Mary Olouch was 25 years old when she died after a botched abortion.

Her grave lies in Karabok, a small village in western Kenya, beside the home where she lived with her husband and two young children.

In July, one of her surviving sons, who was not identified due to cultural views on abortion, flipped through photos of his mother at the family home.

Nearby, Loice Ochieng, the community health volunteer in charge of family planning in Karabok, walked to the site where Mary was buried, a bare patch of land marked only with a small sapling.

Ochieng knew Mary, but she didn’t know she had sought an abortion until after she died.

She said she believes Olouch was afraid of the fallout she would receive if she told others she had sought an abortion. “She knew it was illegal and that no one in the community would accept or allow abortion, and this made her lie about it, and she hid the truth.”

Abortion is heavily stigmatized in Karabok, but Ochieng says attitudes are shifting.

In Kenya, abortion is legal in certain circumstances, such as when a woman’s health is in danger. But what counts as a threat to health is widely debated. Some doctors perform abortions due to risks to mental health, but most public hospitals do not offer the procedure. Women are left with a choice: pay for a private clinic or resort to unsafe, illegal methods.

A 24-year-old woman from Bondo, Kenya, who spoke on the condition of anonymity due to fear of backlash, said she sought an abortion outside of the healthcare system. She already had two children when she became pregnant by her boyfriend at the time.

He said he had a friend who could provide her with abortion pills. She doesn’t know what she took, but soon she was bleeding heavily.

In severe pain, she went to a clinic. “By the time I went there, the doctor told me it was (almost) too late, if I couldn’t make it (there) at that time, I could have died.”

She spent two weeks in the hospital before being discharged.

Some political and religious leaders argue that citing mental health to justify abortion is a loophole amounting to what they call “abortion on demand”.

Lawyer Charles Kanjama, a prominent anti-abortion advocate, chairs the Nairobi-based African Christian Professionals Forum. Last year, the forum co-hosted a conference with far-right groups from Africa, the U.S., and Europe to promote “family values” and oppose abortion rights.

Kanjama said he is regularly in court fighting organizations that provide abortion services.

“Right now there is one appeal filed by my organization in the Court of Appeal on the question of interpretation of what is the extent permitted of abortion,” he said.

“I will not say there is complexity. I think the situation is simple. Abortion on demand is a crime in Kenya.”

Tucked into alleyways and side streets across the country, clinics are still working to provide women with post-abortion care at great risk.

One doctor told The Associated Press that his clinic has been subject to relentless police raids, as security cameras monitored the building in testament to the constant threat.

For women like Mary Olouch, the consequences of silence and stigma remain painfully clear.