible without reproductive choice at its core? What economic independence can be gained when one is pregnant every year? What liberation can be experienced without being boss of one’s own belly?
In both theory and practice there is a gaping hole in the logic that says, “We in Catholic healthcare are here to serve the people, but we are also here to teach them how to live their lives.”
“At the end of the day,” Ilo concludes, “All issues related to HIV/AIDS are moral issues.”
And therein lies the problem in a nutshell. Taking the role of moral instructor might be a defensible position for a church, but it is not for people in the healthcare field. For healthcare providers, HIV should be seen as a virus that causes a terminal illness called AIDS, and thus it should be addressed by prevention, treatment and care, not by moral teachings.
MEET JOYCE, FAITH AND VICKY:
Joyce, 22, and Faith, 23, are studying medicine in Nairobi, while 19-year-old Vicky is at a secretarial college.
Together, we are watching a talk show on TV where the discussion is about female students entertaining sugar daddies. Relatively well-to-do men want female company and are prepared to pay for it. Facebook facilitates this widespread practice at Kenya’s universities. In the studio are two female students and a whole range of male experts. “These men do not want company,” the talk show host fumes, “They want sex.”
The Catholic hierarchy enforces its dogma on all clients, both Catholics and non-Catholics.
The girls who are on screen, and those in front of the screen, laugh—that much had already occurred to them.
Joyce says, “I had three last year. It did cater for all my needs,” and she displays her iPad.
Faith adds, “I am starting this year. My mother is working very hard and she still cannot afford all the money I need for books, hostel, etc.”
On the show, the experts are trying to convince the girls that receiving favors from older men in exchange for sex is wrong, admonishing them, “You’d better take two jobs apart from your study.”
Joyce, Faith, Vicky respond, “What jobs?” and then, “Because then you can have the feeling that you really did it yourself after all.”
Then Faith replies, “Hello, that is why I do not have sex with the professors for better grades. I am going to be a doctor so I better learn how to do it properly or I will end up killing people”.
“I slept with the janitor to get a better room in the hostel, though,” Joyce admits.
Vicky is quiet.
On the television the host asks the students whether the experts have convinced them not to go down this road. The girls in the studio look puzzled. Faith, Joyce and Vicky stare intently at the screen. “Frankly, no,” says one of the students. “I simply see no other way to finish my study in due time, otherwise.”
The girls in front of the screen cheer.
Note that one very useful piece of advice has not been delivered to these girls by anyone from the group of experts. “Please protect yourself against HIV and unwanted pregnancy,” they should have said. “Please force these men to use condoms. Please tell them that it’s safe sex or no sex.”
Most Kenyan teenagers will receive some sort of sex education. The majority will be subjected to the infamous ABC curriculum, which amounts to Abstain; Be faithful; and if you are too stupid or too morally flawed to accomplish the first two, use Condoms. In a Catholic environment this comes with an additional C—Certainly do not expect us to help you to obtain condoms because we are against condom culture, aka the culture of death.
Both Stan Chu Ilo and Pope Benedict softened their stance on condoms over time. Ilo now thinks that it should be possible for Catholic healthcare providers to cooperate with NGOs that are not “too explicit” about condoms.
Oh, that evasion about condoms. It is present in the myth of the Catholic nun who quietly but persistently helps women and young people access family planning and condoms, against the wishes of her bishop, because she is loved by the community and driven by compassion.
Apart from the fact that I yet have to meet that wonderful person (I am sure she exists; after all there is truth in every cliché), what good would this approach do? A few years ago, a -campaign was conducted in the Netherlands to help young people bring up condom use with a sexual partner. Research had shown that young people did not know how to approach the subject, so tag lines were developed, giving young people sentences like, “Your condom or mine?” These were Dutch teenagers in the 21st century, brought up in a relatively open culture when it comes to sex, and still they needed help negotiating safer sex. Do we really think that condoms handed out in a secret, shameful way will turn Kenyan teenagers into confident, consistent and correct condom users?
Francis is working at the Ministry of Health, and thus does not want anyone to know his real feelings about HIV & AIDS education.
“Moral messages are limiting the services. The focus is on A and B. It is not helping that key funding from the US is basically doing the same. It also does not help that sex work is illegal, as is msm [men who have sex with men]. Sex workers are only being harassed and msm are criminalized. The policy is in profound dissonance with what people practice.”
After many years of implementing this policy in which the C in ABC is all but silent, research is starting to show that apart from dissonant, it is also spectacularly ineffective.
In Poor Economics: A Radical Rethinking of the Way to Fight Global Poverty, Esther Dufloo analyzes several programs providing sex education and HIV & AIDS awareness that target Kenyan schoolgirls ages 12–15. Firstly, she finds that ABC programs are, in reality, AB programs because “condoms are not discussed.” After 170 teachers in randomly chosen schools had been trained in the AB curriculum, the time spent on AIDS education in schools increased, but there were no changes in reported sexual behavior or even in knowledge about HIV & AIDS. One, three and five years after the training, pregnancy rates (proving risky behavior) were the same in schools where teachers were trained and where they were not. In other words, the curriculum did nothing.
In another program, adolescent girls received one piece of information—that older men were more likely to be infected with HIV than their peers. That turned out to be infor-mation that teenagers could turn into safer behavior, as cases of teenage pregnancy where an older partner was involved went down sharply. Finally they gave school uniforms to one group of teenage girls, and school uniforms plus a version of the ABC curriculum to another. The girls who received school uniforms tended to stay in school and the pregnancy rate in this group went down. But nothing happened in the group getting both school uniforms and the program with ABC education. It seemed that the ABC information counteracted the effect of the school uniform. The researchers concluded, “Uniforms reduce teenage pregnancy by giving girls the ability to stay in school and thus a reason not to be pregnant. But the sex education pro-gram, because it discourages extra-marital sex and promotes marriage, focuses the girls on finding a husband (who more or less has to be a sugar daddy), undoing the effect of the uniforms.”
Janet is 17 and graduating from high school in 2014.
“I am pregnant, I believe. I am late. I went to a government hospital but they did not want to help me. Maybe I am also HIV positive, what do I know? Where can I go? I do not know what to do. My boyfriend is my age but maybe we made a mistake to have sex. But maybe not—he says it is a sign of love. But now I really do not know. He is going to university; he says I can be his campus wife. Those are women who take care of the students, cook and so on, but they almost never marry them. If I can get rid of this thing, maybe I can continue my education. I do not really know. But maybe I should tell my parents and his so that they will force him to marry me. Can I continue my education when I am married, do you think?”
I take Janet to Irene.
Irene is Vicky’s mother. We are having a drink at the quiet bar in an international hotel in Nairobi. Irene comes here every evening after a day selling second-hand clothes in the market while looking for paying sex partners so that her daughter does not have to do the same.
There are many players responsible for the fact that women and girls are being dealt such a poor hand in Kenya when it comes to reproductive health and rights. However, the Catholic hierarchy is one of the bigger players on the team opposing women’s rights.
With thanks to Mitchelle Kimathi and Dr. Boaz Otieno-Nyunya.