African Woman and Child Feature Service

The lifting of the Gag Rule, which had prohibited the US government from funding organizations that talk about abortion or offer related services, has been greeted with tears of joy by Kenyan women, but scoffed and criticized by anti-abortion groups.

This lifting means that the more than US$ one million (79 million shillings) from United States Agency for International Development (USAID) that was available to Kenyan organizations before the Gag rule was initiated will start flowing again.

It also means thousands of contraceptives including, Microgynon, Microlut and Nordette, whose availability suffered greatly when Bush Administration reinstated the Rule, will be given once again to local organizations that were distributing them.

The lifting is a big relief to Family Health Options Kenya (FHOK), which suffered greatly when the Rule was effected. Delighted officials at the organization now say they are likely to reopen the clinics or open new ones once the funding is resumed.

“We hope with the removal of the Rule our partnership with USAID is going to be restored and we now readying ourselves for further consultations on how to regain the lost ground in helping women manage their fertility,” says Muraguri Muchira, the organization’s Director of Programs.

The organization lost more than Sh 25 million and over 50,000 cycles of Microgynon, Microlut and Nordette it was receiving every year from USAID towards it contraceptive programmes.

Also affected were FHOK’s clinics which used to function as clinical training sites for the Ministry of Health’s doctors and nurses on how to insert Norplant and IUDs, perform sterilization procedures and improve quality of STI and HIV/Aids counselling. New funding is going to reactivate them.

“In countries such as Kenya, Uganda, Tanzania and Ghana we have witnessed fertility rate rise partly due to this policy.

With this new funding, these countries should work to regain the lost gains and bring smiles on the faces of many couples,” says Jo Reinders, Technical Adviser, World Population Foundation.

The Global Gag Rule undermines democracy and puts women's lives at risk, and hence the steps taken moves away from ideology and toward making sound policies that are based on evidence and reality, according to Serra Sippel, Acting Executive Director at the Center for Health and Gender Equity

Other reproductive health experts say many organizations who dependent heavily on USAID contraceptive funding suffered irreparably just because they uttered the word abortion or attended forums where abortion issues were discussed.

To many countries in sub-Saharan Africa, where family planning indicators are saddening, the lifting means the over US$ 35 million (over Sh 2.7 billion) for support of family planning and reproductive health programmes which was cut will be reinstated.

Organizations that were affected by the rule say reversing of the policy by Obama has come just at the right time when more than 40 percent of births in Kenya are unplanned, and one in four married women have an unmet need for contraceptives, all due to problems facing family planning programmes.

This is according to a study findings published late last year in Guttmacher Institute of Sexual and Reproductive Health Series No. 4 of 2008.

Likewise, lack of access to family planning commodities and information is partly blamed for the approximately 14,700 Kenyan women and girls who die each year due to pregnancy-related complications and another 294,000 to 441,000 who suffer from disabilities caused by complications during pregnancy and childbirth.

Mexico City Policy, also known as the "Gag rule," was installed in 1984 by President Ronald Reagan. The rule restricts USAID from giving family planning aid to any foreign NGO that provides abortion, abortion counselling and referrals services or abortion related advocacy with their own funds other than those given by US, even when abortion is legal in that country.

Trouble for many Kenyan organizations started when the Bush Administration reinstated this rule in 2001 to undo Bill Clinton orders that had earlier lifted it. Kenyan organizations that offer information or counsel women on safe abortion and post-care services, or participated in discussion on legalizing abortion, were identified and denied funding.

When it happened, rural and urban poor who benefited from these services described the decision as a bitter pill to swallow.

FHOK, which had received approximately 75,000 cycles of pills from USAID in 1999 before the Gag rule came into effect, wept.

The organization had also received Sh 135 million between 1997 and 2001 as support for five of its 14 clinics – in Eastleigh, Kisii, Embu, Mombasa, and Phoenix House-which were offering reproductive health services to the poor. 

But when support was withdrawn in line with the Gag rule, the organization was forced to close three clinics and lay-off close to 40 staff members. Services were scaled down by 40 per cent, with the number of tubal ligations done per year declining from over 3,000 to less than 1,000.

A total of 1,560 women, men and children who received services everyday from these clinics could not access them.

“The development threw us off balance, and had to dig in the little saving we had to cater for desperate women, men and young girls who were still knocking on our doors searching for contraceptives,” says Muchira.

In its monthly report in 2002, FHOK said aproximately 56,000 family planning clients living in slums and densely polluted areas where the clinics operated were going to be denied access to services with the closure of the clinics.

The net effect of all this, the report said, couples, or adolescents who depended on the organisations for Sexual Reproductive Health (SRH) and other services were going to find it difficult to control their fertility resulting in unwanted pregnancies and more unsafe abortion.

Equally overjoyed with the lifting is Marie Stopes International (MSI)-Kenya, where staffs describe the action as the best gift this year.

According to staffs at the organization, which runs many clinics in Kenya, the lifting is going to allow more contraceptives to come in and help bridge the huge unmet need of family planning in the country estimated to be over 60 percent.

Their celebration is for a reason. When the Gag rule was reactivated, they were forced to close over 10 clinics. More than 2,000 women who were their family planning clients were affected, with over 80 employees being retrenched.

Closure of the clinics in the slums of Nairobi and Kisumu seriously affected the delivery of services in these poor settings. In one of the clinics, more than 400 women who were attended to every day could not access family planning after it was closed.

Pleas by FHOK and MSI-Kenya that they do not procure abortion because it is illegal in Kenya; but offer post-abortion care services just like Kenyatta National Hospital did not soften the stand of the Bush Administration.

At the global level, the International Planned Parenthood Federation (IPPF), that also funds FHOK, estimates it lost about $100 million (Sh 7.9 billion) in U.S. funding in the past eight years. This money, it approximates could have prevented 36 million pregnancies and 15 million abortions.

“For eight long years the global gag rule has been used by the Bush administration to play politics with the lives of poor women across the world," said Gill Greer of the IPPF in London. "In rescinding this disastrous and unjust policy, President Obama has returned the United States to the international consensus on women's health."

Access Denied: US Restriction on International Family Planning, a study conducted by Planned Parenthood Federation of America, Inc., Pathfinder International, Population Action, IPAS and EngederHealth, in four countries, Kenya, Ethiopia, Zambia and Romania, concluded that:

“The Global Gag Rule has eroded women’s access to contraception and reproductive Health care. This can only lead to more, not fewer, unsafe abortion and maternal deaths.”

It was further argued that the rule worsened the situation of over 360 million women-, majority of them in Africa, who have no access to contraceptives.

But there were organizations that decided to bend their principles in order to access the USAID money.

Those who were desperate for funds had to agree to sign an agreement denouncing abortion or any related issues and indicating that the money was not going to be used on anything that was in anyway related to abortion. Only those who agreed to these tough conditions were given funding. A number of organizations in Kenya signed the agreement.

IPPF’s governing council on the other hand refused to abide with the rule, and warned the over 45 organizations affiliated to it to count themselves struck from the membership list if they commit themselves to the Gag rule provisions through signing an agreement with the Bush Administration.