US policy blocking funding of health NGOs affects access to sexual reproductive services

Fifty three per cent of the 386,000 adolescent pregnancies in Uganda are unintended. More than 300,000 abortions occur annually among Ugandan women aged 15 to 49, of which 83 unintended are carried out under unsafe conditions and methods thus contributing 26 per cent of total maternal mortality due to abortion complications (Singh. D et al; 2005). Additionally, 1,500 women die annually due to unsafe abortion in Uganda. With the enforcement of the global gag rule, it is inevitable that these statistics could drastically increase.
The Global Gag Rule (GGR) also known as the Mexico policy is a policy reinstated by Executive Order by US president Donald Trump. The policy blocks US Federal Funding for non-governmental organisations that provide abortion counselling or referrals, advocate to decriminalise abortion or expand abortion services. The GGR depends on the US political direction - whether a Democrat or a Republican president is elected or not. It was reinstated once in 1993 during president George W. Bush’s tenure in office and recently in 2017 by President Donald Trump. It should be noted that the global gag rule traces its history as early as 1973 when the 1961 US foreign assistance act authorised international development funding was amended into the Helms Amendment provision. The provision (amendment) prohibited US foreign funding to be used for abortion as a family planning method and that; no US foreign assistance funds could be used to pay for abortion, biomedical research relating to abortions or involuntary sterilisation as family planning methods. In1984, a decade later at a population conference in Mexico, President Ronald Reagan introduced the Mexico policy. The Presidential Memorandum issued by President Donald Trump’s administration in January 2017 through the “Protecting Life in Global Health Assistance” plan highlighted the scope of the policy. It is clear the policy does not reduce global health assistance amounts by the US but for non-compliant entities, funds are diverted to other projects and already granted funds are not subject to the policy.
The policy applies to entities that receive family planning funding and global health assistance under US government agencies. PEPFAR under US Department of State in the President’s Cabinet - one of Uganda’s biggest funders for HIV/Aids programmes is subject to the policy. Centers for Disease Control and Prevention (CDC) and National Institute of Health under the department of health and human services are also subject to this policy. The protecting Life in Global Health Assistance plan scope of global health assistance, includes international health programs like HIV/Aids, maternal and child health, malaria, family planning, global health security and reproductive health.
However, in addition to excluding humanitarian aid, the policy does not apply to national governments, international organisations like UN Fund for Population Activities and multilateral entities like Vaccine Alliance, Gavi, and Global Fund to Fight AIDS, Tuberculosis and Malaria. With support from Alert Fund for Youth, Rural Aid Foundation is undertaking a project to popularise the Mexico policy and its implications to enable adolescent girls and young women hold government accountable for SRHR service delivery through identifying alternative funding streams for SRHR services.
On September 23, the UN held the first high level meeting on UHC and leaving no one behind was a cornerstone for realisation of UHC. The global gag rule is a threat to the realisation of universal health coverage as it affects access to sexual reproductive health services for the most vulnerable including women, children, adolescents, sex workers, refugees especially in the rural communities in Africa. There is need to popularise the global gag rule and its implications on sexual reproductive health to enable CSOs engage policy makers in prioritising alternative funding sources for sexual reproductive health as a key driver to the realisation of universal health coverage.
Ms Nasaazi is founder and community health mobiliser, Rural Aid Foundation.