Sarah Elliott

Poor Choices

Women persisting in their drive to control unwanted pregnancies, in defiance of the criminalization of abortion and the risk to themselves. A juxtaposition of the available termination methods, hygienic settings and overall safety of women procuring abortions based on their class. “Abortion is here to stay whether illegal or legal. The Big question is how safe it is.” “Studies have shown that restrictive abortion laws do not prevent abortions; instead, they prevent access to safe abortion. Limiting access to this procedure is devastating for women’s lives and health, for women’s families and communities, for the health care system and—ultimately—for the country.”  

  • KIBERA SLUM - JULY 9: A garbage dump in {quote}Soweto{quote} an area in the slum of Kibera where fetuses are regularly dumped. Every week they find aborted fetuses in the garbage-filled stream. They wash away or are eaten by pigs. A young girl hangs her laundry to dry in the slum of Kibera in Nairobi, Kenya on July 9th, 2010.
  • KIBERA SLUM - JULY 11: A 31-year old single woman prays at church with the 9 children who she takes care of in the slum of Kibera in Nairobi, Kenya on July, 11th, 2010. Her brother and his wife died of HIV and her sister died in 2008 after ingesting 25 aspirin to terminate an unwanted pregnancy. Their children now live with her in a single room in Kibera. {quote}It is very difficult to bring up all these kids alone, work is unpredictable, we usually skip lunch and porridge is our main meal in the evening.{quote} On a good month she can make up to 1,500 Kenya shillings, on a bad month she will only earn 900. Her 17-year-old niece who also lives with her is 6 months pregnant. Her boyfriend left her after learning of the pregnancy. She contemplated an unsafe abortion but her aunt and her pastor urged her to keep the child, as an abortion is life-threatening procedure in Kenya.
  • KIBERA SLUM - JULY 11: A 31-year old single woman prays at church with the 9 children who she takes care of in the slum of Kibera in Nairobi, Kenya on July, 11th, 2010. Her brother and his wife died of HIV and her sister died in 2008 after ingesting 25 aspirin to terminate an unwanted pregnancy. Their children now live with her in a single room in Kibera. {quote}It is very difficult to bring up all these kids alone, work is unpredictable, we usually skip lunch and porridge is our main meal in the evening.{quote} On a good month she can make up to 1,500 Kenya shillings, on a bad month she will only earn 900. Her 17-year-old niece who also lives with her is 6 months pregnant. Her boyfriend left her after learning of the pregnancy. She contemplated an unsafe abortion but her aunt and her pastor urged her to keep the child, as an abortion is life-threatening procedure in Kenya.
  • KIBERA SLUM - JULY 11: Children play in the alley way outside their home in the slum of Kibera in Nairobi, Kenya on July, 11th, 2010. Their aunt, a 31-year old single woman takes care of the 9 children. Her brother and his wife died of HIV and her sister died in 2008 after ingesting 25 aspirin to terminate an unwanted pregnancy. Their children now live with her in a single room in Kibera. {quote}It is very difficult to bring up all these kids alone, work is unpredictable, we usually skip lunch and porridge is our main meal in the evening.{quote} On a good month she can make up to 1,500 Kenya shillings, on a bad month she will only earn 900. Her 17-year-old niece who also lives with her is 6 months pregnant. Her boyfriend left her after learning of the pregnancy. She contemplated an unsafe abortion but her aunt and her pastor urged her to keep the child, as an abortion is life-threatening procedure in Kenya.
  • KIBERA SLUM - JULY 11: A 31-year old single woman takes care of 9 children who are her nieces and nephews in the slum of Kibera in Nairobi, Kenya on July, 11th, 2010. Her brother and his wife died of HIV and her sister died in 2008 after ingesting 25 aspirin to terminate an unwanted pregnancy. Their children now live with her in a single room in Kibera. {quote}It is very difficult to bring up all these kids alone, work is unpredictable, we usually skip lunch and porridge is our main meal in the evening.{quote} On a good month she can make up to 1,500 Kenya shillings, on a bad month she will only earn 900. Her 17-year-old niece who also lives with her is 6 months pregnant (pictured). Her boyfriend left her after learning of the pregnancy. She contemplated an unsafe abortion but her aunt and her pastor urged her to keep the child, as an abortion is life-threatening procedure in Kenya.
  • KISUMU – JULY 5: The positive pregnancy test of an 18 year old girl sits on the counter of a clinic in Kisumu, Kenya on July 5th, 2010. The Kenya Constitution states, “Any woman who, being with child, with intent to procure her own miscarriage, unlawfully administers to herself any poison or other noxious thing, or uses any force of any kind, or uses any other means whatever, or permits any such thing or means to be administered or used to her, is guilty of a felony and is liable to imprisonment for seven years.”
  • NAIROBI – JUNE 9: A surgery theater in a gynecology office in Nairobi, Kenya’s City Center on June 9th, 2010. Doctors working in the office are trained professionals and use MVA otherwise know as manual vacuum aspiration. Vacuum aspiration was originally developed by two doctors, Yuantai Wu and Xianzhen Wu from Shanghai, and published in 1958 in the Chinese Journal of Obstetrics and Gynecology. The Procedure is said to be one of the most common and safest ways to terminate an unwanted pregnancy and takes less than 15 minutes.
  • KIBERA SLUM - JULY 29: A surgery theater carefully hidden behind a chemist in the slum of Kibera on July 29th, 2010 in Nairobi, Kenya. The doctor who preforms illegal abortions in this makeshift clinic is not a trained professional, and was taught the MVA (manual vacuum aspiration) method by a friend. The environment is not sterile, which increases the health risk of the patient.
  • ONGATA RUNGAI – JUNE 21: A 29-year old Kenyan woman procures an abortion in Onagata Rungai, a town situated outside the capital of Nairobi, Kenya on June 21st, 2010. She is a single mother to a 9-year old boy and has never been married. The doctor uses the manual vacuum aspiration (MVA) termination method at a nursing home/family health clinic theater that he has rented out for the procedure. She nervously sits on the operating table waiting for the procedure to begin.
  • KIBERA SLUM – JULY 9: A 46-year old Kenyan woman who has never been married has four children, 22, 18 and 14 year old twins. During the day she runs a small restaurant, but it's not enough to support her family; at night she is a sex worker. Men will pay her 200 Kenya shillings to sleep with her when they wear a condom, and 500 Kenya shillings when they do not. She is HIV positive and guesses that the men who do not want to wear a condom are too, though she never tells them of her status. Nine months ago she procured her 3rd unsafe abortion in Kibera. She paid 200 Kenya shillings to a woman who used a soda straw to blow a liquid into her uterus, inducing labor. She was 6 months pregnant. Many single women in Kenya living in slums like Kibera live day to day, and do not have the money upfront to pay for a termination. By the time women have raised the funds to pay for such a procedure they can be 6 to 7 months pregnant. {quote}It is very scary, I may die and leave my children alone, but am forced by my circumstance. I cannot afford another child.{quote} After her 3rd abortion she developed fibroids, a benign tumor of the uterus, which can cause prolonged bleeding, pelvic pressure and pain. She has been bleeding for the last 9 months, but cannot afford the operation to fix it. She sits in the restaurant that she runs on July 9th, 2010 in the slum of Kibera in Nairobi, Kenya.
  • KIBERA SLUM – AUGUST 11: A chemist and an illegal abortion doctor’s clinic, which has been in operation in Kibera since 1999. He says that poverty is the main cause of abortion. Women come to him with an unwanted pregnancy and he provides them with ergometrine and oxytocin to induce their pregnancy. He will charge 2,000 to 4,000 Kenya shillings for these pills, which include a check up after the termination is complete. Most women take the pills at their homes in Kibera when they are alone and expel the fetus by themselves without the help of a physician or nurse. A pair of latex gloves, which are washed and reused after procedures hang dry in the chemist office in the slum of Kibera in Nairobi, Kenya on August 11th, 2010.
  • ONGATA RUNGAI – JUNE 21: A 29-year old Kenyan woman procures an abortion in Onagata Rungai, a town situated outside the capital of Nairobi, Kenya on June 21st, 2010. She is a single mother to a 9-year old boy and has never been married. The doctor uses the manual vacuum aspiration (MVA) termination method at a nursing home/family health clinic theater that he has rented out for the procedure. . Vacuum aspiration was originally developed by two doctors, Yuantai Wu and Xianzhen Wu from Shanghai, and published in 1958 in the Chinese Journal of Obstetrics and Gynecology. The Procedure is said to be one of the most common and safest ways to terminate an unwanted pregnancy and takes less than 15 minutes. The doctor begins the procedure by administering general anesthesia, a shot in her cervix.
  • KISUMU – JULY 4: A 24-year old Kenyan woman cringes from extreme pain as a doctor preforms a speculum exam at the Kisumu District hospital in Kenya on July 4th, 2010. She is suffering from what the doctor calls septic abortion. Septic abortion whether spontaneous or induced is the termination of a pregnancy in which the mother's life may be threatened because of infection and germs. The woman requires immediate care, antibiotics and possibly evacuation of the uterus.
  • KIBERA SLUM – JULY 20: A 46 year old Kenyan woman stands with her eldest daughter in their one room home in the slum of Kibera in Nairobi, Kenya on July 20th, 2010. Though she has never been married she has four children, 22, 18 and 14 year old twins. During the day she runs a small restaurant, but it's not enough to support her family; at night she is a sex worker. Men will pay her 200 Kenya shillings to sleep with her when they wear a condom, and 500 Kenya shillings when they do not. She is HIV positive and guesses that the men who do not want to wear a condom are too, though she never tells them of her status. Nine months ago she procured her 3rd unsafe abortion in Kibera. She paid 200 Kenya shillings to a woman who used a soda straw to blow a liquid into her uterus, inducing labor. She was 6 months pregnant. Many single women in Kenya living in slums like Kibera live day to day, and do not have the money upfront to pay for a termination. By the time women have raised the funds to pay for such a procedure they can be 6 to 7 months pregnant. {quote}It is very scary, I may die and leave my children alone, but am forced by my circumstance. I cannot afford another child.{quote} After her 3rd abortion she developed fibroids, a benign tumor of the uterus, which can cause prolonged bleeding, pelvic pressure and pain. She has been bleeding for the last 9 months, but cannot afford the operation to fix it.
  • KIBERA SLUM – MARCH 31: In March of 2011, Kenya was hit by a condom shortage. Health authorities stated the shortage was due to high demand and made an emergency order of 45 million condoms. Many Kenyan's had already began re-using condoms by washing them after use and hanging them to dry. A woman in the slum of Kibera washes a used female condom in her house on March 31st, 2011.
  • KIBERA SLUM – JULY 29: A 20 year old Kenyan woman who is 6 months pregnant sits in a midwifes house in the slum of Kibera in Nairobi, Kenya on July 29th, 2010. Her father, the main bread winner in her family passed away 3 years ago. She lives with her mother, 2 brothers and 3 sisters in a one-room shack in Kibera; they can barely afford to pay the rent each month. Her boyfriend abandoned her when he found out that she was 2 months pregnant, she is due October 3rd. Due to lack of family planning in Kenya, many women are left to raise children alone without any means of an income. She says that her culture believes if you abort your first pregnancy then you will become barren and never have children so she plans to keep her baby. {quote}Feeding my baby will be a problem, it won't eat a balanced diet.{quote}
  • KIBERA SLUM – AUGUST 5: A 44-year-old Kenyan woman who lives in Kibera has been performing unsafe abortions since 1986. She learned how to induce labor using a knitting needle and a rubber straw from a midwife in Machakos. She preformed her first illegal abortion on the midwife who had originally taught her the method. The midwife was 6 months pregnant and the abortion was procured while her husband was out of town. The 44-year-old abortionist has had 3 abortions herself and has preformed them for her daughters as well. Her 26-year-old daughter has had 2 and her 18-year-old daughter has had 2 as well, the first being at age 12. She charges up to 1,000 Kenya shillings for the procedure, but also performs it for free for women who don't have enough money. She estimates that she performs between 1 and 3 unsafe, illegal abortion per month, December being her busiest month. {quote}It should be legally permitted, it must be accepted in the country otherwise many women will die because they are too poor.{quote} A diagram the abortionist drew to show clients the procedure in the slum of Kibera in Nairobi, Kenya on August 5th, 2010.
  • KIBERA SLUM – JULY 19: A chemist and an illegal abortion doctor’s clinic, which has been in operation in Kibera since 1999. He says that poverty is the main cause of abortion. Women come to him with an unwanted pregnancy and he provides them with ergometrine and oxytocin to induce their pregnancy. He will charge 2,000 to 4,000 Kenya shillings for these pills, which include a check up after the termination is complete. Most women take the pills at their homes in Kibera when they are alone and expel the fetus by themselves without the help of a physician or nurse.
  • KIBERA SLUM – AUGUST 5: A 44-year-old Kenyan woman who lives in Kibera has been performing unsafe abortions since 1986. She learned how to induce labor using a knitting needle and a rubber straw from a midwife in Machakos. She preformed her first illegal abortion on the midwife who had originally taught her the method. The midwife was 6 months pregnant and the abortion was procured while her husband was out of town. The 44-year-old abortionist has had 3 abortions herself and has preformed them for her daughters as well. Her 26-year-old daughter has had 2 and her 18-year-old daughter has had 2 as well, the first being at age 12. She charges up to 1,000 Kenya shillings for the procedure, but also performs it for free for women who don't have enough money. She estimates that she performs between 1 and 3 unsafe, illegal abortion per month, December being her busiest month. {quote}It should be legally permitted, it must be accepted in the country otherwise many women will die because they are too poor.{quote} The abortionist holds a knitting needle and a rubber straw in her hands, the tools she uses to perform unsafe abortions in the slum of Kibera in Nairobi, Kenya on August 5th, 2010.
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  • KIBERA SLUM – AUGUST 11: A 24 year old Kenya women lays on the exam table in a chemists office. She recieved an injection of ergometrine and is now in the process of terminating her 4 month pregnancy. She has never been married and has 2 daughters, 11 and 8. She works at a bar to support her daughters and her 2 younger brothers. Both of her parents have died, so she is now responsible for her siblings. {quote}I think abortion should be permitted, I cannot afford to raise another child, I already have 2, as a single woman, and am supporting my brothers. I was nervous to have this done, because I know women die from it in Kibera.{quote}
  • ONGATA RUNGAI – JUNE 21: The fetal tissue and blood is then washed down the sink after the illegal abortion is preformed in Ongata Rungai, Kenya on June 21st, 2010. The doctor states, {quote}this is how you dispose of the evidence.{quote} Abortions in Kenya are illegal, unless the life of the woman or child is in danger.
  • KISUMU – JULY 4: A 24 year old Kenyan woman relaxes on a bed in Kisumu District Hospital after a speculum exam shows that she is suffering from septic abortion in Kenya on July 4th, 2010. Septic abortion whether spontaneous or induced is the termination of a pregnancy in which the mother's life may be threatened because of infection and germs. The woman requires immediate care, antibiotics and possibly evacuation of the uterus.
  • KIBERA SLUM – MARCH 24: When this 42 year old Kenyan woman started bleading during pregnancy, a {quote}chemist{quote} in the slum of Kibera suggested she abort the child in order to stop the bleeding. She could not afford to pay for a safe termination so she opted to keep her baby. She has now suffered from a fibroid for the past 15 years. She states that she has been bleading since that time, and again, can not afford the procudure to have it fixed. The restrictive abortion law negatively effects the low income women, living below the poverty line on less than a dollar a day. She is pictured in her house in the slum of Kibera in Nairobi, Kenya on March 24th, 2011.
  • ONGATA RUNGAI – JUNE 21: Blood on the operating table is the only evidence left that an illegal abortion took place in the theater in Ongata Rungai, Kenya on June 21st, 2010.
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