'Global gag rule' prompts uncertainty in Uganda, Nigeria, PAI finds

While her husband holds their youngest child, Twesigye Christente waits to receive a long-acting contraceptive at the Kinaaba Health Center II in Uganda. Photo by: UNFPA / CC BY-NC-ND

NEW YORK — It could take several years before United States aid recipient countries such as Uganda and Nigeria feel the full impact of the expanded Mexico City Policy. But new analysis shows there are already clear signs now that the policy is pushing these countries to limit their expansion of key health services, including for women’s health care.

This is according to research conducted by the global health organization PAI, following country visits in November 2017 to Uganda and Nigeria. The findings from these trips were released last week.

The policy, also known as the “global gag rule,” bars any U.S. global health assistance to any foreign NGO that engages in abortion counseling or services. The Trump administration’s cuts to global health assistance have also extended beyond the “global gag rule,” as it also announced on Monday it would not fund the U.N. Population Fund for a second year running.

The global gag rule is causing organizations in both Uganda and Nigeria to grapple with first understanding how to comply with policy, according to Jamie Vernaelde, a senior research and policy analyst at PAI.  

“There’s immense confusion. What people are failing to understand is that you are not going to see those immediate impacts on women and their communities just yet. That is going to come as these organizations struggle to get that sustained funding,” she explained. “What we are seeing is organizations that are accepting the funding taking them literally months to figure out how to comply. And that is rolling down to being months behind on service delivery.”

Abortion is limited in both Uganda and Nigeria to the extreme circumstances of life endangerment for the mother, though not in cases of rape or incest, as the new U.S. policy permits.

Nigeria is the single largest recipient of U.S. international development aid. Uganda, meanwhile, has looked to the U.S. as its largest single provider of global health assistance.

But the two countries are experiencing the policy differently, according to PAI.

In Nigeria, where U.S. health funding totaled more than $256 million in 2016, pressure is being felt beyond the direct line of U.S. Agency for International Development funding. Much of the growing young population in Nigeria — 63 percent of whom are under the age of 25 — has historically looked to the U.N. Population Fund for contraceptives. In 2015, 70 percent of all contraceptives in Nigeria were provided by UNFPA. Another 25 percent was supplied by USAID. The Trump administration’s defunding of UNFPA last year has resulted in a loss of about $70 million.

Much of the worry organization staffers expressed to PAI in Nigeria surrounded the cuts to UNFPA, Vernaelde says.

“It was much clearer in Nigeria how it is not just the ‘global gag rule,’  but the negative environment and influence the U.S. is creating out there, because of the defunding of UNFPA, because of the threats the administration has made to cutting family planning overall. The wider undercurrent of negative U.S. foreign policy was much stronger in Nigeria,” she said.

The Trump administration announced it would cut funding to UNFPA last March, citing a violation of the Kemp-Kasten amendment. This prohibits the U.S. funding any organization that supports coercive abortion or involuntary sterilization. UNFPA has denied that it engages in any such work in China, as other Republican administrations have claimed. On Monday, UNFPA responded to the news it would not receive U.S. assistance for a second year.

“This unfortunate decision will impede UNFPA’s crucial work to protect the health and lives of hundreds of millions of women and girls around the globe, including in humanitarian settings,” UNFPA said in a statement. “Therefore, UNFPA hopes that the United States will reconsider its position.”

In Uganda, both U.S. and local NGOs seemed more concerned about the return of the “global gag rule,” which some had previously seen during the George W. Bush administration.

In 2017, USAID delivered nearly 350,000 contraceptive implants to Uganda, more than 5 million injectable contraceptives, 1.4 million condoms, and over 4 million oral contraceptives. About 27 percent of women in Uganda use modern forms of contraceptives.

“They were much more concerned about how it would impact them, especially since the U.S. is such a major player and partner to a lot of these organizations in doing advocacy and work with the government,” Vernaelde said. “There is concern this policy will reinforce a hostile environment to women’s reproductive health care.”

UK aid official offers 'loud and strong' support for access to abortion worldwide

The United Kingdom's International development minister, Alistair Burt, has said that "in a world where some people would like to close down choices for women," the Department for International Development is proud to support access to the full range of sexual and reproductive health and rights services. A parliamentary group has issued recommendations on how that support can be improved.

Marie Stopes International, a large international NGO that has chosen to not receive U.S. funding, is now relying on Britain’s Department for International Development to make up for the loss of donor support. There is still a question of how this funding will be sustained in the longer term for MSI and other organizations, like International Planned Parenthood affiliates operating in Uganda.

“They feel okay for now. It is just the sense that it is going to be in a year, it is going to be in two years, how is the funding actually sustained? For a lot of these organizations like Planned Parenthood federations and MSI, which had all these plans to go above and beyond what they were doing with U.S. funding, they just cannot do it anymore,” Vernaelde says.

In some cases, that means not expanding work to vulnerable populations, including in humanitarian settings.

MSI reported early this year that it is facing a $80 million funding gap and that the U.S. policy has cut 17 percent of its donor income, as Devex reported.

The full impact of the global gag rule may not be evident until late 2018 or 2020, as the continuity of this donor funding will again come into question, according to PAI.

PAI, meanwhile, is conducting other evaluations in Ethiopia — a report for that country will be released in the spring — as well as other African nations.

“It is a document we really want to use to build evidence for hopefully the next administration,” Vernaelde said. “There is also a hunger in-country to have advocacy materials to use, so these organizations can show their own donors this is what the lay of the land currently is and this is why we are having problems.”

About the author

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    Amy Lieberman

    Amy Lieberman is the New York Correspondent for Devex. She covers the United Nations and reports on global development and politics. Amy previously worked as a freelance reporter, covering the environment, human rights, immigration, and health across the U.S. and in more than 10 countries, including Colombia, Mexico, Nepal, and Cambodia. Her coverage has appeared in the Guardian, the Atlantic, Slate, and the Los Angeles Times. A native New Yorker, Amy received her master’s degree in politics and government from Columbia’s School of Journalism.