During his first week in office, American President Donald Trump imposed the global gag rule, formally known as the Mexico City Policy, which dictates that non-governmental organisations that receive any global health assistance from the United States may no longer use their own money to provide safe and legal abortion services, information or referrals for safe abortion, or engage in advocacy to ensure that safe abortion is more widely available.
The gag rule is not about how US funds are used – it instead imposes harmful restrictions on how local organisations use their own money, limits their ability to refer ailing women to hospitals, and undermines their freedom of speech. The restriction is particularly coercive, given that US aid accounts for a significant amount of health spending in Kenya. Last year alone, it was nearly $100 million.
Mr Trump’s gag rule is much more expansive than previous ones by Republican administrations. The policy restricts all US global health assistance, including funds for organisations working on HIV/Aids. The political back and forth over this rule has a chilling effect on the provision of essential and legal health services and affects our own government’s allocation of resources to our health budget instead of just being donor dependent. In developing countries, family planning clinics are often the best, if not the only, place for people to access help to prevent pregnancy and sexually transmitted infections, including HIV/Aids. The last time the rule was imposed in 2001, two leading reproductive healthcare organisations, Marie Stopes International (MSI) Kenya and the Family Planning Association of Kenya (FPAK), refused to comply and lost all US funding. MSI Kenya was forced to close two clinics and lay off staff. By 2005, FPAK had closed 15 clinics since they were unable to raise enough funds to replace the USAid money lost.
The gag rule forces recipients of US funding to make value judgments about the services they provide: they must either sacrifice their commitment enabling women to access safe and legal abortion or reduce the number of people they can serve due to constrained budgets.
Through the rule, the US will further exacerbate the already inadequate access to legal abortion in Kenya. It has been widely reported that in 2014, the United States Agency for International Development (USAid) stopped its grantees from attending a Ministry of Health meeting because safe abortion – though legal in limited circumstances under the Constitution – was on the agenda. Soon after, the ministry withdrew the government’s guidelines for reducing morbidity and mortality from unsafe abortion and banned safe abortion training for health care professionals. The arbitrary actions are being challenged in the High Court through a petition filed on behalf of Fida Kenya and others. In Malawi, a government official was told he could not attend a meeting on unsafe abortions because his job was supported with US funding.
Unsafe abortion is one of the five major causes of maternal mortality worldwide, with 465,000 induced abortions in Kenya yearly, according to a 2013 ministry report. The medical consequences of unsafe abortion are dire and we should do more to minimise these preventable deaths and disabilities. We must resist the use of power and influence to distort the promise of the 2010 Constitution and the government must increase funding to achieve our vision of a healthy society.
Evelyn Opondo is regional director for Africa, Centre for Reproductive Rights.