Global Gag Rule: Implications For Women In Nigeria

March of each year is set aside to celebrate women worldwide as pillars who despite gender disparity strife to make headway in life.

A common saying, “educate a woman or girl child, you educate a nation” resonates strongly, but sadly, most issues concerning the girl-child is relegated to the background as she is believed in some parts of the world to be seen and not heard.

Nothing best illustrates the dangers the girl-child faces in Nigeria than the issue of funding challenge for reproductive health and security in schools, especially the troubled North East.

With little financial commitment from the Nigeria government in making available regularly, modern contraceptive commodities for women and young adolescents, lives of millions of girls are at risk and face the prospect of dying yearly from complications of unsafe abortions as a result of unintended pregnancies.

In Lagos State, Southwest region of Nigeria, Mary Adams, 33 who resides in the Ogba area, along College Road, narrated to our correspondent that, “I don’t use any family planning method because a friend of mine told me how she was told at the Primary Health Care, (PHC) that commodities are not available. That alone discouraged me.

“I am a petty trader and I don’t have such time going to get my preferred family planning method and be told it’s not available. So, I and my husband has been practising withdrawal method for some years now and we currently have three children.

“We are done with child birthing. We want to concentrate on training the children we have. I can’t really explain what happened that night when my husband came back and we had sexual intercourse. We were both at the peak of the intimacy and we didn’t realise he ejaculated inside me. Since then, I carried on with my daily routine. One month later, I realised some changes in my body that seem like pregnancy.”

Mrs. Adams revealed that she was scared of the next step to take when she was confirmed pregnant. “At that moment, I thought of my life, what will I do? How will I cope? I decided to get rid of the pregnancy but how do I go about it? That was my greatest fear.

“My desperation increased and I had no money to get a proper abortion done and so I took several concoction but the baby refused to give way. I just resolved to carry the pregnancy, since I had no choice,” she cried

The husband of Mary, Mr Abiodun Adams, a car mechanic, recounted how withdrawal method during sexual intercourse has been working for him and his wife but has failed him.

Another respondent, Mrs. Cecilia Amadi, 40, resident in Oke-ira, Ogba, Ifako Ijaiye, said, “I already have four children and don’t need another. My last child is three years old. Unknown to me, the implant that was inserted on my arm at a family planning clinic had expired. I went for a test and was confirmed pregnant. I felt my life was coming to an end.

“I and my husband really want to get rid of the pregnancy. I ended up in a ‘clinic’ and the pregnancy was removed in a dark room. Weeks later, I started bleeding and was rushed to the health centre close to my house. According to the test conducted, my uterus was affected. I am still living with the pain. I can’t talk anymore. You have opened old wound.” Mrs. Amadi was sobbing as she recounted her ordeal.

These women are just two of the over 10,000 women who are at risk, with hundreds of thousands more likely to die across the world with no access to safe abortion and birth control.

It is estimated that in almost all developing countries, more than 22 million women every year are likely to have unsafe abortion because they lack access to safe, high quality abortion care.

According to the Guttmacher Institute, 44 percent of all pregnancy worldwide are unintended and more than half (56%) of unintended pregnancies ended in abortion from 2010 to 2014.

There are 225 million women in developing countries who want to avoid pregnancy but lack access to modern contraception. Death from pregnancy related causes is the second leading killer of teen girls and women in the global south with most at risk of injury or death from unsafe abortion.

Despite these shocking figures and the implications, President Donald Trump chose to expand the Global Gag Rule, (GGR), a harmful US policy clearly stipulates that non U.S. non-governmental organizations (NGOs), receiving U.S. family planning funding cannot inform the public or educate their governments on the need to make safe abortion available, provide legal abortion services, or provide advice on where to get an abortion.

Documentation and analysis of the impact of the global gag rule has shown that the policy restricts a basic right to speech and the right to make informed health decisions, as well as harms the health and lives of poor women by making it more difficult to access family planning services. It has also been found that the policy does not reduce abortion.

Under the Global Gag Rule, foreign NGOs are forced to choose between one of two options; accept U.S. family planning funds and be prohibited from providing abortion counseling, referrals, or even advocacy efforts as well as from providing abortions outside of the three exceptions: refuse U.S. family planning funds and attempt to secure alternative sources of funding in order to keep health clinics open, continue providing a range of sexual and reproductive health services to clients, and continue advocating for law reforms to reduce unsafe abortion.

Governments around the world have made progress towards ensuring every woman can exercise her right to abortion, a progress that will be slowed by the GGR.

However, lack of access to contraception and safe abortion is a major public health crisis for women in the world’s poorest countries. But rather than addressing these crisis, the Global Gag Rule broadens restrictions already imposed by the Helms Amendment, which prohibits the use of U.S. funds for abortion related work overseas.

Accessing the impact of the expanded GGR by Trump, a Professor of Obstetrics and Gynaecology, Innocent Ujah, who is also a Consultant Obstetrician Gynaecological Surgeon of the Jos University Teaching Hospital Plateau State said, the reproductive health and rights of women, men, boys as well as girls will definitely be worse, as teenage pregnancy will increase, the number of girls that are out of school will also increase.

Ujah also pointed out that unsafe abortion will increase geometrically with increased complications. The Maternal Mortality Ratio, (MMR) in Nigeria will increase and this will further worsen the socio-economic circumstances of Nigeria.

He also points to the economic implication, stressing that the job losses of many Nigerians as a result of the effects of the GGR was obvious. Ujah noted that many NGOs that depended wholly on U.S. funding for their activities are shutting down, downsizing and outright lay off of their workforce, which further swells the labour market with its attendant consequences, including armed robbery, kidnapping, prostitution and terrorism.

While addressing the impact of the rule on women and girls, Ujah suggested that the Nigerian government should respond appropriately by increasing the budget for reproductive health and also make family planning widely available to mitigate the effects of the GAG Rule.

He said, perhaps, the over-dependence on donor funds may have been responsible for our inability to rise to the challenge posed by donors, adding that Nigeria should be able to provide quality reproductive health care for its populace.

The way forward, he said, Nigeria must intensify its efforts in aggressive advocacy and sensitization for increased use and uptake of contraception for girls, women, boys and also men, stressing that once the family planning and contraceptive uptake increases from the current 10-17% to about 80-90% (a tall order), the incidence of unwanted pregnancies resulting in unsafe abortion will crash.

Another medical expert, former Secretary General, Association of General and Private Medical Practitioners of Nigeria (AGPMPN), Dr. Kay Adesola, had this to say about the GGR. “Already Nigeria’s maternal mortality rate is very high and with the expanded GGR is going to create a huge gap. Women and girls are the most affected as many of these women are going to die from causes related to pregnancy and unsafe abortion.”

The family doctor charged federal, state and local governments to fill the gap of international donors by providing modern contraceptives through increased budgetary allocation for family planning commodities, emphasising that once this is done, Nigeria’s MMR will reduce as well as unintended pregnancies.

The director, Family Planning and Nutrition, Lagos State Ministry of Health, Dr. Folasade Oludara, said in 2017, family planning department’s allocated budget was N27 million while this year, 2018 it got N186 million, stating that the increase in the allocation came about as a result of the Global Gag Rule.

Oludara stated, “In addition, the government have gone further to add family planning as part of basic comprehensive health care services to be rendered at entry level ones the Lagos State health insurance scheme starts later this year. The scheme includes private health sector which will give it high coverage.

“A lot of our family planning programs are funded by donors since the government cannot do everything. Just like the State health insurance, the government has promised 1percent consolidated revenue fund to be used for the poor.”

According to Oludara, the United Nations Population Fund (UNFPA), have been supporting family planning programs in the state especially as it concerns adolescents and sexual reproductive health, rehabilitation mechanism for post-abortal patients and family planning services.

She said, “UNFPA have been telling us since 2017 that their funding will reduce. Right now, we are rounding off first quarter of 2018 and UNFPA has not approved anything for Lagos State.”

The director charged media practitioners to correct the socio- cultural myths that any woman who embraces family planning is promiscuous rather, family planning prevents maternal deaths by 34 percent and it does that by preventing unwanted pregnancy, unsafe abortion.

She however added that the GGR will awaken Nigerians to embracing family planning and looking at the country’s domestic law, there is need for a review to address sexual and reproductive health and right of women and also to cater for those sexually abused and victims of incest.

She said, public sensitization will help prevent cases like rape, incest, adding that Lagos States Domestic and Sexual Violence Response Team (DSVRT), ensures that people are protected as she charged parents to educate their children concerning sexuality as well as sexual rights.