ABUJA, Nigeria — At Adeoyo Hospital in Ibadan, Nigeria, reproductive health supplies are kept in the special store located almost directly beneath the accident and emergency unit. The store serves hospitals and NGOs conducting family planning work across the southwest region of the country.
But stock is rapidly depleting. A Devex visit found low supplies of family planning products provided by the United Nations Population Fund after the United States pulled funding from the agency just under two years’ ago.
“It is affecting not just family planning; it is affecting other areas including malaria and tuberculosis.”— Dr. Eugene Kongnyuy, interim representative, UNFPA
Funding data puts the shortage into broader perspective. In 2016, when UNFPA got its last support from the U.S. government, it was able to spend $15,444,880 on family planning in Nigeria. In 2017, it spent just $6,132,632. UNFPA Nigeria lost over 60 percent of its family planning funds within one year, in a country that is facing a potentially crippling population boom.
The administration of U.S. President Donald Trump cut funding for UNFPA in April 2017, accusing it of cooperating with coercive abortions or involuntary sterilization as part of the Chinese government's one-child policy, which has now been phased out.
While the funding loss was expected, the United Nations' reproductive and sexual health agency is still grappling with how the cuts will play out across its various programs and work worldwide.
UNFPA vociferously denied the accusation and was quickly backed by human rights and U.N. observer organizations, but it was not enough to save funding worth around $69 million a year from its second-largest donor.
Several Nigerian NGOs that had been receiving reproductive health supplies from UNFPA told Devex that if new funds are not mobilized from elsewhere, it could significantly harm family planning efforts in Nigeria, where the use of contraceptives remains low. Women have an average of 5.5 children during their lifetime and suffer one of the world’s highest rates of maternal mortality.
These problems have been compounded by the effects of another Trump administration policy — the so-called “global gag rule,” which prohibits any U.S. government funding from going to foreign NGOs involved in abortion-related work.
Various Nigerian NGOs working in the sector have lost funding as a result. Africa’s most populous country is one of the largest recipients of U.S. international development aid and relies heavily on global health assistance for family planning and maternal health initiatives, making it particularly vulnerable to the effects of the policy changes. A bill attempting to reverse the gag rule is expected to be reintroduced in Congress this week, but is seen as largely symbolic.
The future of family planning
The goals set for Nigeria by FP2020 — a family planning initiative launched in 2012 by several major aid donors — include improving access to family planning services and commodities, slowing the rate of population growth, and enabling an environment in which women and girls can make informed choices about their health.
To achieve this, FP2020 is relying on organizations such as the Lagos-based Generation Initiative for Women and Youth Network, which advocates for reproductive health and rights, and works with local women’s groups to reach marginalized communities. Its information hotline receives an average of 1,833 calls a month from across Nigeria and neighboring countries.
Because GIWYN informs women about access to safe abortion and postabortion care, among many other issues, it is unable to attract U.S. funding under the global gag rule, which has been enacted on and off since the 1980s but saw an unprecedented expansion under the Trump administration to cover nearly $9 billion of global health care funding.
The move has resulted in a significant shortfall for GIWYN, its executive director Sybil Nmezi said, since it can no longer act as a subcontractor for organizations receiving U.S. funding. The loss has limited its work, and made it extremely difficult to retain its hotline counsellors.
"Funding is significantly shrinking due to the U.S. government's policies, most especially the gag rule … Our efforts toward promoting reproductive rights among women have been greatly limited," Nmezi told Devex.
Currently, the only international support they have comes from the International Women's Health Coalition. Erin Williams, program officer for grantmaking and international partnerships at IWHC, told Devex the U.S. policies had exacerbated the dire situation for women and girls in Nigeria who are in need of sexual and reproductive health services.
"As a result, Nigerian health services will continue to fragment, deteriorate, and decrease, increasing the burden on vulnerable women and girls in search of comprehensive and quality health care. More women will look for contraceptive and pregnancy alternatives outside the medical and legal system," Williams said.
"Marie Stopes International and International Planned Parenthood Federation, two of the three largest foreign NGOs that provide comprehensive sexual reproductive health care in Nigeria, have already refused to sign the global gag rule and must now try to meet the service needs of their clients with fewer dollars," she added.
The effects of the policies have been far more wide-reaching than their apparent targets, advocates told Devex, threatening efforts around gender equality, education, and humanitarian assistance, alongside safe abortion and family planning.
Speaking to Devex in the Nigerian capital Abuja, Dr. Eugene Kongnyuy, UNFPA’s interim representative, said the agency’s humanitarian efforts — addressing maternal health needs and gender-based violence among displaced people in the north of the country — had been gathering momentum, thanks in part to $2.5 million that UNFPA Nigeria received from the U.S. in 2016. But its plans hit a wall when no funds were released in 2017, 2018 or 2019, meaning it could not get the staffing, commodities, materials or supplies it needed to help Nigerian women trapped in the crisis, Kongnyuy said.
He added that UNFPA Nigeria’s ability to scale up its work on gender-based violence and maternal mortality across the country had also been affected, and that other NGOs working on these issues had experienced the same problem. "It is affecting not just family planning; it is affecting other areas including malaria and tuberculosis,” Kongnyuy said.
In spite of the U.S. government’s attempt to clamp down on abortion globally, studies suggest its policies have led to increased abortion rates in the sub-Saharan African countries worst affected by the loss of funding, while rates have remained relatively stable in countries less reliant on it.
In response, advocates have been campaigning for other governments, multilateral institutions and foundations to find a way of narrowing the funding gap. “[It] will be almost impossible to fill, but increasing and diversifying funding from other sources will be life-saving,” said Human Rights Watch in a statement published last year. Some efforts toward this have already emerged but a large funding gap remains.
In Nigeria, UNFPA believes its financial crisis could have a silver lining — ensuring government officials know that donor funds cannot be relied on for critical national health policies. The government has already increased its support for the local UNFPA by $1 million, or 25 percent, since the rules came into effect.
“There are several countries that have taken over their country’s family planning programs fully. Nigeria is a middle-income country and we are hoping that as the economy improves, government will pick and will eventually fully take over contraceptive procurement,” Kongnyuy explained.
But many do not believe that efforts to mitigate the impacts of the Trump administration’s policies can completely fill the gap. Williams argued that passing the Global Health, Empowerment and Rights Act, which would permanently repeal the global gag rule, is the only way of ensuring that international NGOs never again have to choose between U.S. funding and offering comprehensive sexual and reproductive health services.
The bill is about to be reintroduced in Congress. But because it would need to be passed by the Republican-controlled Senate and signed by President Trump, it is unlikely to become law.