This story is one in the Faithful Providers series published by Lauren Barbato in Conscience Magazine.

Joachim Osur, MD Director of Regional Programs and Field Offices, Amref Health Africa, Kenya

When you choose to become a medical person, there are ethics you have to live by. Medical science is different from faith. Faith is about believing; there is no evidence in faith.

Sometimes, medicine and faith clash but, if you’ve chosen to be a medical person, you have to accept the scientific evidence. You have to live by these ethics. It may come down to choosing between saving a life and sticking to your faith. As a health provider, I always choose to provide a service to save a life, because even that is godly.

I made the decision to become a doctor at a young age. I had just started high school, where I became interested in learning the life sciences and biology. Even then, at age 14, I knew I would end up as a doctor. That is just what I wanted to be.

During medical school, I developed an interest in sexual and reproductive health. As a practitioner in this field, I am either delivering babies, treating sick women who soon become well or providing family planning to women who want to better their lives. I especially work with many men and women with sexual problems.

The issue of abortion kept coming up with my patients soon after I began practicing. Many women came to us with complications from unsafe abortions. We treated women who had attempted to self-terminate and now faced medical emergencies. Then, our women patients began asking for abortions, but we were not providing them because the healthcare system did not allow it.

We had so many patients who needed abortions, and some of them ended up with severe complications. Others died. That compelled me to look more deeply at the science behind abortion. While I was in medical school, abortion was illegal, and so that was what we were taught; however, now that I was a practicing health provider, I needed to come to my own conclusion about abortion. (

When I joined Family Health Options Kenya, I learned even more about reproductive health and rights. I saw that the evidence is there. If you look at countries where safe abortion is available, women don’t die. And if you look at where it is unavailable, women still obtain abortions, but they die.

The abortion rates across the world are the same whether you are in Europe or the Americas or Africa; women will have abortions when they need them. So, if you refuse to give women access to safe abortion, they will turn to unsafe and dangerous options. When they do, they die. That is what we know; that is the evidence we have.

When you think about it ethically, you’re supposed to be saving lives. That is what a doctor does. When you see that these women are going to die because they’re having unsafe abortions, and you as a health provider let that happen, that is unethical. That is how I decided that it is better for women to have access to safe and legal abortion care.

I am convinced that God wants these women to live, not die. If anything, they can only convert to Christianity when they are alive, not after death.

I am of the Anglican faith, and the Anglican church is very strong in Kenya. The Anglican church is opposed to abortion. But, as a health provider, I don’t sit in a clinic and preach my faith to patients. Ethics do not allow that, and so, it is not what health providers do.

Our main concern is providing the healthcare that our patients need. The decision to have an abortion is not for the doctor or the nurse to make—it is the patient who makes the decision. And when patients come to us for an abortion, they have gone to their churches or their mosques. They have their own values. They know what their faith is about.

Patients, though, may have moral or spiritual conflicts about having an abortion. They don’t come to us laughing about it. They cry. It is a very difficult decision they have to make. They have a lot of emotional baggage when they come for services, because there’s a lot of stigma around the issue.

If you’re providing abortions professionally—and obtaining an abortion legally—there is less stigma, but it’s still very present here in Kenya. Providers are harassed at their private clinics. Antiabortion groups in Kenya are strong and receive a lot of support from American individuals connected to the anti-abortion movement.

And problems arise when the courts get involved. Recently, a nurse was arrested and convicted of murder because a patient died while he was treating her for complications from an unsafe abortion. After a lot of legal intervention, he was released. This is when the issue of abortion gets publicized, and not in a good way.

Our constitutional law strives to expand the healthcare options women have, and we have been advocating for an expansion of these choices so that we are not restricting the decisions people make. However, we still need service-delivery guidelines to enforce the law. Without guidelines, quality of services cannot be assured.

We need guidelines that show doctors what to do when a patient comes in for an abortion, and to show that we are providing abortions in accordance with the constitution. We also need an approved curriculum for training health workers on abortion issues. When I worked for Ipas, we supported the University of Nairobi in reviewing the school’s curriculum for training on abortion, and afterwards the university revised its training.

If you are a person of faith, then you need to create a balance. Health workers need to consider the ethics of abortion care—to allow patients to make the decision about which services they want, and to provide these services in a lawful way.

It is not about me anymore. I believe that providing reproductive healthcare is moral, because it benefits those who have made the decision to want the service. I do not need to preach to my patients. I do not need to interfere with their faith and values either. It always goes back to their choice.