The “Global Gag Rule” is a US government policy that requires non-governmental organisations (NGOs) that are not based in the US and that receive US global health assistance to certify that they will not provide, refer for, counsel on, or advocate for abortion as a method of family planning. It means that an organisation that provides HIV care and treatment with US funding may not also provide safe abortion.
Kenya relies heavily on foreign aid to finance its sexual and reproductive health services. The vast majority of this aid comes from the US government. The US provides 55% of Kenya’s development aid for health and 95% of sexual and reproductive health aid. The African Population and Health Research Center, in partnership with the Global Health Justice and Governance Program of Columbia University, carried out a study to establish how Trump’s expanded rule affected sexual and reproductive health services including family planning, safe abortion, and post-abortion care in Kenya.
It found that in the first 18 months, the expanded rule’s effects transcended the limitation of abortion care. It affected funding and disrupted collaboration and health promotion activities. It also strengthened opposition to sexual and reproductive health and rights, These losses weaken NGO support to the Kenyan health system and, we believe, will likely have a substantial impact on clients seeking sexual and reproductive health services.
The policy had far-reaching implications.
NGOs were forced to choose between providing safe legal abortion services and accepting US global health funding. NGOs that turned down US funding had to then find replacement funding from other sources. This led to health facilities being closed, frequent contraceptive stock shortages, staff layoffs and salary cuts. It also led to the curtailment of community-based activities, such as community health volunteers referring women for services.
In addition, NGOs that provided comprehensive integrated sexual and reproductive health services – such as HIV, child health and maternal health – reported closure of some components of their service delivery when they were forced to choose between US funding and funding for these other services. This meant that women encountered more difficulties obtaining these services.
The Global Gag Rule is ambiguous and confusing, purposefully so, leaving ample room for over-interpretation. This led to organisations reducing or ending services not restricted by the rule, such as post-abortion care, out of fear of violating the policy. It also emboldened opponents of sexual and reproductive health and rights and safe abortion. This stifled the efforts of those advocating for safe and quality care. It also compounded existing legal, policy and cultural barriers in the delivery of these services.