US restrictions a blow for Kenya, Uganda health sector

Essential health services in Kenya and Uganda could suffer following the Donald Trump administration’s restrictions on funding, the Human Rights Watch has warned.

The two countries are likely to lose part of the Sh914 billion the United States intends to withhold from Africa as part of its efforts to freeze funding for NGOs that recommend or provide abortions.

In a letter to US Secretary of State Rex Tillerson released Thursday, HRW sounded the alarm over President Trump’s “Mexico City Policy”, later renamed the “Protecting Life in Global Health Assistance” policy.

ABORTION
The lobby sent its findings in advance of a six-month review by the State Department of the funding restrictions.

The policy, which President Trump reissued on January 23, instituted changes that required foreign NGOs receiving US global health assistance to confirm they did not use the money to provide abortions except in situations of rape, incest or when the life of a woman was in danger.

If they wish to keep the funding, the groups are also not allowed to offer information or referrals for abortion — even where abortions are legal — or advocate liberalising abortion laws.

FAMILY PLANNING
It is widely known as the “Global Gag Rule” as it restricts the information organisations can provide even with their own funds.

It also restricts what a doctor can say to a patient.

US law already prohibits using public funds for abortion in foreign countries for family planning assistance.

HRW women’s rights emergencies researcher Skye Wheeler said the Trump administration’s decision would restrict aid to essential health services in Kenya and Uganda.

“Our research shows that the expanded Mexico City Policy is erecting healthcare barriers on Kenyans and Ugandans,” Ms Wheeler said.

POLICY
She added that the changes would put the lives of many women and girls benefiting from reproductive health and family planning services at risk.

“The US is the world’s largest health donor and President Trump should rescind this indefensible and devastating policy, which will set back hard-won global health gains,” Ms Wheeler said.

Previous Republican administrations have consistently enacted versions of the Mexico City Policy.

The administration’s policy extends the restrictions to an estimated $8.8 billion (914 billion) US global health assistance, including aid for family planning and reproductive health, maternal and child health, nutrition, malaria, tuberculosis, infectious diseases, neglected tropical illnesses, water, sanitation, hygiene programmes, and HIV/Aids – including the President’s Plan for Emergency Relief for Aids, also known as Pepfar.

HIV INFECTIONS
In July, HRW interviewed representatives of 24 organisations in Kenya and 21 in Uganda affected by the restrictions.

These agencies conduct outreach programmes to marginalised populations, advocate improved health policies and provide reproductive and HIV/Aids health services.

Kenya and Uganda are heavily dependent on US health funds to combat high maternal mortality rates and HIV/Aids.

In Kenya, one of the six countries with the highest number of HIV infections in the world, maternal mortality accounts for 14 per cent of deaths of females aged 15 to 49.

US global health funds pay for anti-retroviral treatment for 890,000 Ugandans, about 93 per cent on HIV treatment in the country.

MATERNAL MORTALITY
The Ugandan government estimates that unsafe abortions contribute to eight per cent of maternal deaths.

HRW said the policy had triggered reductions in key sexual and reproductive health services from well-established organisations “which cannot be easily replaced”.

Family Health Options Kenya, for example, runs 16 clinics in the country.

Representatives said the organisation would not comply with the restrictions and therefore stood to lose funds from the US Government, which contributes up to 60 per cent of its budget.

OUTREACH
FHOK has already closed a clinic and cancelled 100 planned outreach events, including those for cervical cancer screening, HIV testing and family planning counselling, that typically reach 100 people at a time.

“Many of the groups that stand to lose funding have established track records and are among the best placed and qualified to do the work,” Ms Wheeler said.

“In many cases, alternatives with comparable infrastructure, expertise and community relationships do not exist.”

Although governments receiving US funds are exempt from the policy, HRW found that many state-run hospitals in Kenya and Uganda, which depended on NGOs for training and equipment for safe abortions, would be weakened.

“Many groups interviewed said they doubted the government clinics would have the capacity to continue providing comprehensive safe abortion care without their support,” the researcher added.

RESTRICTIONS
Many of the health care providers said they feared an increase in unsafe abortions and maternal deaths as a result of the cuts in services, reductions in referrals, reduced capacity of government clinics and uncertainty on whether materials and equipment would be available.

Interviews with sex worker organisations that needed funding renewal illustrated that they had to make cruel choices, including choosing between funds for lifesaving anti-retroviral therapy for members or lifesaving reproductive health services.

“These donor-imposed restrictions undermine hard-won relationships of trust developed with a key population on the frontlines of efforts to fight HIV,” Ms Wheeler said.

The majority of people interviewed said they had not received communication or explanation of the policy from US Government grant administrators.