Campaigners warn the reinstatement of a policy cutting aid to organisations that offer abortion services will devastate family planning.
Each day that Elizabeth Akoth sets out to speak to young girls about family planning, the 23-year-old sees how myths about the use of contraceptives are entrenched in her west Kenya community.
When she explains the various methods they can use to prevent unintended pregnancies, they ask searching questions such as: “Is it true drugs offered for family planning can lead to death?” and “Do they even work?”
Akoth and her fellow peer educators in Homa Bay, a town on the shores of Lake Victoria, have taught dozens of girls in their teens about the family planning options available to them, undoubtedly saving many from the unintended pregnancies that often force them to drop out of school.
But their work could grind to a halt following the reimposition by the Trump administration of the global gag rule, a policy that cuts funding to foreign organisations if they provide abortion information, referrals or services, or if they engage in any advocacy on abortion rights with their own funds. Organisations are offered the choice to stop offering these services and still receive funding, or to continue and lose financial support.
Campaigners say the policy will have a devastating effect on millions of women and girls in many developing countries.
“This blocks access to sexual and reproductive health services in the poorest and hardest-to-reach communities where we are currently changing lives,” says Tewodros Melesse, the director general of the International Planned Parenthood Federation (IPPF). “We can’t support something which tries to restrict people’s choices or take them away. The global gag rule undermines those human rights, so IPPF cannot sign the policy.”
Ending the US aid, which is $600-million, will result in cuts to funding for sexual and reproductive health services in at least 30 countries where IPPF partner organisations work. Campaigners say this will have a negative effect on the most vulnerable groups that benefit from family planning advice — teenage girls.
About 16-million aged 15 to 19, and one million under the age of 15, give birth every year, according to the World Health Organisation (WHO). The majority of these teenagers live in low- and middle-income countries. Globally, complications during pregnancy and childbirth are the second leading cause of death for those aged between 15 and 19.
Teenagers who become pregnant face considerable stigma and are often forced to drop out of school, spelling a life marked by early marriage and low-skilled jobs. This has a larger economic cost to countries as they lose out on the income an educated young woman would have earned if she had finished school.
Babies born to adolescent mothers also face a substantially higher risk of dying young than those born to women aged 20 to 24, the WHO finds.
Bernard Washiaka, the programme manager of Family Health Options Kenya, one of the country’s main providers of sexual and reproductive health services, says an end to its programmes would have a major effect on many women and teenage girls.
“We live in a patriarchal, male-dominated society and the advice and information we offer helps to empower girls,” he says. “They can enjoy their sexuality while avoiding unintended pregnancy and sexually transmitted diseases. The services are entirely voluntary and based on the decisions of the girls, but we have seen the impact they have … Girls are able to stay in school for longer, which opens up a world of opportunity.”
Washiaka, whose organisation’s primary outreach tool is deploying trained peer educators such as Akoth, said there is a risk of returning to the situation of the 1980s and 1990s, when the implementation of the global gag rule by successive Republican administrations caused the closure of many clinics in many underserved communities in Kenya.
Other programmes that may face closure include a pilot initiative in Uganda that distributes Sayana Press, a three-month injectable contraceptive that combines the drug and needle in one unit. The contraceptive can be distributed easily and can be self-administered at home.
Uganda has one of the highest fertility rates and youngest populations in the world — almost half of Ugandans are under the age of 15 and 78% of the population is younger than 30.
Millions of Ugandans living in rural areas do not have access to family planning facilities and Jackson Chekweko, the executive director of Reproductive Health Uganda, said the organisation will have to end many of its activities if USAid terminates financial assistance.
“As well as reaching more people with family planning services, we need to give women more choices about the form of contraception they want. Sayana Press does that,” he says.
Family Health Options Kenya is lobbying local government administrations to allocate funds for family planning from their health budgets. But, says Washiaka, they face a difficult battle because county administrators have to cater for many health problems with a limited budget.
“We will also have to lobby non-traditional donors, such as the Japanese aid agency [Jica] and the Swedish aid agency [Sida]. The alternative is to leave our young children facing a bleak future.”
This feature was originally published as part of The Guardian’s Global Development project.