Q&A: Uganda's RHU warns of impact of global gag rule

KAMPALA, Uganda — Reproductive Health Uganda is one of Uganda’s leading NGOs providing services related to sexual health and reproductive rights, but it now faces a number of challenges to its work, including a recent move by the United States to bring back the Mexico City policy, also known as the “global gag rule.”

In 2016, RHU reached over 6.8 million people in the east African nation, with 3.3 million services offered to youth. They accessed nearly 1 million people across the country with family planning services. RHU offer services around safe motherhood, family planning, HIV/AIDS, adolescent interventions and more, targeting mainly youth and other vulnerable groups, with a particular focus on people in remote areas. They also carry out advocacy around abortion.

According to the Guttmacher Institute, 52 percent of pregnancies in Uganda are unintended, and about a quarter end in abortion annually. Meanwhile, about 8 percent of maternal deaths are due to unsafe abortions, said the country’s ministry of health. RHU’s “rights-based family planning services” include a “Sayana Press learning project,” which was being supported with funding from the U.S. Agency for International Development to increase learning for the provision of the injectable contraceptive by village health teams and facility-based providers.

But RHU will not comply with the “global gag rule,” which was reinstated by U.S. President Donald Trump in January and hits funding for groups seen as promoting abortion, and that has damaged the roll out of Sayana Press and some other RHU programs. Nor is it alone. In October, Human Rights Watch warned that early effects of the “global gag rule,” renamed the “Protecting Life in Global Health Assistance” policy, were being seen in Uganda and neighbouring Kenya through “loss of training and equipment from NGO groups for government health clinics, and widespread confusion about implementation.”

Devex spoke to RHU Executive Director Jackson Chekweko about the issues the group faces, and the impact of the “global gag rule” on its programs and Uganda as a whole. The following interview has been edited for clarity and length.

What are some of the main issues that Uganda is facing when it comes to sexual reproductive health?

We have one of the highest fertility growths in the world. We also have very high abortion rates due to unintended pregnancies. We have one of the highest teenage pregnancies of 25 percent in the world.

Why have RHU taken a strong stance against the global gag rule?

We are a member of The International Planned Parenthood Federation and we stand for women’s rights. Any policy that wants to limit choice, wants to limit rights of women, we cannot be party to that. For example, we are doing advocacy for the Maputo Plan of Action 2016-30, which calls for provision of comprehensive sexual and reproductive health rights, and provision of safe abortion is one of the elements of providing comprehensive reproductive health service rights. Anything that interferes with or is a barrier to our initiatives definitely is not good for Uganda.

Uganda has a long-term partnership with USAID. They have been one of the main drivers of family planning [in Uganda]. It is a hypocritical policy. While the same organization in the U.S. is not affected, organizations here are affected. For example, Population Services International is also a rights-based organization. While PSI gets money in the U.S., its affiliate in Uganda may not get money. And yet they are one organization. Why have a discriminatory policy? I don’t understand it.

Is the global gag rule now having an impact in Uganda?

[Funding is drying up] because according to the policy you will not get the next release of funds unless you sign [the “global gag rule”]. It does not apply to those who have already received funding, but it applies to any additional funding you were going to receive, and the USAID planning cycle ends in September. So from September, most of the programs that were not in line with the policy came to an end. That is having a big impact.

How has it hit RHU specifically?

Some of our programs have come to an end. One ended in May, our partnership with Advocacy for Better Health. It was covering several partners funded by USAID, but because we were not ready to sign the “global gag rule,” it stopped.

One of our programs which has also come to an end is a project we were rolling out, this new [self-injectable] technology, Sayana Press. We were rolling it out to young people. It’s a very popular method of family planning. We were using funding from USAID to roll it out though our clinics in seven districts.

We had also another program which was building the capacity of the health structure to deliver sexual reproductive health services using a rights-based approach. So we have been engaging the ministry of health, a working group has been put in place, we have been training health workers in selected health facilities in three districts, but now the funding is no more. And yet this was a big success story, making providers respect clients’ rights and making the health structure leadership respect provider needs … And now the program has come to an end. The program had not matured, we had only trained a skeleton of health workers but it had not reached the intended audience. RHU went to the extent of developing a rights-based approach policy for its organization. The next phase was to train the staff.

Was RHU seeing success with Sayana Press in Uganda?

We were doing a lot to roll it out among young people, and participated in the pilot which led to the approval by the ministry of health. It was very successful, it was changing lives. It [Sayana Press] was pre-packed, you don’t have to remove it from a bottle. Women can inject themselves anywhere. It was being embraced by women and it was increasing access to family planning, but unfortunately now with the gag rule, that funding has come to an end.

RHU had a unique target group. We are an adolescent-focused organization, so as much as other organisations could be reaching women, this would be adult women. But when it comes to the adolescents, who are now increasingly becoming the majority of the women who need these services most, they can’t access it easily. We are struggling because [there were] women who had been introduced to this service and now the money has dried up.

There have been some claims women will die because of the global gag rule. What do you think?

Definitely. Some will be affected. We have been doing a great job in extending services. We serve 1 million people annually across Uganda with reproductive health services. So if an institution like RHU is affected, definitely you know that it will have an impact. It will have a devastating effect. You will see a rise in unintended pregnancies leading to abortions.

What are you going to do about the impact of the policy?

There could be other partners out there who are willing to come and support. We have not accessed them yet. We have international partners such as the Canadian International Development Agency. They are working in Uganda, not with us now, but we worked with them before. There are organizations such as the Danish International Development Agency with whom we have a strong partnership.

Is there a silver lining?

We have developed resilience. Whenever the Republicans come into power, they put back this policy. It is not shaking us like it was before. We are more resilient. First of all, we have diversified our income sources, so we don't rely only on USAID. Right now I can’t say that our budget has gone down, no. We are moving on.

As much as these fellows want to mess us up, I think they’re shooting themselves in the foot. Governments in Scandinavia have come out very strongly. There is the “She Decides” campaign, which has mobilized a lot of money. In London, Melinda Gates issued a very strong statement and through the FP2020 a lot of resources are still continuing to be mobilized. So eventually it may become like climate change, where the U.S. pulled out but the others became even stronger.

Besides the challenges that the policy poses for Uganda, in the past year comprehensive sex education has also been banned in the country and religious bodies played a role in this. Are you worried about the influence they’re having on the country’s sexual reproductive health policies?

[The education ministry is] still working on the draft framework. We are skeptical about the outcome — because of the U.S. inclination, the religious set is now center stage. Of course, the Inter-Religious Council of Uganda is now more empowered. They bring in issues of LGBT and yet it [sex education] is not about that. When you talk about sexual rights, they think it is issues of homosexuality. No, they are the rights of young people to access accurate information. What has that to do with homosexuality? They use that [argument] just because they know that it is a contentious issue in Uganda.

Read more Devex coverage on  sexual and reproductive health.