EXECUTIVE SUMMARY

The Global Gag Rule Impact Project undertook research to examine whether and how the policy is disrupting access to basic family planning and reproductive healthcare, including HIV prevention services, for couples and young people who desperately want and need them. From July 2002 to May 2003, research was conducted in four countries — Ethiopia, Kenya, Romania and Zambia. Research teams interviewed a range of experts involved in family planning and reproductive healthcare, medical personnel, government policymakers and program managers, and donor agency representatives. The research teams also conducted site visits to facilities in both urban and rural areas, including NGO and government clinics and hospitals, youth centers, rural outreach programs, and a freestanding maternity facility. In some instances, teams were able to interview clients of these facilities about their reproductive health needs and preferences.

Our research has found that the Global Gag Rule is taking a toll on the lives and health of women, children and families around the world. Even as NGOs work hard to improve the health of overseas communities by providing access to family planning, related maternal and child healthcare, and HIV/AIDS prevention, the loss of resources due to the Global Gag Rule serves to break down these vitally needed services. The following is a brief summary of our key findings. For a detailed narrative report on each country, see the individual case studies.

Reducing Access to Family Planning and Related Health Services

Established family planning organizations forced to close clinics and cut services
A quarter of all married women in Kenya who want to space or limit births are not currently using family planning, and maternal deaths at 1,300 per 100,000 live births are extremely high. Yet, as a result of the Global Gag Rule and consequent loss of USAID funding, two of the leading family planning NGOs have closed five of their clinics. These NGOs have also had to cut their staffing by as much as 30 percent, reduce services in remaining clinics, and raise fees in order to remain viable.

• Three of the clinics were operated by the Family Planning Association of Kenya (FPAK), the oldest family planning organization in Africa, which served almost 19,000 clients in 2000. The clinics provided not only family planning services, but also pre- and post-natal obstetric care and well-baby care for mothers and infants. One of the three clinics was in a slum neighborhood in Nairobi where no government-run clinic exists to serve as an alternative.
• Marie Stopes International Kenya (MSI Kenya) has been providing services in Kenya since 1985. Prior to the Global Gag Rule, MSI Kenya had 21 clinics offering services such as screening and treatment of malaria, screening for cervical cancer, as well as infant and child healthcare check-ups, vitamin A tablets and immunizations. For 10 years, the now-closed Mathare Valley clinic in a slum neighborhood of Nairobi was the only health facility serving a community of 300,000 people. Because women in this area rarely, if ever, leave the community, the loss of services from the clinic is enormous. The women interviewed said they may be forced to forgo contraception and healthcare for themselves and their children.

Abortion is legal in Zambia for a range of indications not permitted by the Global Gag Rule, including risk to the physical or mental health of the woman, and fetal abnormalities. Although Planned Parenthood Association of Zambia (PPAZ) does not provide abortion services, they rejected the gag rule because they could not ethically withhold abortion counseling and referral information from their clients. PPAZ is Zambia’s leading family planning organization, and the only NGO in the country that operates clinics. As a result of its stand on the gag rule, PPAZ has lost 24 percent of its funding and has had to cut back on clinic-based services and crucial community outreach programs to rural areas. PPAZ had also been a key conduit of contraceptive supplies to smaller NGOs and government health centers, a role it is unable to sustain since refusing the gag rule.

Family planning providers and their clients deprived of contraceptives

The demand for contraceptives has never been higher in developing countries, yet the funding available for supplies is not keeping pace with demand. Compounding this crisis is the fact that NGOs that refuse to sign the Global Gag Rule lose access to U.S.-donated contraceptives. It is ironic that the Global Gag Rule denies many NGOs access to in-kind donations of the very contraceptives that can prevent recourse to abortions. For example:

• In Ethiopia, one of the world’s poorest countries, where the rate of maternal death is exceedingly high, women are often desperate for contraception. A rural clinic in Ethiopia that is now ineligible to receive USAID supplies due to the Global Gag Rule reported being nearly out of Depo-Provera, a long-acting contraceptive method used by 70 percent of its clients.
• In Lesotho, one in four women is infected with HIV/AIDS — one of the highest rates in southern Africa. Over a three-year period, from 1998-2000, the Lesotho Planned Parenthood Association (LPPA) received 426,000 condoms, along with smaller quantities of IUDs and Depo Provera — all donated by USAID. Because of their refusal to agree to the gag rule restrictions, they no longer receive USAID contraceptives including condoms. LPPA was the sole recipient of USAID supplies; 2000 was the last year that USAID shipped family planning supplies to Lesotho.

The impact of the Global Gag Rule on access to contraceptives including condoms is far-reaching. Desperately needed USAID-supplied contraceptives are no longer being shipped to 16 developing countries in Africa, Asia and the Middle East. These family planning organizations were the only recipients of USAID contraceptives in their countries. The leading providers of family planning in 13 other developing nations are also no longer receiving USAID contraceptives.

Efforts to counteract women’s reliance on abortion hindered
In Romania, women routinely turn to abortion because of their lack of access to family planning information and services and because the health system compensates physicians more for abortions than for contraception. Poorly-performed abortions continue to account for many maternal deaths in Romania. The Global Gag Rule has reinforced the longstanding separation between abortion and family planning services, rendering the United States — one of Romania’s largest health donors — unable to forthrightly address the need to integrate family planning counseling into abortion services. The gag rule makes it much more difficult for USAID to take the steps required to help lower the abortion rate and improve women’s health overall. The same is true in other Central and Eastern European countries where the situation is similar.

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The Global Gag Rule is taking a toll on the lives and health of women, children and families around the world. Educate yourself. Educate others. Act.