It has been one year since the US President Donald Trump reinstated and expanded the Mexico City Policy. With the stroke of -a pen, and support of his Republican colleagues, that decision has become very detrimental to the lives of many young girls and women in developing countries. This policy dubbed the ‘global gag rule’ has in the past and will continue to have profound negative consequences for global health, beyond reproductive health, especially in
The Mexico City Policy, was a guideline sponsored by former US President Regan in 1984 at the International Conference on Population in Mexico City. The guideline specified that US federal funds that support family planning were only available to organizations that agreed not to perform or promote abortion as a form of family planning. It was rescinded in 2001 by President Clinton and again reinstated by President George Bush. This policy has always shown the different ideological position between the Republican party which is pro and the Democratic party which is against it. What then does the reinstatement of the global gag rule mean to organizations receiving U.S funding in the areas of family planning and global health assistance? In true practice, the policy bars any of these organizations from providing abortion services and even discussing abortion as an option for family planning.
Apart from prohibiting US funds to be used on safe abortion as a method of family planning, this policy will also not allow organizations that support abortion through information sharing. This version extends and will affect recipients of all global health assistance from US government departments or agencies. The effects are profound because US federal-funded NGOs focus on diseases such as HIV/ AIDS, Ebola virus, Zika Virus and tuberculosis.
Kenya will be adversely affected with the reintroduction of the global gag rule. According to Hivos, about half of the pregnancies in the country are unplanned, with about 40% leading to abortion. In 2012 alone, that translated to 460,000 abortions. The country has reduced maternal mortality, however estimates show that still, around 1,600 women die every year from abortion related complications. The Kenya Demographic Health Survey (KDHS, 2014) outlines that maternal mortality is among the leading causes of death for young adolescent girls age 15-19 years.
Marie Stopes International report that 2 million women around the world are now at risk of losing access to contraception and more that 800,000 risk unsafe abortion. It is projected that by 2020, the gag will result in 2.1 million unsafe abortion and over 21,700 maternal deaths in countries impacted by the rule.
Kenya being one of the biggest recipients of USAID funding has made great steps towards universal health care In the 2016/2017 budget, KES 60 billion was allocated to health. 60% of the health development spending is financed by development partners and much of the support is in reproductive health, immunizations and supporting health systems. In 2016 alone the country received $265m for health, $233m of that was for population and reproductive health services, while 25m was for basic health. Reducing the funding for these programs will have major implications on the Kenyan Governments health spending. The She Decides initiative has stepped up to fill the gap, but is unlikely to completely make up the shortfall on funding. NGOs working in the reproductive health sector will now have to find different sources of funding and support countries that have agreed to fill the gap such as the Netherlands, Belgium, Canada and private foundations such as Gates Foundation.
Domestically, the Kenyan government must prioritize the national health budget and increase its allocation to 15% target as set by the Abuja Declaration where Kenya is a signatory. The total national health budget allocation for 2016/2017 fiscal year was 3.6%; while in 2015/2016 fiscal year it was 3.7%. Our work is cut out to increase health budget advocacy efforts with the Kenyan government. With President Kenyatta now serving his final term, universal health care is listed among his ‘big 4 agenda’. The timing is therefore right for our budget to set aside 15% of the total revenue for health care.
Mwikali Kivuvani, Program Manager