'Global gag rule' hampers reproductive health actors in rural Colombia

Edna Villa, a Profamilia project adviser in Colombia’s municipality of Guamal, calls out reproductive rights and relationship myths to women participating in a Profamilia workshop. Photo by: Kelli Rogers / Devex

Editor’s note: Around the world, women’s health care providers and those they serve are bracing for the impact of the “global gag rule.” But what does the policy look like on the ground from the perspective of those running soon-to-be cut programs? And how will the women who count on such programs get by? To find out, Devex spent a week with the rural teams of Profamilia, Colombia’s largest family planning provider. This is the second of a three-part seriesRead part one and part three.

GUAMAL, Colombia — Edna Villa is animated, pacing, as she calls reproductive rights and relationship myths aloud.

“Highly educated women can also be exposed to violence in their relationships,” she says, challenging the 15 women sitting in the bleachers of the open-air sports complex to explain whether this statement is true or false, and what it means to them.

But her progress in the community suddenly feels stalled, the Profamilia project adviser in Colombia’s municipality of Guamal told Devex.

In March, Villa learned that the United States Agency for International Development-funded project she’d come on board in January to manage for Profamilia, Colombia’s largest family planning service provider, would be ending in December of the same year, rather than December 2018 as planned.

“The principal problem is that we won’t have enough time to impact communities,” Villa told Devex of her work in central Colombia’s department of Meta. “Now it feels like we are just like other projects who come and leave too quickly.”

In January, Profamilia, the main provider of safe abortions in Colombia, chose not to comply with U.S. President Donald Trump’s reinstated “global gag rule,” otherwise known as the Mexico City Policy. The order prevents all non-U.S. NGOs that provide services or information related to abortion from receiving U.S. government funding for any of their programs.

The organization serves 600,000 people a year. Of those, 90 percent are women, and of those, 90 percent are very poor women. The funding Profamilia receives from USAID has been targeted to some of the most vulnerable populations in the poorest areas of the country.

Now, Profamilia is no longer eligible for the $1.2 million in USAID funding for their sexual and reproductive health project for conflict affected populations in 11 municipalities, a two-year extension to a program that ran from 2014 to 2016.

The two years of workshops, community therapies, health brigades, sensitizations and youth groups Villa was tasked with spearheading in the vulnerable communities of Guamal now feel like an overwhelming assignment with just seven months left. Already, the local government is requesting she form two youth groups, one with 14 to 19 year olds, the other comprised of 18 to 25 year olds. It will likely only be possible to do outreach and organization for one before funding and time runs out, she said.

At headquarters in Bogotá’s Teusaquillo neighborhood, “profound sadness” enveloped those working at Profamilia when the “global gag rule” announcement and decision was made official, Profamila President Marta Royo told Devex.

She knew instantly that the USAID-funded program would close, and that talented people would lose their jobs. Though they’d been prepared for the news, it was still hard to accept, she said.

“You just keep hoping … that something will happen that will stop it,” Royo said of the Trump reinstated directive, recently renamed the “Protecting Life in Global Health Assistance” policy.

Royo will need to let go of about 20 staff members. For her and others involved on the project in the field, it’s a devastating blow to committed professionals and the progress made with contraceptive provision and workshops in the past few years.

Nearly 1 in 5 adolescents in Colombia aged 15-19 years is pregnant or has one or more children, according to the United Nations Population Fund. And adolescent mothers in Colombia are more common among rural women, at 26.7 percent, and displaced adolescents, at 30 percent — both demographics Profamilia has been targeting through the USAID project.

From 2014-2016, they reached 1,720 direct beneficiaries and 6,880 indirectly. Profamilia predicted its extended program would directly impact 11,400 people and indirectly impact 99,000, across 11 municipalities.

“We get very involved in the communities with all different age groups,” said Nadia Rivera Bonilla, coordinator of the USAID-funded project. “It’s not just ‘let’s reach a community, give them the facts on sexual and reproductive rights and get out.’ We want to really understand their lives.”

“It’s not just ‘let’s reach a community, give them the facts on sexual and reproductive rights and get out.’ We want to really understand their lives.”

— Nadia Rivera Bonilla, coordinator at Profamilia

Maria Elena Santo Domingo Viscaino, Profamilia’s USAID program adviser in the northern municipality of Fundación, knows this all too well, having worked as a project adviser on the program since 2014.

Santo Domingo greets everyone in town with a smile, a kiss on the cheek and personalized question: “How is your husband? Is your youngest still sick?” She knows where they live, how many children they have, and what their current struggles are.

The most changes she’s seen, she said, are in the younger populations. Youth “multiplacadores,” or young people who volunteer to get involved with Profamilia workshops and present sexual and reproductive health information within communities, feel much more empowered and less afraid to broach topics they might not have raised otherwise, she added.

She’s also seen a change in the local government with Profamilia’s capacity building efforts in harnessing “the human resources and the knowledge that the municipality already has, which we find that they themselves have difficulty recognizing,” she said, to overcome the problems in their community.

It will be difficult, however, for her to leave Fundación and the progress she’s seen, especially since she’s doubtful the local ministries can maintain any of the programs, including the youth group activities, with the same energy and frequency.

Royo will continue to try to identify alternate sources of funding in order to finance the rest of the program, but she’s doubtful: “I think Colombia is going through a peculiar moment, with the peace treaty … and the lack of resources.”

The attitude of many politicians and others in the country is also concerning, she added.

“I had a [local] politician tell me that the worst that will happen with the end of this program is that a woman will get pregnant, and no one dies from getting pregnant,” Royo said. “It was so wrong, and so sad.”

No, a 14-year-old girl won’t necessarily die if she gets pregnant, Royo said: “But is that supposed to happen when you are 14? Is that what you want to see happening in your country?”

For now, Profamilia will get as much as they can done in the coming months before the program closes in December. As for what’s next, teams in the field will speak to the local government and women’s groups personally to let them know about their departure — and will plan to stay in touch, Royo said.

“We won’t be able to develop the workshops and have the people working there right now,” she said. “But you see, especially young women, you see what their life is going to be in the future if you don’t educate them and help them see other choices. We’ll be back.”

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About the author

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    Kelli Rogers

    Kelli Rogers is a global development reporter for Devex. Based in Bangkok, she covers disaster and crisis response, innovation, women’s rights, and development trends throughout Asia. Prior to her current post, she covered leadership, careers, and the USAID implementer community from Washington, D.C. Previously, she reported on social and environmental issues from Nairobi, Kenya. Kelli holds a bachelor’s degree in journalism from the University of Missouri, and has since reported from more than 20 countries.