The Kisumu region in western Kenya struggles with high rates of adolescent pregnancy and maternal death due to unsafe abortion. Many girls facing poverty in the region trade sex for food, school fees and even menstrual pads.
It is one of the many places around the world where President Donald Trump’s policies will stand between women and access to reproductive health services, and where already fragile health systems will be decimated by this Administration’s restrictions on global health funds.
In particular, President Trump’s Global Gag Rule forbids any non-governmental organization receiving US global health funds from using even their own, non-US funding to provide legal abortion services, information or referrals. It also bans them from engaging in advocacy to expand abortion access within their own country. The extended version of the policy affects almost $9 billion in funding that covers a vast array of programs, including HIV/Aids, malaria, tuberculosis, water, sanitation, and maternal and child health, in addition to family planning and reproductive health.
The policy has triggered significant confusion, misinformation, fear and even self-censorship among organizations in Kenya, Nigeria and South Africa, initial research by the International Women’s Health Coalition (IWHC) shows. In taking an early pulse, it is clear that the full impacts of the policy will not be apparent for some time, and that ongoing review will be critical to any serious effort to understand its full effects. The findings are contained in an assessment and recommendations submitted to the State Department ahead of a six-month review. Additionally, IWHC briefed congressional staff in October, together with researchers from CHANGE and Human Rights Watch who have conducted similar research in other countries, and participated in a webinar based on the collective findings of all three organizations.
Studies of previous versions of the policy clearly show that the Global Gag Rule imperils women’s health. There is evidence that restrictions on abortion access make abortion less safe and lead to increased maternal mortality, by driving women underground to seek the services they need. Contrary to conservative political rhetoric, the policy does not stem abortion. On the contrary, a Stanford University study from 2011 found that, across 20 African countries, abortion rates increased under the a previous iteration of the Global Gag Rule.
In Kenya, IWHC grantee partner, the Kisumu Medical and Education Trust (KMET), was slated to receive approximately 56 percent of its budget from US foreign assistance from 2017 to 2021. The funds KMET now stands to lose would have included significant funding for a project aimed at reducing maternal mortality from post-partum hemorrhage. Since the organization refuses to take the medically irresponsible step of hiding information regarding abortion, or discontinue the service, other vital programs that are part of a comprehensive health package, are threatened.
The Gag Rule is also threatening progress toward integrated healthcare systems, a priority in US foreign assistance. In South Africa, IWHC’s research has highlighted persistent fears that the Global Gag Rule will thwart recent progress toward the integration of HIV prevention, treatment, and care with other health care services—a high priority for South Africa and the US in recent years. In South Africa, where abortion is both legal and constitutionally protected, IWHC’s research to date suggests that the Gag Rule may well undo many years of investment, fragmenting funding and the delivery of services while also undermining the efficiency of the health system.
The policy threatens the implementation of health programs across the board. Initial research by IWHC suggests that misinterpretations of the policy have led some organizations to believe they can no longer partner, even informally, with any organization that does work on abortion. These groups become isolated and untouchable despite rendering valuable services, expanding the stigma on abortion.
In Nigeria, IWHC’s preliminary research has found some awareness of the policy, and a lack of knowledge about how it is being introduced or how Trump’s version is different. Among those interviewed, the Gag Rule is seen as “barbaric”—a donor country’s funding conditions causing direct harm on the most vulnerable populations in another country.
During previous Republican Administrations, IWHC has raised the alarm regarding the Gag Rule’s destructive effects. The unprecedented expansion held in Trump’s version of the policy makes the need to rescind it even more acute. IWHC supports the Global Health, Empowerment, and Rights (HER) Act, which would permanently repeal the Global Gag Rule, ensuring that this deadly and counterproductive policy no longer threatens the most vulnerable women around the world.
In the meantime, the US government must commit to ongoing review of this policy through a comprehensive, transparent, and consultative process that includes civil society, and take action on the policies and challenges identified during the review process.
Photo: Dutch Ministry of Foreign Affairs