We weren’t officially there to talk about abortion, but I asked the four Kenyan women in a Laikipia health clinic anyway. Did any of them have friends who had died of illegal abortions?

Three out of the four said they did.

What, if anything, did they think needed to be done? The oldest woman had already fiercely declared abortion to be wrong. “Family planning,” each one replied, by way of a solution. Then one said to the interpreter, quietly, that she had something to add. “Family planning doesn’t always work,” she half-whispered.

Something else, in fact, has been done to address the fact that unsafe abortion leads to 30 to 40 percent of maternal deaths in Kenya, according to one estimate. In 2010, after a heated proxy war fought by both sides of the American political divide, Kenyans approved a constitution that moderately eases the country’s abortion restrictions. Whereas abortion was previously allowed only with permission from three doctors – one of whom had to be a psychiatrist, an impossibility in most parts of the country – now a single medical professional can certify that an abortion is necessary for a woman’s life or health, which can be broadly construed. And for the first time, reproductive health is enumerated as a constitutional right.

But what both will mean in practice is very much an open question.

“I don’t expect that overnight, providers everywhere are going to be providing lifesaving abortions,” says Charlotte Smith, director of policy at Ipas, which advocates for safe abortion worldwide and is providing technical support to the government’s transition. “I imagine that as in any place that has over 150 years of a very restrictive abortion law, it’s going to take a lot of providers a lot of time to feel that they would be protected,” even if they support abortion rights. Still, Smith says,  “It’s kind of amazing progress if you look at where Kenya has come from.”

Getting the constitutional language alone didn’t come easily. After both Obama and Biden lent their support to constitutional reform, Republican Rep. Chris Smith declared, “This is an administration that is very aggressive in promoting the killing of unborn children and the wounding of their mothers by way of abortion worldwide.” Smith and his American conservative allies charged that U.S. funds marked for civic education around constitutional review were actually illegally advocating for abortion rights and intimidating opponents. The U.S. embassy in Nairobi was unequivocal: “These claims are categorically false, and those making such allegations are lying.” Jay Sekulow’s American Center for Law and Justice, a key architect for the conservative legal revolution, even opened an office in Kenya that year. By way of compromise, the final constitution also included language about life beginning at conception, but church leaders urged Kenyans to vote no anyway.

“A lot of the talking points said by the Kenyan judges and the politicians came straight from the Republicans,” Dr. Joachim Osur, the director for Ipas’ Africa Alliance programs, told me, adding, “Some of them were saying that women in the streets would be forced to have an abortion even if they didn’t want to.”

Kenyans I spoke to around the country remain annoyed at the hijacking of the constitutional review process, which emerged as a way of healing after a violent political crisis that killed over a thousand people and displaced hundreds of thousands. Osur went so far as to suggest that abortion was a poison pill, an attempt by vested interests against land reform to take the whole thing down.

“There were a lot of people who did not want change to happen in Kenya,” he says.

He and other reproductive health advocates would have preferred to go through an act of parliament rather than the constitution, but they fought the battle that came to them, with the support of some of the major medical leadership in the country. They, after all, were the ones who had to deal with the women who had “backstreet abortions,” who harmed themselves, who overdosed on quinine intended for malaria patients or on herbal concoctions.

“We medics, we advocate for safe abortion,” Eunice Wanjiku, the nurse in charge at the clinic where I met those four women, told me. On the other hand, she came up with what seemed like a pretext to get as far away as possible from everyone else to tell me that.