At a call centre in the heart of Karen, Nairobi, the phone rings and the voice of a girl comes through as soon as a counsellor at the centre picks up. The girl speaks inaudibly, almost in a whimper. She is a school girl and she is pregnant. She says she needs someone to speak to.
After helping her calm down, the counsellor listens patiently as the girl explains her situation. She then takes her through the options available for her and refers her to a friendly health facility for further help.
The helpline, known as Aunty Jane Hotline, is a live counselling service that provides information on sexual and reproductive health, including information on contraception, unwanted pregnancy and safe abortion.
Such services are expected to become rare in Kenya once an executive order signed by US president Donald Trump on his first day in office, takes effect.
The Mexico City Policy requires that all foreign organisations that receive US government funding neither perform nor speak about abortion. This means that NGOs must forfeit all US government aid if they so much as tell a woman abortion is a legal option in her country.
Reproductive health experts and NGOs that provide these services say the order will cripple family planning services and cause an increase in backstreet abortions and deaths from such abortions, in Kenya and many other African countries. The US government is the biggest funder of reproductive health services in Sub- Saharan Africa.
“Choices have consequences and it is unfortunate that Kenyan women will bear the consequences of an election in which they had absolutely no say,” says Jedidah Maina, the deputy director of Trust for Indigenous Culture and Health (TICA), an NGO that runs the Aunty Jane hotline.
The Mexico City Policy, famously known as the Global Gag Rule was first announced in the US in 1984 by the Reagan administration. Since then, the policy has been rescinded or reinstated whenever a new administration assumes power.
“Normally whenever a republican government comes to power, they pronounce it because, well, they say they don’t like abortion” says Dr Joachim Osur, the technical director, reproductive, maternal and child Health at Amref.
There are three aspects to this policy, Osur says. It stops non-US-based organisations that receive funding from USAID from counselling women on abortion, prohibits the organisations from offering abortion services and bans advocacy on abortion.
“If someone has an unwanted pregnancy, they are counselled on options available for them and abortion is normally one of the options. The gag rule prohibits this from happening,” Osur says.
The gag rule is so far reaching that organisations that do not offer abortion services or counsel women on abortion but receive support from pro-abortion donors cannot qualify for USAid grants.
Trump’s proclamation is even more encompassing than what other republican administrations have had. The last time the gag order was in place, between 2001 and 2008, organisations which offered HIV services were spared. The organisations could still get USAid grants even if they were getting support from institutions that support abortion.
This time round, all NGOs have to comply with the gag rule irrespective of the services they offer, Osur says. Most organisations will have to choose between offering abortion services (or receiving funding from pro-abortion institutions) and receiving USAid grants.
Previously, the gag rule only applied to family planning funds. But under the new version of the policy, all the US health funding, such as HIV/Aids maternal and child health, infectious diseases, malaria, tuberculosis, and neglected tropical diseases will fall under the rule. Consequently, organisations likely to be affected by this policy will be more many than before.
Marie Stopes Kenya says it will forfeit USAid funds and continue providing comprehensive reproductive health services with support from other donors.
“The British government, the Dutch government and many other European governments and private foundations are still supportive of women’s right to access comprehensive reproductive health services. We are grateful for the support from these donors,” says Marie Stopes Kenya country director Dana Tilson in a statement.
The organisation says abortion is legal in Kenya if a woman’s health is in danger and that it considers safe abortion as a vital component of women’s reproductive healthcare. It therefore cannot agree to the global gag rule conditions and will have to forfeit funding from USAid as long as Trump’s executive order is in place.
Marie Stopes Kenya says as a result of not receiving US government funding, it will be unable to provide more than 75,000 women and girls with contraception that would prevent unwanted pregnancies.
“Tragically, the implementation of the gag rule will result in more Kenyan women having unwanted pregnancies, and therefore more unsafe abortions will be conducted, resulting in even more women dying,” Tilson says.
TICA, the organisation that runs Aunty Jane Hotline says it will not seek USAid funds because it does not want to be gagged.
“We want to continue to be brave,” Maina the deputy director says. “We do not want partnerships that will curtail our efforts of providing women with information about their reproductive health rights.”
Dr Osur says many organisations will have to scale down provision of important health services such as contraceptives and maternal care once the US government starts withholding funds from NGOs that provide family planning services.
“We can expect what happened the last time the order was in place to happen again,” Osur says. “A lot of organisations which provide family planning services such as Family Health Options Kenya had their funding suddenly stopped. Marie Stopes the same. Many other smaller organisations suffered the same fate. The FHOK, where I was working at the time, closed nearly half of its clinics.”
Consequently, most women could not access family planning services and many of them had unwanted pregnancies.
“As a result of that, the rate of abortion actually went up,” Osur says. “What has been seen whenever they pronounce that policy is that it is counter-productive. You end up actually with more abortions that when the policy is not there.”
According to World Health Organisation statistics, an increase in abortions in Sub-Saharan Africa coincided with the reinstatement of the gag rule in 2001. About 1,200 women and girls die from unsafe abortions every year in Kenya and about 18 per cent of girls aged 15-19 years have had an unwanted pregnancy, according to Marie Stopes estimates.
Osur says the gag rule, even though targeted at reproductive health services, will affect provision of other health services such as HIV and maternal care, since organisations that provide family planning services are the same ones that offer these other services.
He says even though other donors might come in to close the funding gap after USAid withdraws its support, they might not be able to match what the US provides.
Maina calls on the government to step in and increase funding for family planning services.
“We need to stop being donor reliant as a country,” Maina says. “We have a trillion shilling budget. A lot of our money is going to corruption. If we sealed the loopholes, I believe we could be able to fund our reproductive health services.”