This paper examines the adversative effects of the Mexico City Policy (or Global Gag Rule) and the overflow-stream of fears towards health that it has drawn to the health rights advocates and NGOs in Uganda. The paper dissects into issues surrounding the policy especially in regards to other health related services that have been deprived of the susceptible key populaces in the pretext of putting a stoppage to abortion linked services
By Denis Bukenya
Health Rights Researchers & Advocates
Human Rights Research Documentation Center (HURIC), and PHM-Network, Uganda
The Global Implications of the Gag Rule and its Manifestations on Reproductive Health Rights in Uganda
The world that is controlled by the frenzied ideological extremists who mind and care less about health is a terrible world. Putting health into consideration should be based on the changing landscape of the nations’ health priorities but not directed by the zillion selfish desires of the sentimental misogynistic political gossipers and propagandists whom the word health seem a soundless gong to their uncompassionate ears. Life has never been a patented good for the privileged few and therefore we all owe it respect in-disregard of the statuses and associations we subscribe to.
For that reason, it’s everyone’s obligation to break to the mantle all sorts of prejudices and partialities that circles a bondage around the right to health for the vulnerable and marginalized individuals. Therefore, as we en-route for the attainment of full Universal Health Coverage (UHC) century dream, closing the wide gender disparity and manifestations of institutionalized misogyny spaces that lower the health and dignity of women should be checked to achieve an egalitarian health for all goals. Countries should independently be allowed to design policies that align best with the priority needs of their nationals without dictation on what to choose. Certain policies can devastate the welfare of people if not properly checked before their implementation. When the current US president, Donald J Trump signed an executive order to implement the Global Gag Rule, it was undeniably true and an ugly corporate interlope to health in the early 2017. This was intended to put an end to federal funding going to multi-lateral groups which execute or provide any information on abortion during his maiden week in the office, few envisaged the policy’s eminent danger, and its despicable picture through its implications on Sexual Reproductive Health (SRH) which has started to gruesomely emerge.
Similarly known as the Mexico City Policy, the Global Gag Rule was first introduced by President Reagan in 1984, withdrawn by President Obama in 2009 and reinstated by President Trump in January 2017 (Jodi-Kay, 2017). This compels overseas Non-Governmental Organizations receiving US global health assistance to declare that they do not use their non US funds to offer pro-abortion services, advice and counsel patients about the choice of abortion, emergency contraception, post abortion services, or campaign for the decriminalization of the abortion. This is a broad policy that brackets in all global health organizations that receive US funding. It further stretches the consequences to the provision of other healthcare related services such as malaria or HIV/AIDS services which patients are now at the risk of not receiving.
This paper examines the adversative effects of the Mexico City Policy and the overflow-stream of fears towards health that it has drawn to the health rights advocates and NGOs. We shall further dissect into issues surrounding the policy especially in regards to other health related services that have been deprived of the susceptible key populaces in the pretext of putting a stoppage to abortion linked services.
Reports show how the policy has significantly weakened the financial capacity of the organizations working on AIDS, Zika virus disease, malaria, reproductive health and child healthcare especially in Africa through reduced provision of malaria medicines and family planning commodities such as condoms, rapid test kits, and HIV/AIDs antiretroviral drugs. The NGOs’ outreach program abilities and their inclusive overall capabilities to provide for the health needs of the women, girls, children and other vulnerable key populations such as the sex workers, refugees and the LGBTI communities in Uganda have been great strained. With time this has chronically stunted the healthcare improvement, undermining the effectiveness of the US investments in global health and compromising the progress of Sustainable Development Goal (SDG) #3.7 of ensuring universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes (WHO, 2015).
The hard-line volatile taste of the Global Gag Rule has been over salted that organizations, healthcare centres and clinics have cut down health services provided and downsized their staff due to the increased defunding insecurity as a result of the nonconformity to this policy. Marie Stopes Uganda shutdown 45 outreach teams across Uganda and twelve more are at a threat of being cut out. This project was offering cervical cancer and breast cancer screenings and promoting the use of Sayana press, a new brand of injectable contraceptive. This ended, however, thus causing SRH commodity stock-outs as shown in a report on the preliminary impacts of Trump’s expanded Global Gag Rule by (PAI, 2018). It was a significant project programme and an incorporated intervention for far-away populations to reach through provision of about 1.1 million Ugandans with contraceptives, and its efforts prevented over 342,800 unplanned pregnancies and 170,700 unsafe perilous abortions in the country (Jodi-Kay, 2017).
But since the organization is financially over stretched amidst aid cuts of over $120 million US-Dollars, they are unable to reach out to the most vulnerable communities and worst of all, the organization has laid-off many of its employees to adjust to the current aid defunding dynamics.
The policy has gone beyond intercepting the individual organizations’ work and started dismantling the work of networks. Before the policy, organizations that had inadequate SRH services would refer their patients and those that sought services such as contraceptive supplies, technical support and equipment, and family planning services to Marie Stopes Uganda or Reproductive Health Uganda. But after the implementation of the policy, organizations that chose to remain compliant to the Global Gag Rule switched from provision of such services and stopped referring people seeking reproductive health services like family planning from organizations that were nonconformists to the policy. This then has created a vacuum in the networks which are instrumental in providing holistic information on maternal mortality, supply chains, and clinical practices.
The research shows Uganda is shouldering the heaviest burden of adolescent and teenage pregnancies in sub-Saharan Africa. Twenty-five per cent, on average, of adolescent and teenage girls aged 15 to 19 are either pregnant or mothers already, while trend is rising in unsafe abortions from 294,000 in 2003 to 314,000 in 2013 as reflected in a report on the Global Gag Rule And What It Means For Africa (Jodi-Kay, 2017)
Uganda’s biggest share of its entire health budget depends on the global health assistance, with US government being largest donor and other health financing partners through the World Bank Global Financing Facility. In Uganda, reports indicate US global health funds pay for over 890,000 HIV positive Ugandans’ anti-retroviral treatment, about 93 percent of the patients. Uganda’s maternal mortality rate is 320 deaths per 100,000 live births, at a time when 33 percent of women aged 20 to 24 had a baby before they were 18 years old, as reflected in the Ministry of Health investment case report (MoH, 2016). This depicts the dire need for a comprehensive family planning for the young people. Uganda’s HIV prevalence still stand at 6.5 percent, thereby making it the tenth-highest in the world.
With the apparent defunding dynamics due to the insensitive Mexico City Policy, the HIV prevalence rates are likely to make a spaceship up-short because organizations are trimming down their support towards SRH in Uganda. Despite the stringent law on abortion in Uganda, allowances and conditions are provided under Article 22 (2) of the constitution whereby abortion can be carried out, stating “No person has the right to terminate (abort) the life of an unborn child except as may be authorized by law.” This means that much as abortions are illegal in Uganda, there are situations where they could be allowable (Uganda, 1995) say if the mother’s life is in danger as a result of the pregnancy, and the abortion is necessary to save her life. However, under this expanded global policy, there is no consideration for this provision. There are hundreds-of-thousands of women facing the risk of losing out on this indispensable and essential reproductive healthcare and advice. This is because of the threat-net that has been casted around the operations of the Uganda’s largest and leading providers of family-planning, antenatal care and cancer screening services, which is making it difficult to reach out to women experiencing medical complications in pre- and post-natal periods.
The general picture of health in Africa is depicted by pathetic unhealthy space thriving ever with disease, poorly maintained dilapidated structures of health centres with ever essential medicines stock-outs, inadequate medical kits and equipment, and poorly remunerated human resources with overwhelming impossible queues of ever decrying patients to attend to and treat. This makes it impossible for the NGOs to provide some of these essential health services to reduce the gap in health service provision. Therefore, the Global Gag Rule is a great nonperforming neocolonialist policy and a disaster to the global south states especially in Africa and it deserves the heaviest denunciation from the right to life activists. It is the women and other key marginalized populations in Africa facing the heavyweight grip of this policy. Ever since the policy was put into effect, the dynamic diversion of the global health aid is shuttering health centers and clinics serving some of the developing world’s most vulnerable groups. The pain of closures is mostly appalling in the poorest remote parts of sub-Saharan Africa, where clinics managed by Non-Governmental Organizations are the key source of women’s reproductive healthcare. Several of these healthcare centers offer maternal health, HIV/AIDS prevention and treatment, counseling on sexual violence such as rape, defilement and Female Genital Mutilation (FGM).
Solution: Prioritizing investment in the public health and financing through a fairer planning and funds distribution for health in the national budget, is the ultimate remedy to close a gap that has been created due to the donor aid cuts. This helps the government to improve the provision of essential health services such as Sexual Reproductive Health services with the main focus on maternal and child health thus reducing Uganda’s reliance on the policy ideologies that hold life-saving aid at hostage through the conditioned- and foreign-tied aid.
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PAI. (2018). THE PRELIMINARY IMPACTS OF TRUMP’S EXPANDED GLOBAL GAG RULE. Washington DC: PAI.
Solomon, F. (2017). The White House Is Cutting More Funds for Overseas Health Organizations Linked to Abortion. Mombasa: Time.
Uganda, T. P. (1995). CONSTITUTION OF THE REPUBLIC OF UGANDA, 1995. Kampala: State house.
WHO. (2015). SDG 3: Ensure healthy lives and promote wellbeing for all at all ages. New york: WHO.