AMNA NAWAZ: Abortion is a closely# watched issue in this year's election,## and not just in the United States.

Former President Trump cut funding for# international groups that offer or even## counsel on abortion services.# Advocates on both sides of the## debate in Kenya are watching for# who wins and what that may mean.

With the support of the Pulitzer Center,# special correspondent Neha Wadekar reports## from Nairobi.

And a warning: This story contains# accounts of sexual and gender-based violence.

NEHA WADEKAR: Anne became an orphan when she# was just 10 years old.

With nowhere to turn,## she moved to Dandora, Kenya's largest dump site,# and began sorting trash to earn some money.

Shortly after she arrived, Anne was# raped by an older man.

We have changed## her name and concealed her identity.# Anne soon started making a living as## a sex worker.

Many of her clients were# abusive and some refused to wear condoms.

ANNE, Sexual Violence and Back Alley Abortion# Survivor (through translator): That's because,## when you meet a guy, if yo.. "I don't eat a sweet while it's still wrapped."

NEHA WADEKAR: At age 13, Anne became# pregnant.

Nearly one in five Kenyan## girls becomes pregnant before they're 18, in# part due to poverty and lack of sex education## and access to contraception.

Back in 2004,# abortion was completely illegal in Kenya.

Anne used black market pills for# her first abortion.

Her second## pregnancy two years later was harder to terminate.

ANNE (through translator): So I used# knitting needles.

It got to the point## where I bled for two months.

I had to go# to the public hospital, where I got help.

NEHA WADEKAR: Anne's story# is far too common in Kenya,## where an estimated seven women and girls# die each day from unsafe abortions.

Many## who survive the procedures are left with# severe complications, says Monica Oguttu,## founding executive director of the# nonprofit health care organization KMET.

MONICA OGUTTU, Founder and Executive Director,# Kisumu Medical and Education Trust: They bleed a## lot from these damaged organs.

We have seen cases.. NEHA WADEKAR: The country's 2010 Constitution# now permits abortion in a narrow handful of## circumstances, like for emergency treatment or if# the life and health of the mother is in danger.

But it's still confusing, even for physicians,# says Dr. Ernest Nyamato, an associate director at## the nonprofit Ipas.

Kenya is also a very religious# country, and abortion is highly stigmatized.

DR ERNEST NYAMATO, Associate Director,# Ipas: When you see this ambiguity, and,## as a medical provider, you# take the safer road and say,## let not provide these services, or# let me allow other people to do it.

So, instead of accepting this thing of this# is a backstreet service, let it stay there.

NEHA WADEKAR: Some government facilities do# perform abortions.

Private clinics also do,## but they can be expensive, so women# look for other, cheaper options.

PAMELA, Traditional Medicine Vendor: For abortion,## we have charged 3,500.

If you have two months,#.. NEHA WADEKAR: Pamela is a traditional medicine# vendor who charges women and girls between $27## and $31 for help.

Pamela claims she stopped# selling abortion-inducing herbs long ago.

This type of denial is commonplace among# black market actors offering illegal## abortion-related services, both in person# and on social media, where misinformation## thrives.

If the herbs don't work, a woman# might turn to a quack doctor for help.

This is a room in a back-alley abortion# clinic in one of Nairobi's informal## settlements.

Many of the people who work# here claim to have medical training,## but really have very little.

They will often use# unsterile instruments like this to perform unsafe## abortion procedures on women and girls, which can# leave them either infertile or even lead to death.

Samuel is a self-proclaimed doctor who# offers surgical abortion to poor women## with nowhere else to turn.

We have changed# his name because his work is illegal.

SAMUEL, Back-Alley Abortion# Provider: The challenge is,## for example, when you want to interact# with somebody who has just com.. it has to be a secret, because# the government doesn't allow.

NEHA WADEKAR: Many poor and indigent women# who die from back-alley abortions end## up at public morgues.

Abandoned# fetuses often end up there too.

Some of those fetuses are fished out of the river# in Dandora, the slum where Anne lives.

After her## own two abortions, Anne helped other women and# girls abort around 150 pregnancies using a rusty## pair of knitting needles.

She throws the fetuses# in this river at night to avoid getting caught.

Do you -- Anne, do you ever feel any guilt?

ANNE (through translator): Yes,# I do.

That's because we're taking## the life of young babies, but we have to# do that because we have no other choice.

NEHA WADEKAR: Since Kenya# adopted its 2010 Constitution,## the country's judges have expanded abortion# access through several major court decisions.

But after Roe v. Wade was overturned# in 2022 in the United States,## abortion rights advocates became concerned# that the same thing could happen in Kenya.## One of the groups pushing for those# decisions to be overturned is the## Kenya Christian Professionals Forum, led by a# constitutional lawyer named Charles Kanjama.

CHARLES KANJAMA, Chair, Kenya Christian# Professionals Forum: We believe that## abortion is not care.

Abortion doesn't# save lives.

Ab.. NEHA WADEKAR: Several cases are making their way# through Kenyan courts, including one petitioning## for unborn children's right to life and for# equal protection and benefit of the law,## a familiar argument in the United States'# own abortion debate, says Martin Onyango,## a lawyer at the Center for Reproductive Rights.

MARTIN ONYANGO, Center for Reproductive# Rights: Those are not new tactics.

Those## are the same tactics being applied# by the opposition group in the U.S.## in various states and also at the Supreme Court.

NEHA WADEKAR: That's in part because# the Kenyan anti-abortion movement## is being bolstered by international# groups, especially American groups,## promoting conservative policies# and ideology in Africa.

These groups travel to Africa as speakers# for events and conduct anti-abortion training## sessions.

According to parliamentarian Esther# Passaris, this type of campaigning is highly## influential, because politicians fear losing the# support of important conservative voting blocs.

ESTHER PASSARIS, Nairobi County Women's# Representative, Parliament: I think the## idea that you will offend the.. the idea that you will lose votes if the# church doesn't endorse you as a candidate.

NEHA WADEKAR: There are huge sums of money# flowing from American conservative groups## into the continent of Africa.

A 2020# investigation by openDemocracy revealed## that $54 million flowed from U.S. Christian# right groups to Africa between 2008 and 2018.

Many of these groups are led by# prominent American evangelicals## with close ties to former President# Donald Trump and his administration.

DONALD TRUMP, Former President (R) and Current#U...

Candidate: To protect#the unborn, I have reinstate... first put in place by President Ronald Reagan.

NEHA WADEKAR: Trump also reinstated# and expanded the Mexico City policy,## known as the global gag rule,# which restricts U.S. funding## to any international organization that# performs or even counsels on abortion.

These policies emboldened anti-abortion# advocates during his term.

CHARLES KANJAMA: They don't# use federal funds to support## pro-abortion organizations.

So the noise# of pro-abortion in our countries goes down.

NEHA WADEKAR: They also created a chilling effect# for Kenyan reproductive health care providers like## KMET, who chose to lose $3 million in U.S. funding# rather than stopping abortion-related services.

MONICA OGUTTU: We had 15 staff that we laid off.## It was the most difficult moment for# me as the CEO of the organization.

NEHA WADEKAR: With an American# election around the corner,## Kenyans on both sides of the issue are# waiting to see which way the chips fall.

MARTIN ONYANGO: Depending on the government# that is elected in the United States,## we may have either continued progress in# realizing reproductive rights or we can## go back, we can lose the gains that we have made.

NEHA WADEKAR: The stakes are highest# for Kenyan women and girls, who will## feel the greatest impact if abortion# rights are rolled back once again.

For "PBS News Hour," I'm Neha# Wadekar in Nairobi, Kenya.