Donor pullout spells doom for family spacing
US policy ban on funding for foreign organisations offering abortion has affected the financial capacity of local sexual and reproductive health bodies offering free services to women in developing countries including Kenya
Melissa Mumbua, a mother of three, sits eagerly at one of the Family Health Option Kenya (FHOK) centres in Kibera waiting for her turn to see the doctor. She is here to receive her contraception after expiration of the previous one.
Twenty minutes later, it is her turn. After explaining to the doctor why she is there, she can’t believe her ears after the doctor tells her she has to pay for the services, which she has previously accessed for free.
Surprisingly, the amount was too high. As a casual labourer, it could take her about a month or so to raise the required Sh3,000.
She is curious to know why she is expected to pay yet in 2016 when she received the recently expired implant, she never paid a cent.
Melissa is not the only woman experiencing this. Thousands of others have had to dig deeper into their pockets since 2017 after the US Government reinstated and dramatically expanded the Mexico City policy, also known as the “Global Gag Rule”.
The new rule requires foreign non-governmental groups that receive US global health aid to certify they do not provide abortion services except in cases of rape, incest or to save a woman’s life.
The organisations were supposed to sign a policy and those who failed to sign it such as International Planned Parenthood Federation (IPPF), a global provider of sexual and reproductive health services, which supports FHOK, were denied funding.
Clinics closed down
Because of funding withdrawal, the facility that used to offer comprehensive range of services, particularly in sexual reproductive health such as family planning advice and contraception, maternal health, HIV testing, prevention and treatment, cervical cancer screenings, can no longer afford to offer these services for free.
Apart from that, their outreach programmes where they distributed supplies, did tests and conducted screenings have been stopped. This means that around 76,000 women who used to receive their services annually are no longer receiving them.
“We lost about Sh22 million in response to the rule. As a result, we have closed down two clinics and about 20 staff have been fired.
We were using the money to offer a number of services and since we are no longer receiving the funds, so patients have to pay for the services,” says Amos Simpano, FHOK’s Director of Clinical Services.
He adds since thousands of women in Kenya have been left without affordable access to contraceptives, many have been forced to resort to services from local pharmacies because they are cheaper.
For example, the three-month injection at a local pharmacy is Sh100 unlike at the clinic, where it costs Sh400.
However, the only worry he has is about the quality of services and products Kenyans get out there despite their affordability because no one can be held accountable in case of anything.
He adds that because of the withdrawal of funding, the number of back streets abortions have gone up, especially in informal settlements.
Reproductive Health Network Kenya, an organisation that supports more than 450 individual doctors, midwives and other health workers, were also affected by the rule.
The rule resulted in the loss of two-thirds of their funding (Sh10 Million) according to Nelly Munyasia, the programme director.
Though their case is different considering that none of the providers they were supporting closed down their facilities, the fate is the same as patients are now forced to pay for services they were getting for free a few years ago.
Because not everyone can afford to pay for the services, a good number of women are now relying on public hospitals, which are sometimes underfunded, making sexual and reproductive health (SRH) services excluded as priority.
“No provider has closed shop so far because there is no specific clinic that was offering safe abortion services alone. All providers are trained and have the capacity to offer SRH services and those services are holistic and integrated,” adds Nelly.
She reveals that currently a good number of women don’t have the choice when it comes to contraception because there is unavailability of choices and no enough supply for HIV testing kits and drugs and contraceptives.
On their side, she says that they had to cut down the support given to the providers, stop their outreach programmes and lay off some staff.
And because of that, providers are now charging for the SRH services, which they initially used to offer for free.
“Girls and women are struggling to afford the services. Because of this teenage pregnancies have gone up and more girls are dying because of unsafe abortions since they can no longer afford to buy contraceptives,” says Nelly.
She also explains that quality of the products might be compromised because providers are now sourcing for the products on their own, unlike when the network used to supply them.
However, all hope is not lost because RHNK is trying to get more donors, policymakers, and governments to fund their projects and so far 122,000 friends both individuals and governments are willing to fund the programmes.
“Talks are underway with different government such as Danish, Finland, Canada, the United Kingdom and there is a positive feedback,” adds Nelly.
