Women are dying. They don’t have to.
Yesterday, people around the world celebrated (or grappled with) Mother’s Day. The day is classically marked by flowers and earnest Hallmark cards. But ideally, it would also be marked by an acknowledgement of what motherhood is like for mothers around the world — women who have been threatened by a particularly cruel policy of the Trump administration.
Some dire facts: Globally, close to 303,000 women die annually from pregnancy-related complications, 99% occurring in developing countries. In Kenya, my country, 488 women die for every 100,000 live births. Unsafe abortion is one of the leading causes of maternal mortality in Kenya, contributing to 35% of maternal deaths each year, compared to 13% around the world.
Motherhood is meant to be a positive and fulfilling experience. Unfortunately, this is never the case for many women, especially in developing countries. In these countries, motherhood is associated with pain, suffering, ill-health, and death.
In 2009 the U.S. rescinded the Global Gag Rule and greatly expanded funding to reproductive health organizations around the world. However, just 48 hours after being inaugurated as President, Donald Trump reinstated the rule, which requires organizations abroad that receive U.S. aid to sign a statement that they will not mention abortion to clients, provide abortions, or refer clients to legal abortion services. Trump’s policy extends restrictions to funding for family planning and reproductive health, maternal and child health, nutrition and HIV/AIDS, as well as other infectious diseases under PEPFAR.
In my work, I see the consequences of this order daily.
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Growing up, women I knew went through physical, sexual, and mental abuse without raising their voices against their perpetrators — most often their husbands. Young girls were sexually abused. They got pregnant, dropped out of school, and got married. They left behind children who suffered from all sorts of abuse in the hands of caregivers.
In the neighborhood I grew up in, I heard the cries and suffering of young girls whose genitals were mutilated, some bleeding to death. All these cries for help went unanswered. This suffering denied me sleep in my teen years.
My first job as a young registered nurse was in a public district hospital. I am haunted by the death of Mary, a 22-year-old mother of two. Mary was rushed into the delivery room with heavy bleeding at 28 weeks gestation. Helplessly, I could not deliver Mary normally, since her unborn baby was in transverse lie. Unfortunately the referral was delayed due to lack of resources and personnel. Mary died.
Mary’s death left me questioning my nursing profession, my idealism, believing that with focused attention on the unmet needs of the community, I could restore health to all in need. As the head of the department, I mobilized money from colleagues and relatives to buy fuel for the ambulance, buy resuscitation drugs and fluids for Mary. But these efforts were in vain. If only the government resource allocation was realized and used for the right purpose, Mary would have lived longer.
As a reproductive health nurse at Family Health Options Kenya (FHOK), my daily encounters and experiences with vulnerable populations leave me devastated. Every day, I serve desperate young girls and women. And every day, I see how the Global Gag Rule affects the women of my community.
One 15-year-old girl, Pauline, was rushed into the emergency room at the verge of death. She was in shock, suffering from a severe infection after undergoing an unsafe procedure to terminate her unwanted pregnancy.
Her whole uterus was removed to save her life. Post operation, with tears rolling, the girl cried out to me, “Pray with me.” In simple words, I asked God to have mercy on her and to restore her health. She burst into sobs as she pronounced, “Amen.” As I retired to bed that night, my mind wandered, “How much more suffering will she endure today, as a student, an African girl, a Christian and as a woman, in the future?”
Another time recently, two women ran into our clinic screaming, carrying Rose, a middle-aged woman who was profusely bleeding and in shock. She had attempted an unsafe procedure to terminate her unplanned pregnancy. She was resuscitated and provided post abortion care and her health was restored.
For a long time, Kenya had the most restrictive legal regime with respect to the provision of safe abortion services. Restrictive legislation and limited service provision remain obstacles for women who seek to terminate unwanted pregnancies. They prevent or delay access to safe abortion and make lawmakers reluctant to relax restrictive legislation that limit information, funding, services, and training of health-care providers.
Studies have shown that restrictive abortion laws do not prevent abortions; instead, they prevent access to safe abortion. Limiting access to this procedure is devastating for women’s lives and health, for women’s families and communities, for the health-care system and — ultimately — for the country.
Limiting access to this procedure is devastating for women’s lives and health, for women’s families and communities, for the health-care system and — ultimately — for the country.
According to a study by Ipas on the magnitude of unsafe abortions in Kenya, every year at least 2,600 women die from unsafe abortion; 21,000 more women are hospitalized annually with complications from incomplete and unsafe abortion.
The rescinding of the Global Gag Rule in 2009 allowed organizations like FHOK to reach and serve desperate girls and women like Pauline who would otherwise die. From 2009 to 2014, FHOK contributed to Kenya’s massive gains in reproductive health indicators. According to the Kenya Demographic Health Survey, maternal morality was cut by 26 percent from 488 deaths per 100,000 live births to 362. This rate is still among the highest in the world. Contraceptive prevalence rate (or use) increased from 39 to 53% and the HIV infection rate dropped from 7.2 to 6% of the population.
FHOK also re-opened clinics that closed down while the Gag Rule was in place and expanded its services, providing more than 3 million reproductive health services in 2016. Services ranged from HIV medication to cervical cancer screenings, free contraceptives, sexual and gender-based violence, as well as skilled delivery.
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But now that Trump’s Global Gag Rule has been reinstated, it stands to gut this progress, and by extension, it will gut Kenyan families, women, and girls.
Women should not be restricted from accessing reproductive health services because a funder dictates what I can and cannot provide. The impact is already evident on the ground. FHOK has terminated outreach services. Our Mombasa clinic has closed. Other clinics like Kibera have laid off staff members and will close in coming months. This led to a reduction in number of services provided in 2017 (2.9 million) compared to services provided in 2016 (3 million).
Subsequently, this will harshly affect the lives of women seeking reproductive health services. We will see a rise in maternal and neonatal deaths from HIV/AIDS-related complications such as tuberculosis, pregnancy complications, sexual and gender-based violence and cancers of reproductive organs, as well as high morbidities
The good news is, these are all preventable deaths.
Sadly, because of this policy, Trump’s Global Gag Rule, I know they will die.
But they don’t have to. Eliminating restrictions on U.S. aid will provide access to comprehensive health care that can save and transform countless lives and see motherhood celebrated in developing countries.