The recent executive action of repealing of the Mexico City policy by US President Joe Biden is welcome news for reproductive healthcare in Kenya.
The Mexico City policy, commonly referred to as the global gag rule, bans U.S. government’s assistance for non-profit organisations that provide family planning unless they commit not to “perform or actively promote abortion as a method of family planning.” In the Mexico City policy, the definition includes providing patients with referrals or information about the procedure, even if those activities are funded by non-U.S. government sources.
First announced in Mexico City by the Reagan administration in 1984, the policy requires all non-governmental organisations operating abroad to refrain from performing or counselling women about abortion as a strict condition for receiving US government funding.
Since then, the Mexico City Policy has been adopted and revoked by executive order along strictly partisan lines in the first week of a new presidential administration—it was rescinded by Democratic President Bill Clinton in January 1993, reinstated by Republican President George W Bush in January 2001, rescinded again by Democratic President Barack Obama in January 2009, and reinstated again by Republican President Donald Trump in January 2017.
President Trump’s version of the policy was more brutal than President Reagan’s and President Bush’s. The Mexico City policy initially applied only to family planning funds, but the Trump administration’s version of it, officially known as Protecting Life in Global Health Assistance, applied to all U.S. health aid.
Implementation of President Trump’s iteration of the policy resulted in loss of funding for hundreds of organisations providing sexual and reproductive healthcare information and services. This loss of funding resulted in millions of people around the world losing access to critical sexual and reproductive health services.
Ironically, for a policy aiming to reduce demand for and access to abortion, a study published in 2019 in the medical journal, The Lancet, demonstrated that the Mexico City Policy increased the rate of abortion in some affected countries, for the reason that the policy also reduced access to contraception, consequently resulting in increase in unintended pregnancies.
Findings of the paper titled “USA aid policy and induced abortion in sub-Saharan Africa: an analysis of the Mexico City Policy” showed that that the Mexico City policy increased the rate of abortions by about forty percent in the twenty-six countries studied in sub-Saharan Africa; Kenya included.
US Government Funding was the largest single source of funding for family planning for Kenya during the development of the National Family Planning Costed Implementation Plan 2017-2020.
Drastic reduction of this funding due to the implementation of the Mexico City policy cut off many Kenyans from vital sexual and reproductive health and family planning services. Especially those Kenyans from poor and underserved communities.
However, even as we welcome this change in shift of policy from the US government that is likely to benefit Kenyans, it is important that Kenya works towards full domestic investment of sexual and reproductive health and family planning programmes for three reasons.
The first reason we need to secure full domestic investment of sexual and reproductive health and family planning programmes is that the Mexico City policy will be reinstated when a republican president is elected in the United States, resulting in loss of US government funding.
The second reason we need to secure full domestic investment of sexual and reproductive health and family planning programmes is that Kenya’s status as a lower middle-income country means that we are slowly being weaned off funding for such programmes as sexual and reproductive health and family planning. Indeed, the Health Sector Working Group Report 2021/22-2023/24 published in October 2020 notes that development Partners for Health Kenya (DFID, UNFPA, USAID, and The Bill and Melinda Gates Foundation) have pledged to match government of Kenya funding for Reproductive Maternal Neonatal Child and Adolescent Health (which includes family planning) funding in a sliding scale till Kenya takes over domestic financing by 2023.
The third reason we need to secure full domestic investment of sexual and reproductive health and family planning programmes is that at the Nairobi Summit on the 25th anniversary of the International Conference on Population and Development (ICPD25) held in November 2019, President Uhuru Kenyatta committed that Kenya would increase financing of family planning commodities from domestic resources.
In January, we received the good news that Kenya is currently on course to meet her family planning goal for modern contraceptive prevalence according to the latest Family Planning 2020 progress report, adding two million modern contraceptive users since 2012.
To sustain this progress, it is important for the national government and county governments to allocate funds for family planning and reproductive healthcare in the budget from our national revenue as opposed to relying on funding from external sources as it has been.
By Evelyn Samba. Ms Samba is the Kenya country director at Deutsche Stiftung Weltbevoelkerung (DSW).
This op-ed article was first published in Kenya’s Standard newspaper on 5th February 2021