By Christabel Ligami

Women in Kenya narrate their stories on how the US President Donald Trump’s anti – aborting gag rule has changed their lives

Winfred Mwikali, 30 years of age never thought after 10 years she would get another child as a result of not taking her daily family planning pill.

Winfred, was on a family planning program at Family Health Options Kenya (FHOK) in Kitengela. Where she got her family daily planning pill every month for close to eight years.

But all over a sudden the clinic was closed down without prior notice.

The mother of two who is also HIV positive, also relied on the clinic for her antiretroviral (ARV) drugs that she got every month through the Comprehensive Care Centre Clinic (CCC)

“I woke up as usual in 2018 to go for my ARVs and family planning pills at the clinic after finishing my monthly dose only for me to find that the hospital locked with a chain and a big padlock,” said Winfred adding that this was her first time to find the hospital closed.

“I immediately called the community health worker (CHW) who initially referred me to the clinic and she confirmed that the clinic had closed indefinitely and that meant no services.”

Winfred said she requested to meet the CHW for an explanation, the CHW said there was nothing to talk about as she was as well never notified and given details about the closure..

“The only advice she offered me was that I should go to the nearby public hospital and get my ARVs. Since I had not been given a referral letter by the doctor in regards to my treatment I knew it was going to be difficult to get the drugs at the hospital and so I chose to just go back home,” she said.

Luckily two days later the CHW called to check on her then learnt that Winfred was not taking her drugs and had not gone to the hospital.

“She offered to take me. I was lucky because she had worked there as a volunteer and so I was immediately enrolled to the hospital’s CCC program without the doctor’s referral letter,” she said.

“I was so relieved to get my drugs again after missing my dose for two days. But the challenge now is the distance. I have to pay $3 to get to the hospital every month to get my drugs which is a lot of money.”

During this time Winfred had not been taking her family planning pill for some days. Within a three months’ period she got pregnant.

“I didn’t know how I could ask for the family planning pills at the hospital and I didn’t have money to buy them on my own. So we agreed with my husband to use the natural method which didn’t last long,” she noted.

At FHOK she said she got all the other medical services free of charge like cervical cancer screening, vitamin supplements and sometimes food supplements.

With now a one-year-old baby that she didn’t plan for Winfred is stressed on how to take care of her two children without a job. However, she is still not on any family planning program and so she still risks getting pregnant again.

The Gag Rule

In 2017, US President Donald Trump signed an executive order expanding his Global Gag rule which bans health care providers that receive U.S. aid from discussing abortion. It penalizes foreign health care providers that provide a full range of information and services that are legal within their own countries. FHOK is one of thehealth facilities in Kenya that was affected and closed down as a result.

Justine Musyoka who was a CHW at FHOK was also surprised in 2018 when she woke up as usual to report to work and found the hospital closed.  

“No one had communicated to us in advance that the clinic would close on athis day to prepare us,” she said adding that it was such a shock to her and the other hospital employees that they had no work and office to report to anymore.

“The hospital programs like outreaches, trainings, workshops had reduced for like over a year and we had been told that it was as a result of reduced funding, but we didn’t expect that the would close down.”

Justine who had worked at the clinic for close to five years says she has struggled since then to cater for her five children as she has not got another job.

“I still get calls from the women in the community asking me where I went to and some have even died. Some gave up on the family planning. I feel bad about it especially when someone calls inquiring if the clinic has now been opened,” she said adding that some of the women only got the medical services like family planning through the outreaches.

“Some of these women had never been to the hospital despite them having five children. We were like the custodians to their health.”

Effects on the health services in Kenya

Melvine Ouyo, a former manager and nurse at FHOK was among the health care clinics that were affected by the Trumps gag rule and as a result faced the consequences of losing funding hence closing down its outlets in the country.

FHOK had to close down their outreach activities and clinics in Kenya, Uganda, Senegal, Madagascar, Pakistan and Myanmar sending home dozens of employees as a result and denying many women access to reproductive health services.

“FHOK was started to give low cost but high quality care to the patients because it relied on funding from various sources but mainly the US,” said Ms Ouyo.

“When Trump announced in 2017 the new global gag rule, we had two options of either signing to the gag and not offer, mention  or procure abortion services to our clients among other reproductive health services then continue receiving the grant or decline to sign then lose the US funding. FHOK chose not to sign because of our mandate as an intuition to our clients. We lost the grant of about $2.2 million.”

As a result she said, the other funding the organization got could not sustain the running of the organization and therefore made a decision to close down.

“We were offering free medical and family planning services to over 60,000 women through outreaches but for lack of funding all these women have had to suffer because FHOK could not sustain it on its own,” she noted.

Lauren Salmiery, National Field Director at Population Connection Action Fund, Washington says the ban had for the last three years made it harder for women and girls to access their reproductive health care services especially in developing countries.

“In countries like Kenya and Nigeria where we have collected data for the last three years, it is clear that young girls and women are no longer getting access to the safe abortion and family planning services in health care clinics that relied heavily on the funding. This has had life threatening consequences to the women,” said Ms Salmiery adding that outreach programs especially on family planning and general health care for women in the communities have had to be cut off by the health centers that are still existing.

“Without outreaches the poor women in the community will not be able to get the services they need and advocacy of health care cannot be possible without outreach programs.”

Salmiery said that women health and their reproductive rights are a serious concern that countries cannot just dismiss and watch women suffer as a result of unsafe abortion, things that can be prevented.

A Stanford Research conducted in 2011 found that the Global Gag caused the abortion rates in African countries to be the highest as the rates doubled between 2001 and 2008 when the policy was being enforced.

Some FHOK clinics have managed to get alternative funding through the international Planned Parenthood federation, donations, emergency funding, government support, trusts and foundations for their outreach programs.

#She Decides Campaign

Among the other efforts that are in progress to ensure reproductive health services are not affected by the trump gag is the She Decides campaign, which is championing the fundamental rights of women and girls of all ages to enjoy their bodies, make their own decisions and have access to comprehensive sexuality education and quality health care.

Salmiery says organizations including Population Connection Action Funds have partnered with some leaders in various countries including Africa to advocate on the dangers of the global gag rule. Through the # FIGHT4HER campaign, they are working with grassroots organizers in eight states in the US to pass the Global HER Act and end the harmful Helms of amendments.

“We hope that this will eventually lead to the financial support health organizations in developing countries get on women reproductive services and child care,” she said.

In 2017, through the She Decides movement, Rutgers, a Non-Governmental Organization based in Netherlands that offers reproductive health education to young girls and advocates for reproductive human rights for women awarded $0.5billion to the reproductive health network of Kenya (RHNK), an organization that works towards reducing maternal mortality and morbidity as a result of unsafe abortion. The program is expected to be scaled up to West African countries.

 A UNFPA report Sexual and Reproductive Health and Rights: An Essential Element of Universal Health Coverage indicates that some of the ways government can increase finances to reproductive health is through income taxes, earmarked taxes and pre – payment health insurance to limit out of pocket expenses for its citizens.

The Kenya’s Family planning costed implementation plan 2017 – 2020 estimates the four year budget at $305million of which most comes from the Protecting Life in Global Health Assistance (PLGHA) and so with the Trump gag policy, the budget has been hard hit.