Understanding Surrogacy in a Kenyan Perspective

 

What is Human Surrogacy

Human surrogacy is a type of assisted reproductive technology (ART) in which a woman, known as the surrogate mother, agrees to carry a pregnancy to term and give birth to a child for another person or couple, known as the intended parents. For human gestation surrogacy, the surrogate mother is not genetically related to the child, and the intended parents will become the legal parents of the child after birth.

Traditional Surrogacy versus Gestational surrogacy

The main difference between traditional surrogacy and gestational surrogacy is the biological connection between the surrogate mother and the child.

In traditional surrogacy, the surrogate mother is inseminated with the sperm of the intended father. Now you are wondering who is the biological mother. YES!, you are right, the surrogate mother is the biological mother of the child in this case.

In gestational surrogacy, the surrogate mother is implanted with an embryo that has been created using the sperm and egg of the intended parents, or using donor sperm and egg. This means that the surrogate mother is NOT the biological mother of the child.

Which type of surrogacy is right for you?

By now you might be wondering which is the best option for surrogacy and particularly in our African set of life.

Based on my observation and research, I will advise that the best type of surrogacy for you will depend on your individual circumstances and preferences. If you are looking for a more affordable option, traditional surrogacy may be a better choice. However, it is important to be aware of the legal and ethical challenges associated with traditional surrogacy.

On the other hand, if you are looking for a more straightforward legal process and a less ethically controversial option, gestational surrogacy may be a better choice. However, it is important to note that gestational surrogacy is typically more expensive than traditional surrogacy.

Remember that, It is important to discuss your options with a fertility specialist or surrogacy agency or legal adviser to determine which type of surrogacy is right for you.

Surrogacy in Kenya

Surrogacy is a complex and controversial issue in Kenya. There is no specific law on surrogacy, but the Kenyan constitution through Article 45(1) guarantees the right to form and be part of a family. My wakili friend will term this as a ‘legislative lacuna’.

This loophole has led to a growing number of people seeking surrogacy services in Kenya, both from within the country and from abroad. Yes, it is the true state of affairs; foreigners would travel all the way from their surrogacy-restrained countries to our legally open state for the convenience to start an ideal family. Thanks to the loophole.

Implications of surrogacy in Kenya:

Ethical concerns: Surrogacy raises a number of ethical concerns, such as the potential for exploitation of surrogate mothers, the commercialization of the human body, and the impact on children born through surrogacy.

Legal issues: The lack of a legal framework for surrogacy in Kenya creates a number of legal challenges, such as determining parental rights and responsibilities.

Social impact: Surrogacy is a relatively new phenomenon in Kenya, and its social impact is still being debated. Some people argue that it is a threat to traditional family values, while others argue that it is a positive development that expands the possibilities for family formation.

Specific examples of the implications of surrogacy in Kenya

Petition case 78 of 2014 (Kenya Law JL N & 2 others v. Director of Children Services & 4 others [2014] eKLR); DCS had seized two children born out of a surrogacy arrangement between a Kenyan couple (the Petitioners) and a surrogate mother. The DCS had argued that the surrogacy agreement was illegal and that the children were at risk of being exploited. This case was a big landmark of surrogacy in Kenya as the High Court of Kenya held that the Director of Children's Services (DCS) has no power to seize children born out of surrogacy agreements.

Petition 443 of 2014 (AMN & 2 others v. Attorney General & 5 others eKLR, BKN, TMK) In 2014, a Kenyan couple who had twins through surrogacy were unable to obtain birth certificates for their children because the Kenyan government did not recognize the surrogacy arrangement. The ruling in this Petition was another significant victory for surrogacy in Kenya. It established that surrogacy is legal in Kenya and that children born through surrogacy have the same rights as children born through natural conception. The ruling also required the government to take steps to implement the court's rulings, including developing a national policy on surrogacy and amending the relevant laws and regulations.

In 2018, a group of people were arrested in Kenya on charges of child trafficking for their involvement in a surrogacy arrangement.

There have been reports of surrogate mothers in Kenya being exploited by surrogacy agencies, who may offer them inadequate compensation or fail to provide them with adequate medical care.

Despite the challenges, surrogacy is a growing phenomenon in Kenya. It is important to have a public conversation about the ethical, legal, and social implications of surrogacy in order to develop a regulatory framework that protects the rights of all parties involved.

The Awakening Path

The awakening journey cannot be described without mention of various individuals who made a mark in the acknowledgement of Surrogacy.

Hon. Majanja, an high court judge was very instrumental through his guidance and ruling of surrogacy and parenting petitions brought before him. In 2014, he ruled that ''Surrogacy is not a hypothetical issue any more. It is real and many Kenyans are resulting to surrogacy as an alternative to being parents especially those who cannot for medical reasons have their own children''

The late Prof. Magoha, and then chairperson of Kenya Medical and Dentists Board (KMDB), was a strong advocate for Assisted Reproductive Technology (ART) and surrogacy in Kenya. In 2018, he authorized the expansion of ART services in Mombasa, which was a significant step towards making ART more accessible to Kenyans.

In 2018, Prof Marion Mutugi and Justice Isaac Lenaola co-authored the book Bioethics of Medical Advances and Genetic Manipulation: Legal, Philosophical and Moral Perspectives. I have had time to peruse this book and can agree that this is an important work that contributes to the understanding of the ethical, legal, and philosophical implications of surrogacy and other genetic manipulation in Kenya and beyond.

In 2014, a tough speaking female parliamentarian, Hon. Millie Othiambo tabled the Assisted Reproductive Technology(ART) Bill that opened the start of legal guidance on surrogacy. 

Evolution of Surrogacy in Kenyan History

Before Assisted Reproductive Technology (ART), surrogacy practices in Kenya were largely informal and unregulated. There were no clear legal guidelines or regulations governing surrogacy arrangements, and surrogate mothers and intended parents were often left to negotiate their own agreements.

One common practice was for surrogate mothers to be recruited from within the extended family or community of the intended parents. This was often seen as a way to build trust and ensure that the surrogate mother was known and respected by the intended parents.

Another common practice was for surrogate mothers to be paid in cash or in kind for their services. The amount of compensation paid varied depending on the circumstances of the arrangement, but it was typically lower than the amount paid to surrogate mothers in developed countries.

There were also some cases of commercial surrogacy in Kenya before ART. However, this practice was less common, as it was not widely accepted by society. 

In general, surrogacy practices in Kenya before ART were less sophisticated and less regulated than they are today. Surrogate mothers and intended parents often faced legal and social challenges, and there was a lack of support for surrogacy arrangements.

I did  some report digging and here are some specific examples of surrogacy practices in Kenya before ART:

In 1989, a Kenyan woman became the first known surrogate mother in the country. She was paid 100,000 Kenyan shillings (approximately $1,000 at the time) to carry a child for a British couple.

In 1994, a Kenyan woman gave birth to twins through surrogacy for a Kenyan couple. The arrangement was negotiated between the two couples without any legal contract or third-party involvement.

In 1997, a Kenyan woman gave birth to a child through surrogacy for a Japanese couple. The arrangement was facilitated by a commercial surrogacy agency, and the surrogate mother was paid 500,000 Kenyan shillings (approximately $5,000 at the time).

The development of ART in Kenya has made surrogacy more accessible and affordable for intended parents. However, there is still a need for clear legal guidelines and regulations to protect the rights of surrogate mothers and intended parents. Let us understand more about the ART bill, 2014 on surrogacy.

Kenya Reproductive Health Care Bill, 2014 on surrogacy:

The Kenya Reproductive Health Care Bill, 2014 (the Bill) is a proposed law that would regulate assisted reproductive technology (ART) in Kenya, including surrogacy. The Bill was introduced in Parliament in 2014, but it has not yet been passed into law.

The Bill defines surrogacy as "an arrangement in which a woman agrees to carry a pregnancy to term and give birth to a child for another person or persons." It sets out a number of requirements for surrogacy arrangements, including that:

• The commissioning parent(s) and the surrogate mother must all be of legal age and capacity to consent to the arrangement.

• The surrogate mother must be medically fit to carry a pregnancy.

• All parties to the arrangement must have received genetic counseling.

• The arrangement must be in writing and signed by all parties.

• The surrogate mother must be paid reasonable compensation for her services.

Take note that the Bill also prohibits certain practices related to surrogacy, such as:

• Commercial surrogacy, where the surrogate mother is paid more than reasonable compensation for her services.

• Altruistic surrogacy, where the surrogate mother is not paid any compensation for her services.

• Surrogacy for single people or same-sex couples.

The Bill has been praised by some for its attempt to regulate surrogacy and protect the rights of all parties involved. However, others have criticized the Bill for being too restrictive and for failing to adequately address the needs of infertile couples, same-sex couples(gay couples), and single people.

Overall, the Kenya Reproductive Health Care Bill, 2014 is a significant step towards regulating surrogacy in Kenya. However, it is important to note that the Bill has not yet been passed into law, and it is possible that it could be amended before it is passed.

Please leave your comment below on this complex and controversial discussion.

Impacts of skilled Nursing workforce to patient safety and quality of healthcare delivery

Skilled Nursing workforce and Patient safety

A skilled nursing workforce has a significant impact on patient safety and the quality of healthcare delivery. Studies have shown that higher nurse staffing levels are associated with lower rates of patient mortality, morbidity, and complications. For example, a study by the Agency for Healthcare Research and Quality (AHRQ) found that a 10% increase in the number of registered nurses (RNs) per patient was associated with a 5% decrease in the risk of patient death.

Skilled nurses play a critical role in ensuring patient safety by:

• Providing high-quality care: Nurses are responsible for administering medications, monitoring patients' vital signs, and providing wound care. They are also responsible for educating patients about their condition and how to manage their care.

• Identifying and responding to changes in patients' condition: Nurses are the eyes and ears of the healthcare team. They are responsible for monitoring patients' condition and reporting any changes to the physician. This is especially important for patients who are at high risk for complications.

• Preventing errors: Nurses are responsible for following safe medication administration practices and other protocols to prevent errors. They are also responsible for reporting any errors that do occur so that they can be investigated and prevented from happening again.

• Advocating for patients: Nurses are patients' advocates. They are responsible for ensuring that patients receive the care they need and that their rights are respected.

In addition to their direct impact on patient safety, skilled nurses also contribute to the quality of healthcare delivery by:

• Providing continuity of care: Nurses often work with patients over extended periods of time. This allows them to build relationships with patients and their families and to gain a deep understanding of their needs.

• Coordinating care: Nurses play a key role in coordinating care among different members of the healthcare team. This helps to ensure that patients receive seamless care and that their needs are met in a timely manner.

• Providing education and support: Nurses are responsible for educating patients about their condition and how to manage their care. They also provide support to patients and their families during difficult times.

In conclusion, a skilled nursing workforce is essential for ensuring patient safety and the quality of healthcare delivery. By investing in nursing education and training, healthcare organizations can help to improve patient outcomes and reduce the risk of adverse events.

International Patient Safety Goals (IPSGs) utilization for maternal and childcare improvement

International Patient Safety Goals (IPSGs) utilization for maternal and childcare improvement

The International Patient Safety Goals (IPSGs) are a set of evidence-based standards developed by the Joint Commission International (JCI) to help healthcare organizations improve patient safety. The IPSGs are widely recognized as a global benchmark for patient safety and are used by accredited organizations in over 100 countries.

The IPSGs can be used to improve maternal and childcare safety in a number of ways. For example:

• Improve the accuracy and completeness of patient identification. This can help to prevent misidentification of mothers and babies, which can lead to medication errors and other problems.

• Improve the effectiveness of communication among caregivers. This can help to ensure that all members of the care team are aware of the mother's and baby's condition and are working together to provide safe care.

• Improve the safety of high-alert medications. This can help to prevent medication errors, which are a leading cause of harm in healthcare.

• Reduce the risk of healthcare-associated infections (HAIs). HAIs are a major cause of morbidity and mortality in mothers and babies. By implementing IPSGs related to hand hygiene, environmental cleaning, and safe injection practices, healthcare organizations can reduce the risk of HAIs.

• Reduce the risk of patient falls. Falls are a leading cause of injury in mothers and babies. By implementing IPSGs related to fall prevention, healthcare organizations can help to keep mothers and babies safe.

In addition to these specific IPSGs, all of the IPSGs can contribute to improved maternal and childcare safety by promoting a culture of safety within healthcare organizations. By focusing on patient safety, healthcare organizations can create a safer environment for mothers, babies, and all patients.

Here are some specific examples of how IPSGs have been used to improve maternal and childcare safety:

• In one study, the implementation of an IPSG on patient identification was associated with a significant reduction in the rate of medication errors in newborns.

• In another study, the implementation of an IPSG on communication among caregivers was associated with a reduction in the rate of adverse events in the neonatal intensive care unit (NICU).

• In a third study, the implementation of an IPSG on the safety of high-alert medications was associated with a reduction in the rate of medication errors in the maternity ward.

These studies provide evidence that the IPSGs can be effective in improving maternal and childcare safety. During my clinical practice in a busy obstetrics and newborn unit, I have seen tremendous reduction of incidences and quality improvement after adoption and utilization of IPSGs. I will affirm that, by implementing the IPSGs, healthcare organizations can make a significant contribution to improving the safety of mothers and babies in Kenya and around the world.

How the agony of underrated BScNs in Kenya equates to the 30-50% churning rate

What is BScN cadre of Nursing?

BScN nurses are highly skilled and knowledgeable professionals who play a vital role in the healthcare system. The extensive 5 year degree training gives them a broad understanding of nursing science, as well as the clinical skills necessary to provide care to patients of all ages. BScN nurses are also able to think critically and solve problems effectively.

Cadre differentiation

For objectivity in this discussion, I will state a clear difference between BScN and KRN/KRM/KRCHN.

According to the regulating body of Kenyan Nurses-NCK, BScN is a 5-year undergraduate degree program that provides students with a broad education in nursing science. BScN graduates are qualified to work in a variety of healthcare settings, including specialized hospital units, clinics, nursing homes, research centers and even training institutions..

On the other hand, KRCHN is a 3 year-diploma program that focuses on community health nursing majorly focused on general nursing, midwifery or psychiatry. KRCHN graduates are qualified to work in a variety of community-based settings, such as health centers, schools, and community development organizations. Based on the KRCHN curriculum, there is always a need for education advancement through Higher National Diploma(HND) for a period not less than one year so as to practice in specialized care units. 

Overall, BScN is a more comprehensive and rigorous program than KRCHN. BScN graduates have a broader range of skills and knowledge, and they are qualified to work in a wider variety of healthcare settings. KRCHN graduates are more specialized in community health nursing, and they are typically focused on direct patient care.

In addition to their clinical skills, BScN nurses are also skilled in communication, collaboration, negotiation, health entrepreneurship and leadership. They are able to work effectively with other members of the healthcare team, as well as with patients and their families. Like other cadres of nurses, BScN nurses are also advocates for their patients and work to ensure that they receive the best possible care. These attributes make them efficient to work in a variety of settings.

The Agony

For ages graduate nurses in Kenya are often underrated and undervalued. This is despite the fact that they play a vital role in the country's healthcare system.  Below are the most obvious struggles of this cadre; 

Lack of recognition

Despite their important role, BScNs in Kenya often face a number of challenges. One of the biggest challenges is the lack of recognition for their skills and expertise. It beats logic how many employers still view BScNs as being less qualified than their lesser trained counterparts, even though they have undergone rigorous training, and education. This lack of recognition can lead to BScNs being underpaid and undervalued.

Career stagnation

Another challenge that BScNs face is the lack of opportunities for advancement. Many BScNs are stuck in dead-end jobs with little hope of moving up the career ladder. This is because there are limited opportunities for BScNs to take on management or supervisory roles despite their qualification.

Poor working conditions

This is a general problem cutting across all cardres of Nurses in Kenya. They often have to work in hospitals and clinics that are understaffed and lack basic resources. This makes it difficult to provide quality care to patients and eventually leads to dissatisfaction among nurses.

Low salaries

BScN nurses just like other nursing cadres in Kenya are among the lowest paid in the world. A study by the Kenya National Bureau of Statistics found that the median monthly salary for a nurse in Kenya is Ksh 35,000 (approximately $230). This is significantly lower than the salaries of nurses in other countries, such as the United Kingdom (where the median salary for a nurse is £35,000) and the United States (where the median salary for a nurse is $75,000).

Discrimination

Younger BScN nurses also face discrimination and stereotyping in the workplace on the basis of their age and gender. This stereotyping flows all the way from human resource policy makers to peer levels. This creates a hostile work environment and makes it difficult to succeed.

Agonizing impact: High churning rates for BScNs

The low status of BScNs in Kenya has a number of negative consequences. First, it discourages young people from pursuing a career in nursing. Second, it makes it difficult to attract and retain qualified nurses. Third, it leads to a shortage of nurses in the country, which can have a negative impact on patient care. 

Increasing emigration

There is no definitive data on the churning rates for BScN nurses in Kenya, but from the Kenya Health Workforce(KHWF) report of 2017, it was estimated to be around 20-30% per year. This was significantly higher than the global average of 10-15%. It is believed that with current(2023) high cost of living and demotivating factors the rate may be above 30% and maybe above 50% by 2030.

Brain drain from emigration of locally produced workforce has left a huge gap of human resource to practice on the swelling sick population. This has impacted to challenges in patient safety, value and quality of healthcare delivery.

Emigration points

Local studies show that BScNs not only emigrate to UK(33%) and USA(49%) but also other well paying countries. This is clear picture of brain-drain

What should be done?

There are a number of things that can be done to improve the status of BScNs in Kenya. One is to increase awareness of the important role that BScNs play in the healthcare system. Another is to provide BScNs with more opportunities for advancement. Finally, it is important to ensure that BScNs are paid fairly for their skills and expertise.

Here are some specific steps that can be taken to improve the status of BScNs in Kenya:

• Increase awareness of the importance of BScNs. The government, NCK, Nursing associations(NNAK) and unions(KNUN), media, and other stakeholders like universities, MoH, need to do more to raise awareness of the important role that BScNs play in the healthcare system. This can be done through public education campaigns, symposiums, Nursing chapter conferences, media coverage, and other initiatives

• Invest in training and development programs: The healthcare industry should invest in training and development programs for nurses. The programs will lead to upgrading of the majority of the workforce and thus setting standards. This will help to improve the quality of care that nurses can provide to patients and will make them more marketable to potential employers.

• Provide BScNs with more opportunities for advancement. Both public and private hospitals and other healthcare facilities need to create more opportunities for BScNs to take clinical, management and supervisory roles. This can be done by developing career ladders for BScNs and providing them with opportunities for training and development. Without this they will be rendered redundant and make them stagnant

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• Ensure that BScNs are paid fairly for their skills and expertise. The government needs to set fair wages for BScNs and ensure that they are paid in line with their skills and experience. This can be done by conducting regular wage surveys and adjusting wages accordingly. Salary and scale standardization will be key in view of decentralization of health function and private sector.

• Policy making on scopes of practice, remunerations and professional standardization from relevant stakeholders.

By taking these steps, we can improve the status of BScNs and the overall Nursing profession thus creating a more attractive and rewarding career path for nurses. Its without doubt that this will ultimately reduce the churning rates and increase confidence in patient safety and quality of healthcare delivery.

Kindly join this conversation by putting your comment below.