A controversial US policy is jeopardizing family planning services and fueling a maternal health crisis in Ethiopia and Uganda.

The lack of reproductive health services in Uganda and Ethiopia leaves those experiencing unwanted pregnancies with few options, and poorer communities with even fewer. Only 13 to 16% of poor, married women in Uganda use modern contraception, according to Guttmacher, resulting in four in 10 births being unplanned. In Ethiopia, 4.5 million women have an unmet need for modern contraception, with 46% of the estimated 4.6 million pregnancies in the country unintended. To support family planning services, these governments rely on international and U.S. funding, which has devastating consequences for health initiatives when support is withdrawn.

The Guttmacher Institute, a research and policy organization focused on advancing sexual and reproductive rights globally, recently published a first-of-its-kind multiyear study on the impact of the U.S. global gag rule (GGR) in Uganda and Ethiopia, a policy that prevents foreign nongovernmental organizations (NGOs) who receive U.S. funding from providing abortion services or referrals.

The findings back claims that global healthcare providers and organizations have made for years, showing that the GGR disrupts health services in these African countries, negatively impacting health outcomes of women and girls. Though Uganda and Ethiopia have different legal approaches to abortion, both rely heavily on assistance from the U.S. for reproductive health and family planning programs and face negative outcomes when those programs are scaled back.

The US has a long history of influencing reproductive healthcare in Africa, often with harmful consequences. Since the 1980s, Republican administrations have repeatedly enacted the Global Gag Rule, while Democrats have rescinded it, creating a cycle of instability for NGOs providing essential services. Under the Trump administration, the policy was expanded dramatically, impacting a wider range of health programs and exacerbating existing challenges in accessing contraceptives and safe abortion.

MSI Reproductive Choices, a global healthcare provider that expands access to contraception and safe abortion services to women and girls, provided insight to the study as an organization impacted by the GGR.

“The U.S. government is by far the largest international donor. So we have the likes of the global gag rule and MSI saying they will not sign up, that means that those resources which are going to come through the civil society to support family planning delivery are going to be withheld,” Senior Director for MSI Africa, Dr. Carole Sekimpi, told Reckon. “When you have a situation like this where we cannot access U.S. government funding, then the most rural, the most vulnerable bear the biggest brunt of these unfriendly policies.”

“The impact of losing that funding does mean a massive increase in unintended pregnancies, which also means a massive increase in unsafe abortions. So it doesn’t prevent abortions, it just makes abortions unsafe,” she said.

According to Sekimpi at the time that the GGR was last implemented, MSI was providing more than half of Uganda’s family planning services.

Though Biden disengaged the GGR in 2021, Trump’s unprecedented expansion of the policy has continued to reverse progress in extending modern contraception in Africa, deteriorating some people’s power over their bodily autonomy.

The global gag rule, sometimes referred to as the Mexico City policy, was first enacted by President Reagan in 1984. According to Guttmacher, this executive order disqualifies non-U.S. NGOs from receiving health assistance funding if they promote abortion services or refer locals to them, even if the NGOs use their own, or funding from other sources, to do so. According to KFF, the Helms Amendment already prevented U.S. funds from being used to pay for abortion as a family planning method, so the GGR adds further restrictions by extending to non-U.S. funding as well.

“The supposed purpose of the global gag rule is to reduce the number of abortions and prevent U.S. funding from being spent on abortion provision or advocacy, but both of those premises are a little bit of a nonsense really, because the 1973 Helms Amendment prohibits expenditure of any US resources on abortion. So, you know, SRHR organizations have never been able to use US government funding for abortion programming since 1973,” said Shaw.

Since Reagan, each Republican president has instituted the order, only to be rescinded by Democrats, teetering back and forth every few years as parties gain and lose power, leaving NGOs’ operation capacities everchanging and women and girls in foreign countries feeling the chilling effect years after the gag rule is rescinded.

In 2017, The Trump Administration expanded the order, from affecting only NGOs specifically receiving family planning assistance to NGOS receiving health assistance for programs unrelated such as HIV/AIDS, nutrition, malaria, tuberculosis, water and sanitation, and other infectious diseases, according to international reproductive health organization PAI. He extended the order again two years later, requiring these restrictions also be applied to NGO subgrantees. According to the U.S. Government Accountability Office, Trump’s changes caused the amount of foreign assistance impacted to jump from $600 million to $12 billion.

Impact beyond funding cuts

Researchers found that the first year after the gag rule was enforced, the outcomes in reproductive health were dependent on if NGOs in a district had programs that were impacted in that area. Where NGOs programs were not affected, there was increased contraceptive use and less unplanned pregnancies, but those improvements were not found in districts with more programs or facilities hit by the GGR.

Uganda historically faces low rates of modern contraception use and high rates of unintended pregnancy. According to a 2011 Demographic and Health Survey, more than four in 10 births were unplanned, but community health workers, usually recruited and trained by NGOs, have been successful in serving communities with low resources, making gains in contraceptive use and less unplanned pregnancies.

According to Sekimpi, MSI provided 98% of Uganda’s geographical districts with long term, reversible contraceptives the last time the GGR was implemented. Where community health workers were not able to provide sexual health education or counseling due to the gag rule, it hindered women’s ability to correctly use contraceptives. This negatively impacted the country’s reproductive health gains and researchers saw a rise in women seeking postabortion care for complications for unsafe abortion when the gag rule was enacted. According to a study published in BMC Health Services, the number of postabortion care cases increased by over 15% in Uganda from 2018 to 2020.

Additionally, the Shaw and Sekimpi said that the GGR creates fear around both providing and receiving reproductive health services.

“The loss of funding is more gradual, but initially there’s fear and then there’s the chilling effect as well, in which entities like MSI who stand for women’s rights are kind of isolated from other implementing partners who are desperate for funding and continue to receive U.S. government funding,” Sekimpi said, adding that some organizations will not partner with MSI in fear of losing their own funding.

With less social conversation and community engagement around contraception, women also become afraid of accessing sexual health resources.

“The result of that is you have fewer and fewer women coming forward to receive services, women hide things, you’ll find violence at home for those who have accessed services again, because the community support and engagement is not happening,” she said.

Stopping the GGR does not instantly reverse the damage done. Sekimpi said the effects of the gag rule enacted by Trump have been felt long after presidency ended.

“It is not enough to just reverse it because it’s the mindset, it’s the culture,” she said. “It takes more than just repealing the gag rule for a short time to be able to reverse the impact of this harmful policy.”

Shaw said MSI and other NGOs are keeping a close eye on the upcoming U.S. elections, as the results can have major influence on the work they’re able to do.

“We’re starting to do scenario planning on all the different scenarios of what could happen, what happens if Biden wins, what happens if Trump wins, what happens if Project 2025 is operationalized to its entirety,” said Shaw. “We’re looking at all options this time so we can be better prepared and we’re engaging the donor community on this so they can also be better prepared to ensure the funding gaps are filled.”

Looking ahead

Conservative think-tank the Heritage Fund has laid out the groundwork for Project 2025, the plan for the next conservative president which jeopardizes reproductive healthcare globally by dismantling equality policies such as Title IX and the Civil Rights Act, placing federal restrictions on abortion. As the U.S. faces its own war on reproductive rights led by right-wing conservatives, the effects are being felt around the world.

“The loss of funding is more gradual, but initially there’s fear and then there’s the chilling effect as well, in which entities like MSI who stand for women’s rights are kind of isolated from other implementing partners who are desperate for funding and continue to receive U.S. government funding,” Sekimpi said, adding that some organizations will not partner with MSI in fear of losing their own funding.

With less social conversation and community engagement around contraception, women also become afraid of accessing sexual health resources.

“The result of that is you have fewer and fewer women coming forward to receive services, women hide things, you’ll find violence at home for those who have accessed services again, because the community support and engagement is not happening,” she said.

Stopping the GGR does not instantly reverse the damage done. Sekimpi said the effects of the gag rule enacted by Trump have been felt long after presidency ended.

“It is not enough to just reverse it because it’s the mindset, it’s the culture,” she said. “It takes more than just repealing the gag rule for a short time to be able to reverse the impact of this harmful policy.”

Shaw said MSI and other NGOs are keeping a close eye on the upcoming U.S. elections, as the results can have major influence on the work they’re able to do.

“We’re starting to do scenario planning on all the different scenarios of what could happen, what happens if Biden wins, what happens if Trump wins, what happens if Project 2025 is operationalized to its entirety,” said Shaw. “We’re looking at all options this time so we can be better prepared and we’re engaging the donor community on this so they can also be better prepared to ensure the funding gaps are filled.”

Looking ahead

Conservative think-tank the Heritage Fund has laid out the groundwork for Project 2025, the plan for the next conservative president which jeopardizes reproductive healthcare globally by dismantling equality policies such as Title IX and the Civil Rights Act, placing federal restrictions on abortion. As the U.S. faces its own war on reproductive rights led by right-wing conservatives, the effects are being felt around the world.

Source: Reckon News