Over the last few decades, Kenya has made significant gains in the provision of reproductive health services, including family planning, as part of the country’s broader health agenda.
There have been improvements in the provision of quality of health services, an increase in the integration of family planning and other health services, and an expansion of services to underserved groups, especially in the slums of Nairobi and other major towns and even in the remote rural areas.
There has also been more progress in the efforts aimed at addressing the needs of adolescents, in expanding access to treatment for the consequences of unsafe abortions, and in providing services that address reproductive health cancers, the incidence of infertility and HIV and Aids.
These gains can be attributed, to a large extent, to the financial assistance from the United States government to Kenya’s public health sector and to other agencies, including the non-governmental organisations providing reproductive health services. These are the gains new American President Donald Trump sadly erased when he reinstated and signed an executive order that bans federal funding to international health organisations that facilitate abortions – or even provide information about them – in their family planning services.
This measure, more commonly known as the Mexico City policy or the global gag rule, was first implemented by President Ronald Reagan in August 1984. Since then, it has been subject to a political back-and-forth between the Democrats and the Republicans during their various tenures in the White House.
It will be recalled that it was revoked by President Bill Clinton in the 1990s, and would later be reinstated by President George W. Bush in the early 2000s, and once again rescinded by President Barack Obama, when he took office in 2008, becoming the first African-American to hold the post.
Assistance is now no longer guaranteed from organisations such as the United States Agency for International Development that have worked with the Kenyan government to build a strong health system, responsive to the needs of individuals, families and communities.
USAid’s support in improving the health work force, health information system, supply chain management, financing, leadership and governance are now in jeopardy since they also have a strong component on the provision of family planning services. Organisations such as the Family Health Option Kenya, which heavily rely on USAid, are in danger of closing their clinics, consequently denying millions of girls and women in the slums and other marginalised areas their only source of reproductive health services. We are likely to experience higher rates of unsafe abortions and maternal deaths, and even blocked HIV and STI prevention efforts if Mr Trump’s order stays.
We are likely to see an upsurge in fertility from the recent remarkably low rates. According to the "2014 Kenya Demographic and Health Survey", Nairobi’s is 2.7, central Kenya 2.8, Eastern and Rift Valley, 3.4 and 4.5, respectively; western Kenya 4.7, Nyanza 4.3, Coast 4.3, and North Eastern, 6.4.
The Trump action will have far-reaching consequences for women and girls around the world. As a result of his executive order, millions of women will be denied necessary family planning services – either because these facilities will no longer provide them or they will have to shut down completely. Reports indicate that the United States spends just over $600 million every year to fund family planning initiatives around the world. In Kenya, USAid is estimated to be spending $500 million annually on healthcare, with about $40 million on reproductive health and HIV and Aids. As a result, an estimated 27 million women and couples have received contraceptive services, and some 6 million unplanned pregnancies have been prevented.
The assistance has also stopped 2.3 million induced abortions, with as many as 2 million of those being unsafe, thus saving the lives of at least 11,000 women worldwide.
However, by reinstating the global gag rule, President Trump threatens to undercut years of progress by disqualifying many of the most experienced family planning providers from funding. That means the lives of some of the most vulnerable women and girls will be at grave risk.
Wandera Ojanji writes about science and health.