Abortion: Nigerian Experts Fault Trump’s Expanded Global Gag Rule

Barely a year and half ago, specifically January 23, 2017, President Donald Trump of the United States issued a Presidential Memorandum Regarding the Global Gag Rule, also known as the ‘Mexico City Policy’. This order reinstates and dramatically expands the ‘Policy’ adopted under previous Republican administrations since 1984 to restrict America’s funding of some aspects of reproductive health.

The GGR due to the restrictions it places on how organisations use their own non-US government funds, which includes limiting conversations that health providers can have with their patients and also prevents them from pressing for legal change in their own countries. Health assistance provided to recipients found to violate the rule can be terminated.

In the wake of the policy announcement, Bill and Melinda Gates of the Bill and Melinda Gates had warned that the ‘Global Gag Rule’ imposed by President Donald Trump blocking U.S. funds to any organisation involved in abortion advice and care overseas could impact millions of women and girls, endangering their lives and those of their babies.

The fundamental issue with the directive is expected to result in funding from the world’s biggest donor to family planning and women’s health programmes in the developing world slashed.

The alarm by the Gates’ was startling to some keen watchers of the sector. In a recent interview, Mr. Gates said that Trump’s Global Gag Rule policy could “create a void that even a foundation like ours can’t fill.”

Today, the reality of Gate’s concern is evident across the world, especially in developing countries, even as stakeholders have raised the alarm that the GGR policy has endangered reproductive and overall health goals in Nigeria.

To this end, experts are warning that it is a ‘time bomb’ which is worsening the maternal morbidity and mortality indices in many developing countries of the world.

Investigation has shown that the alarming impacts of Trump’s GGR on Nigeria’s women’s sexual and reproductive health ranges from commodity insecurity to loss of key U.S. health partners, even financial and administrative burden of compliance.

Further disturbing effects of the policy termed, ‘Protecting Life in Global Health Assistance,’ are noticeable in diminished health assistance, chilling effects on advocacy with increasingly hostile domestic environment for sexual and reproductive health and rights.

This is even as analysts have raised alarm over the dangers of the reinstatement of GGR, noting that it seriously portends grave consequences for Nigeria for many reasons.

First, the country as the single largest recipient of U.S. international development aid relies heavily on global health assistance to meet the needs of its large and growing population.

Second, abortion is legal only when performed to save a woman’s life in Nigeria. Yet, the practice is common, and most are unsafe because they are done clandestinely, by unskilled providers.

Speaking on the development, Dr Abiola Akiyode-Afolabi, Women Advocates Research and Documentation Center (WARDC), Lagos, laments that the GGR rule has penalised hundreds of Non-Governmental Organisations (NGOs) and the women they serve in nearly 60 countries across the world.

Akiyode-Afolabi, who spoke during a recent training of the Network of Reproductive Health Journalists of Nigeria (NRHJN), in Ibadan, Oyo state, decried the rate of illegal abortion, saying the “GGR has destroyed the world and killed women who are at the receiving end. The rule thus jeopardises women’s right.”

She provided the context of unsafe abortion in Nigeria in her presentation titled; ‘Global Gag Rule Overview and the Implications for NRHJN.’

“Of the 40 to 60 million abortions that take place annually, at least 20 million are performed under unsafe, illegal conditions and up to 50 per cent of these women require follow- up gynecological care,” Akiyode-Afolabi said.

Bemoaning the impact of unsafe abortion in Nigeria, she says; “millions suffer permanent physical injuries, and at least 78,000 women die. Most of these deaths are preventable, and occur in countries where access to abortion is highly restricted or illegal altogether.

“The U.S. government is complicit in these preventable injuries and deaths due to President Trump’s decision to reinstate the global gag rule,” she maintained.

As research shows, nearly half of all unplanned pregnancies end in abortion in Nigeria. One in seven Nigerian women aged 15 to 49 have tried to obtain an unsafe abortion, either from ‘unqualified practitioners or qualified ones working under substandard medical conditions.’

“The restrictive abortion law means most abortions are clandestine and “very frequently unsafe,” Akiyode-Afolabi adds.

Painting a gory picture of the consequences, she states; “as a result, one quarter of all Nigerian women who have had an abortion report moderate or severe complications, and two thirds of women who have an unsafe abortion experience serious health consequences.

“Every year, hospitals in Nigeria treat approximately 142,000 women and girls for complications resulting from unsafe abortion. Based on recent reports, between 10, 000 to 34,000 women in Nigeria die annually as a result of unsafe abortion.

“Even where a woman obtains a legal abortion at a health care facility, inadequate staffing, training and equipment expose women to unnecessary risks. Among those who have an abortion performed by a physician, a large number developed complications and sought post-abortion care, indicating that the performing physician was not well-trained in abortion services. Few general practitioners receive training to perform abortions.

“The government, however, in its current report to the African Commission failed to include information regarding the number of deaths as a result of unsafe abortions and the measures it is undertaking to reduce this rate by ensuring women’s and girls’ access to safe abortion,” she notes regrettably.

She insisted that GGR is harmful to women’s reproductive health.

The Chairman, Association for the Advancement of Family Planning (AAFP), Dr. Ejike Oji, also expressed similar concerns stating that, “The GGR which has reproductive rights advocates reeling is significantly broader than similar bans in place intermittently since 1984. Those past actions were limited to about $600 million in family planning funding.”

Dr. Oji thoughts are contained in a presentation at the NRHJN meeting in Ibadan. In a presentation, “Historical antecedents of the GGR and its impact on Sexual Reproductive Health and Right, Civil Society Organisation Focal Point for FP 2020,” he argued that “there is a small health center in Lagos, Nigeria, a nurse advises women on how to have a healthy pregnancy, the center is supported by the U.N. Population Fund. This centre will be defunded.”

On her part, Hauwa Shekarau, Country Director, Ipas Nigeria, in her paper titled; “Barriers to safe abortion services in Nigeria”, says both the Criminal Code and Penal Code on abortion are restrictive and outdated.

Her words; “The law is obsolete and is not meeting the yearnings of the people. The law was inelegantly drafted.

Legally restricting reproductive health services such as abortion does not affect the number of abortions that happen.

“Legal restrictions on abortion make abortion unsafe, especially for poor women. Where abortion is legal and safe services are available, deaths and disabilities from abortion are greatly reduced.”

Shekarau cited Dr. H. Nakajima, Director-General, WHO, 1999, while condemning the country’s restrictive abortion law saying; “Hundreds of pregnant women, alive at sunset last night never saw the sunrise this morning.

“Some of them died in labour, some died of hemorrhage in a hospital lacking blood, some died in the painful convulsions of eclampsia and some died on the table of an unskilled abortionist trying to terminate an unwanted pregnancy.”

Also, the Guttmacher Institute 2015 fact sheet shows that unsafe abortion is a major contributor to Nigeria’s high levels of maternal death, ill health and disability.

Giving a broader view the vice-president of Marie Stopes International, Marjorie Newman-Williams said in a statement, “Evidence shows that by blocking funding to the world’s largest NGO providers of modern contraception, unintended pregnancies and abortions go up. As a result, women and girls are less likely to complete their education, have a career, or pursue their dreams for the future.”