US Health Policy Harming Kenya and Uganda
By Irene Gairtirira
Published November 2, 2017
A human rights group has asked President Donald Trump of the United States of America to withdraw his Protecting Life in Global Health Assistance policy that, it says, is harming health service in Kenya and Uganda.
Human Rights Watch (HRW) says Trump’s Expanded ‘Mexico City Policy’ has led to cuts in HIV and Reproductive Care, loss of training and equipment from non-governmental groups for government health clinics, and widespread confusion about its implementation.
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President Trump’s expanded “Mexico City Policy,” that was issued on January 23, 2017, requires foreign non-governmental organisations receiving US global health aid to certify they do not use their own, non-US funds to provide abortion–except in cases of rape, incest, or to save a woman’s life–offer information or referral for abortion even where abortion is legal, or advocate liberalising abortion laws, HRW says.
Explaining that the policy is widely known as the “Global Gag Rule” because of its restrictions on the type of information organisations can provide even with their own funds from non-US sources, including restricting what a doctor can say to patients, says Skye Wheeler, women’s rights emergencies researcher at HRW, “research shows that the expanded Mexico City Policy is already erecting barriers that will block people in Kenya and Uganda from the health care they need.”
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The Trump administration’s policy extends the restrictions to an estimated US$8.8 billion in US global health assistance, including for family planning and reproductive health, maternal and child health, nutrition, malaria, tuberculosis, infectious diseases, neglected tropical diseases, water, sanitation, and hygiene programs, and HIV/AIDS – including The President’s Plan for Emergency Relief for AIDS (PEPFAR).
HRW says, to assess the impact of the Global Gag Rule, has interviewed representatives of organisations that provide reproductive and HIV health services, conduct health outreach to marginalised populations, or advocate for improved health policies in Kenya and Uganda that both rely heavily on US health funds to combat high maternal mortality rates and the HIV/AIDS epidemic.
While maternal deaths account for 14 percent of deaths of women ages 15 to 49 in Kenya that ranks among the six countries with the highest total number of HIV infections in the world, US global health funds pay for anti-retroviral treatment for 890000 Ugandans with HIV, about 93 percent of the people receiving HIV treatment in the country, HRW says.
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The Global Gag Rule, HRW says, “has triggered reductions in key sexual and reproductive health services from well-established organizations that cannot easily be replaced. For example, Family Health Options Kenya (FHOK) runs 16 healthcare facilities in the country. FHOK representatives told us the organization will not comply with the restrictions and therefore will lose US funds, which make up roughly 60 percent of its budget, and that it may have to cut as many as half of its services. The organization has already closed one clinic and canceled 100 planned outreach events, including for cervical cancer screening, HIV testing, and family planning counseling, that typically reach 100 people each time.”
Although governments receiving US funds are exempt from the policy, HRW says many government health clinics in Kenya and Uganda are indirectly weakened as they depend on non-governmental groups for training and equipment to provide safe abortion care in cases of rape or incest, or to save a woman’s life.
“These donor-imposed restrictions undermine hard-won relationships of trust developed with a key population on the front lines of efforts to fight HIV,” Wheeler says.
