Foreign assistance or attack? Impact of the expanded Global Gag Rule on sexual and reproductive health and rights in Kenya

Abstract

In 2017, the Trump Administration reinstated and expanded the Global Gag Rule (GGR). This policy requires non-governmental organisations (NGOs) not based in the US to certify that they will not provide, counsel, refer, or advocate for abortion as a method of family planning in order to receive most categories of US global health assistance. Robust empirical evidence demonstrating the policy's impacts is acutely lacking. This paper describes the effects of the expanded GGR policy in Kenya eighteen months after its reinstatement. We conducted semi-structured interviews with purposively selected representatives of US-and non-US-based NGOs, as well as managers and health providers at public and private health facilities, between September 2018 and March 2019. Organisations reported critical funding loss as they were forced to choose between US government-funded projects and projects supporting safe abortion. This resulted in the fragmentation of sexual and reproductive health and HIV services, and closure of some service delivery programmes. At public and private health facilities, participants reported staffing shortages and increased stock-outs of family planning and safe abortion commodities. The expanded GGR's effects transcended abortion care by also disrupting collaboration and health promotion activities, strengthening opposition to sexual and reproductive health and rights in some segments of Kenyan civil society and government. Our findings indicate that the GGR exposes and exacerbates the weaknesses and vulnerabilities of the Kenyan health system, and illuminates the need for action to mitigate these harms.

Permanently Repealing the Global Gag Rule Will Internationally Advance Reproductive and Sexual Health

“…The Global Gag Rule gives NGOs only two choices: end abortion-related care to continue receiving U.S. global health assistance funding or elect to forgo U.S. funding to continue providing abortion services, referrals, and advocacy. At its core, the choice is between providing comprehensive sexual and reproductive healthcare or receiving funding from the U.S. government (Tanyag 2017;Munzur-E-Murshi and Haque 2020;Ushie et al 2020).…”

Exporting bad policy: an introduction to the special issue on the GGR’s impact

“…NGO participants discussed how organisations that both do and do not certify the policy are experiencing financial and partnership losses due to the choices forced by the GGR, which in turn affects their sustainability and roles in the health system. 6 In some cases, non-certifying NGOs have closed clinics, laid off health workers, and discontinued training and material support to public facilities. This has a particularly devastating impact on women in rural and remote areas where there may be only one clinic offering a wide array of services.…”

“…At public and private health facilities, participants reported staffing shortages, stockouts of family planning and safe abortion commodities, and a disruption of referral networks. 6–8 The GGR also exacerbated existing contraceptive supply problems in all three countries.…”

“…Many NGO and facility-level participants at certifying NGO facilities stopped referring women to non-certifying NGO facilities for SRH services permitted under the policy. 6 , 7 Often, the forced choice between sources of funding meant organisations had to narrow their areas of focus; many had to halt either HIV or other SRH projects and discontinue partnerships with health facilities or community-based organisations that conduct outreach and connect rural populations with the health system.…”

“…Financial support for community health workers has been reduced, resulting in less community mobilisation and community-based distribution. 6–8 …”