Policy change boost for family planning

The recent action of repealing the Mexico City policy by US President Joe Biden is welcome news for reproductive healthcare in Kenya.

The Mexico City policy, referred to as the global gag rule, bans US 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-US 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 policy has been adopted and revoked by executive orders along partisan lines. It was rescinded by Democratic President Bill Clinton in January 1993, reinstated by Republican President George W Bush in January 2001, rescinded again by Democratic President Barack Obama in January 2009, and reinstated again by Republican President Donald Trump in January 2017.

The Mexico City policy initially applied only to family planning funds, but the Trump administration’s version known as Protecting Life in Global Health Assistance, applied to all US health aid. Implementation of Trump’s iteration of the policy resulted in loss of funding for hundreds of organisations providing sexual and reproductive healthcare services. This resulted in millions of people 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, resulting in increased 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 the policy increased the rate of abortions by about 40 per cent in the 26 countries studied in sub-Saharan Africa. 

US government funding was the largest single source of funding for family planning in Kenya during the development of the National Family Planning Costed Implementation Plan 2017-2020. Drastic reduction of this funding cut off many Kenyans from vital sexual and reproductive health services. 

However, even as we welcome this policy change from the US government that is likely to benefit Kenyans, it is important that Kenya works towards full domestic investment in sexual and reproductive health and family planning programmes for three reasons.

The first reason we need to secure full domestic investment is that the Mexico City policy could be reinstated when a Republican president is elected in the United States. 

The second reason 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  funding till Kenya takes over domestic financing by 2023. 

Two million

The third reason 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 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 and county governments to allocate funds for family planning and reproductive healthcare in the budget from our national revenue.

Ms. Samba is the Kenya country director at Deutsche Stiftung Weltbevoelkerung. evelyn.samba@dswkenya.org