A Malawian nurse at a training session. A report looking into the discontinuation of U.S. global health assistance to foreign non-governmental facilities providing abortion or abortion-related services, says that the ban is affecting the population in Malawi. Credit:Claire Ngozo/IPS

By Samira Sadeque
UNITED NATIONS, Feb 19 2020 (IPS)

A report released last week has detailed the complex ways in which President Donald Trump’s ‘Global Gag Rule’ (GGR), that blocks U.S. global health assistance to foreign non-governmental facilities providing abortion or abortion-related services, is affecting the population in Malawi, a country already hard hit with numerous climate change disasters. 

The report, titled ‘A Powerful Force: U.S. Global Health Assistance and Sexual and Reproductive Health and Rights in Malawi’ was released on Feb. 10 by Washington, D.C.-based sexual and reproductive health rights organisation CHANGE, the Center for Health and Gender Equity. 

Serra Sippel, president of CHANGE, told IPS they chose to study Malawi in part because the country is a recipient of U.S. assistance in the three key fields of sexual and reproductive health: family planning, maternal and child health, and HIV and AIDS. 

“The GGR impacts health structures and when health structures are impacted, it is often the marginalised and criminalised groups who bear the brunt of the impact,” Sippel told IPS. “This includes people living in rural areas, adolescent girls and young women, and female sex workers.”

The report details the numerous ways in which GGR affects the fabric of a country where many communities are already averse to abortion, often owing to religious concerns. This means that when a young woman needs to get an abortion, they might do so in unsafe ways in order to keep them secret. 

One partner organisation is quoted in the report as saying, sometimes a girl “would drink a potion like a solution of washing powder and some will use sticks” to engineer her own abortion. 

In the Sub-Saharan country, where abortion is a taboo and can even lead to 14 years in prison in cases where there is no “life endangerment” of the pregnant person, more than 50,000 women suffer annually from unsafe abortion practices, according to the report. 

Marie Stopes International (MSI), which doesn’t have direct services in Malawi, estimates that about 78,000 women undergo unsafe abortion practices in the country, according to the report. Abebe Shibru, MSI’s country director in Zimbabwe, shared with IPS the general effect it’s having in sub-Saharan Africa.  

“The GGR continues to aggravate the situation of undermining women’s right for choice,” Shibru told IPS. “Lack of adequate services for family planning, increasing rate of teen age pregnancy and increasing maternal mortality, mostly from unsafe abortions, are some of the issues that the GGR contributes to.”   

Sippel told IPS that the local MSI affiliate Banja La Mtsogolo (BLM) was “forced to end their participation in the U.S. PEPFAR DREAMS Partnership, a highly effective HIV prevention programme, because of the GGR”.

Some of the impact is top-down from the government. In 2015, the Termination of Pregnancy Bill, introduced in Malawi to ensure safe abortion in cases of incest, rape, fetal anomaly, was “slowed down” by the Minister of Health given their fears that it would affect U.S. foreign aid in the country while President Trump is in office, according to the report. 

“We also met with the International Planned Parenthood Federation affiliate Family Planning Association of Malawi (FPAM) who was forced to stop their participation in the LINKAGES project which provides HIV and AIDS prevention, care, and treatment services for key populations. Because of the GGR they were forced to close four clinics,” Sippel added. 

There is also a further effect on a community that’s hard hit by climate change, and vulnerable to a range of climate concerns such as intense rainfall and droughts, among many other issues. These issues, although not directly related to GGR, further amplify the negative effects such foreign policy has on those at the center of the crisis, according to advocates.

“When women are displaced because of climate change, their risk of exposure to gender-based violence often increases,” Sippel told IPS. “They are walking longer distances to get water and firewood. Also, as women enter camps post-disaster, their access to SRHR services can often be limited.”

Young Bangladeshi women raise their fists at a protest in Shahbagh. Credit: Kajal Hazra/IPS

By Stella Paul
KUALA LUMPUR, May 29 2013 (IPS)

“If I am thirsty and want a bottle of Coca-Cola I can get it, no matter where in the world I am. Why can’t I get contraceptives or sexual heathcare?” asked Carlos Jimmy Macazana Quispe, a youth representative from Peru currently in Kuala Lumpur for the third edition of the Women Deliver global conference on the “health and well-being of women and girls.”

A member of the Lima-based Instituto Peruano de Paternidad Responsable (INPPARES), a non-profit organisation that helps young Peruvians learn about sexual and reproductive rights, Quispe was expressing frustration that 36 percent of sexually active Peruvians – the majority of them youth – do not have access to contraceptives.

There are over a hundred youth like Quispe participating in the three-day conference that started on May 28, most of them from developing countries in Asia, Africa and Latin America where “contraceptives” are equated with condoms, teen pregnancy is on the rise and child marriage is often considered a social norm.

One of these ambassadors is Shreejana Bajracharya, a youth consultant from the Nepal-based Ipas, an NGO working to prevent deaths and disease from unsafe abortions in a country where 21 percent of all mothers are aged below 18 years.

Bajrachayra, who counsels young married and unmarried women factory workers about safe sex, says that over 80 percent of sexually active young women practice unsafe sex and risk pregnancy because they fear that contraceptives could cause them physical harm.

“I meet youth who tell me that…(birth control) pills could damage their kidneys or their heart,” she told IPS, adding incredulously: “And these are women who live in the capital (Kathmandu). If awareness levels in the capital are so low, imagine what youth in rural areas are experiencing.”

According to Pablo Aguilera, head of the New York-based HIV Young Leaders Fund, the situation is particularly bad for minority communities like those who identify as transgender, or people living with HIV/AIDS.

Aguilera, himself a young person living with HIV, identified two simultaneous problems: not only are at-risk populations unaware of the most basic information regarding safe sex and reproductive health, but they are also unaccounted for, passing under the radar of surveys or other attempts to identify target populations.

“We need to engage more youth from marginalised and stigmatised communities, such as transgender (people),” he told IPS, adding that vulnerable youth must be included in studies and surveys “not as interviewees but as interviewer. This will not only help them receive information firsthand, but will also sensitise them on the issue instantly.”

Leading experts in the field are keenly aware of the need to step up efforts. Babatunde Osotimehin, executive director of the United Nations Population Fund (UNFPA), admits that there is a lack of hard data on sexual and reproductive health, but says the UNFPA is helping government agencies across the world recognise the need to overcome this.

Even in cases where data exists, governments do not utilise it for “practical purposes such as planning, and that is a big challenge,” Osotimehin told IPS.

Jyoti Shreshtha, a post-graduate student from Kathmandu, says the Nepali government “does not make a conscious effort to educate” youth on issues like HIV/AIDS and sexual rights.

In countries like Bangladesh, says student leader Umme Mahbuba, events and conferences around pregnancy, early motherhood, safe sex and contraceptives are targeted mostly at professionals, experts or academics. “Youth often stay away from these forums thinking ‘this issue is not for me’,” Mahbuba told IPS.

This can be attributed partly to the jargon that surrounds conversations about sexual health. According to Faustina Fynn-Nyame, country director for Marie Stopes International (MSI) in Ghana, young people are put off by “incomprehensible literature” and terms like “family planning”, which they cannot identify with.

“There is a need to take communication more seriously and coin terms that are youth-friendly,” she said.

But none of these tactics on youth engagement will go far without massive investment in this global effort.

“There is an urgent need to invest more (in)…creating effective tools of communication and building communication skills,” said Aguilera.

Some countries are feeling the financial crunch more than others. Sinthuka Vive, a student from the war-ravaged town of Jaffna in northern Sri Lanka, says the state is struggling to fund reproductive health services.

“During the war, many hospitals were damaged,” she told IPS. “The few that survived are struggling to provide care to married women. Youth, meanwhile, have nowhere to go, no one to provide them with counseling or information.”

The issue of funds has been a major topic of debate at the conference underway in Malaysia, particularly with regards to promises made at the July 2012 London Summit on Family Planning, where global leaders pledged a total of 2.6 billion dollars to provide 120 million more women and girls in the world’s poorest countries with voluntary access to contraceptive services, supplies and information by 2020.

It remains to be seen whether or not these funds will be leveraged to improve the sexual health and reproductive rights of youth around the world.