The pills arrived with no instructions. They were delivered on a Sunday to Joy’s home in Kayole, an informal settlement in Kenya’s capital Nairobi, by someone she didn’t know.

She had ordered them because she was pregnant, and didn’t want to be. At 19, she said, she couldn’t support a baby, and the father had stopped answering his phone after she told him. Desperate, she had asked an older friend, who said she knew someone who could help.

She took all three pills at once and the bleeding started soon after. Her lower abdomen hurt so badly that she didn’t sleep all night.

“That was when I knew I’d gone wrong,” Joy said, relating her story from Kenyatta National hospital a few days later. Her surname has been withheld to protect her identity.

The bleeding continued for two days, soaking a sanitary pad every few minutes. She lost consciousness once and “had no blood left in [her] hands” when she finally went to the hospital on Wednesday, she said.

Tucked away in the winding halls of Kenyatta, the country’s largest hospital, is a ward that handles acute gynaecology issues. Dozens of women with complications from unsafe abortions pass through it each month. Consultant Dr Allan Ikol Adungo said the patients range from young teenagers to married women in their mid-30s. They are usually from poor backgrounds.

In Kenya, where abortion is illegal in most cases, and not all women have access to contraception, unregulated – and unsafe – abortions like Joy’s are common.

More than 40% of pregnancies in Kenya are not planned, according to a study from 2012, the latest year for which data is available, by the health ministry and the African Population and Health Research Centre (APHRC). And while the Kenyan constitution permits abortion only when a woman’s life or health is in danger and emergency treatment is necessary, the study found in the same year that nearly half a million abortions were carried out. This translates to one in every 21 Kenyan women of childbearing age having an abortion in that year alone.

Edita Ochieng, a women’s rights activist, holds up the abortion pills she has bought from a chemist in Kibera slum in Nairobi. Photograph: Kate Holt/The Guardian

Most of these abortions were unsafe and resulted in various complications such as organ failure, sepsis and shock, a subsequent study concluded. The death rate from unsafe abortion is “disproportionately high” compared with other east African countries, it found.

“You cannot govern backstreet abortion, because you don’t know who is providing it and how it is being done,” said Prof Jaldesa Guyo, regional coordinator for the International Federation of Gynaecology and Obstetrics (Figo) initiative for preventing unsafe abortion. “A lot of things could be prevented.”

This reasoning leads some public health advocates to back relaxing restrictions on abortion. A step towards this was taken last year when Kenya’s high court ruled that some rape survivors can terminate their pregnancies.

Esther Passaris, a Nairobi MP, wants the government to go further, and legalise abortion on demand. “Women and girls have the right to make decisions about their bodies,” she said. “[And] whether we legalise it or not, it’s happening.”

Passaris is a local leader for SheDecides, an international movement advocating for female empowerment in reproductive healthcare. It was formed in 2017 in response to Donald Trump’s reinstatement of the “global gag rule”, under which international NGOs cannot receive funding from the US government if they provide access to or information about abortions.

Kenyan groups were hit hard by the policy. “We lost 100% of our funding,” said Nelly Munyasia, from Reproductive Health Network Kenya (RHNK). SheDecides helped the network and others find alternative funding, and advocates for progressive policies in the country.

But the campaign has provoked a backlash from conservative groups in Kenya, a country where 85% of the population identifies as Christian.

On 12 March, the day after Joy was admitted to Kenyatta hospital, around three dozen women and men gathered outside Nairobi’s parliament buildings. They were protesting after marching from the nearby Holy Family Minor Basilica with a petition denouncing SheDecides, and Passaris specifically. The petition had more than 5,400 signatures.

Ann Kioko, author of the petition, is Africa’s campaign director for CitizenGO, a Madrid-based conservative lobby group that opposes abortion worldwide. Kioko is from Nairobi, and said she has worked in the community with traumatised women who have come for counselling after abortions. “This other side of abortion is not talked about,” she said. “Abortion hurts women.”

Ann Kioko, centre, holds a petition protesting against the SheDecides campaign and MP Esther Passaris. Photograph: Ginger Hervey

Hellen Mbecca, a schoolteacher from Machakos, said she was protesting to stop other women from making what could be a mistake. She had tried to have an abortion when she was younger, she said, but someone at the clinic knew her family and had called them. They intervened to stop her.

Kioko claimed her petition showed that Passaris was not listening to all of her constituents. Her organisation would continue to protest against Passaris until elections in 2022, she said. “We don’t want her to be elected again in Nairobi.”

In turn, Passaris said she would “stick to her guns” in supporting abortion on demand. She is also calling on the government to release guidelines on conducting safe abortions and provide training for healthcare workers, which it has yet to do despite being ordered to by the high court.

She argues that restricted access to abortion disproportionately affects the poor who are often unable to support a child. “Walk into any slum and you will find 10 or 15 orphanages – packed,” she said. “No one has the resources to provide for [the children].”