The US President, Donald Trump signed an executive order that would block funding and foreign aid to any international nongovernmental organisations that provide abortion services to women seeking them or those that even offer abortion as an option to unwanted pregnancies.

The Global Gag Rule, as it was dubbed was first established in 1984 by the Republican president, Ronald Reagan; when Barack Obama took office, he rescinded the policy in 2009. OYEYEMI GBENGA-MUSTAPHA reports that the Global Gag Rule has ripple effects not only on women’s freedom on reproduction choice but on adolescents too.

Access of sexually active adolescents to contraception can make a difference. And forestall untimely deaths. Nigeria has the highest rates of adolescent fertility in sub-Saharan Africa. Over 900 000 births to adolescents occur annually and 150 out of every 1000 women who give birth in Nigeria are 19 years old or under.

These are the stark realities painted by Dr (Mrs) Morenike Oluwatoyin Folayan who is the Coordinator of the New HIV Vaccine and Microbicide Advocacy Society. Dr Folayan is a Reader with the Obafemi Awolowo University (OAU), Ile-Ife, Nigeria. As an advocate involved in youth’s reproductive and sexual health, she could not but express her concerns about the effects of Global Gag Rule (GGR) on Nigerian youths.

The New HIV Vaccine and Microbicide Advocacy Society (NHVMAS) recognised that access and use of effective contraception provide both health and social benefits by reducing unintended pregnancies and abortions. These critical benefits of contraception use are of importance to adolescents in Nigeria, especially female adolescents.

Female adolescents are more at risk of having unintended pregnancies and unwanted births which can lead to non-psychotic major depression (postpartum depression), feelings of powerlessness, and a reduction in overall physical health. For adolescents who have unintended pregnancies, school drop-out and complications of illegally induced abortion are some of the complications reported with dare consequences. Pregnant adolescents also have greater risks than adults for sexually transmitted infections, especially HIV-1 infection.

Sadly in Nigeria, contraception access and its promotion are limited to married women. Its association with family planning makes the public, community and health care providers think of contraception for use only among couples who are thinking of spacing children. While there are clear guidelines and programmes that promote access of women to contraception, there are conflicting guidelines on access and programmes for sexually active adolescents to contraception. Family planning centres also have limited competency to education and support adolescents’ use of contraception. Finally, the concept of parental consent prior to sexually active adolescents’ access to contraception creates a barrier to access of adolescent to education and uptake of contraception services.

Nigeria is a signatory to the FP2020 targets. It made a commitment at the 2012 London Summit on Family Planning to achieve a modern contraceptive rate of 27 percent among all women by 2020 and updated this commitment in 2017. It, however, did not make clear statements on promoting access of adolescents to contraception within its framework for increasing contraceptive rates.

With the stark reality that Nigeria gets its support on commodities from international donors, the issue of adolescents’ access to contraception will be further plunged, and more unplanned pregnancies will occur, leading to termination with its consequences. Girls also get pregnant from rape. So those safe spaces from abortion are needed.

Dr Folayan said GGR, as a policy serves to deny U.S. funding to global health organisations if they use money from other donors to provide abortion services, counseling or referrals, this is despite these services being legal in the U.S.; and ultimately, it removes critical funding for life-saving health services like contraception, maternal health, and HIV prevention and treatment in developing countries such as Nigeria.

Dr Folayan is apprehensive that her organisation’s roles in advocating, supporting and creating the right environment that facilitate access and free choices of youth to contraception will soon be dampened, and the little progress recorded so far will be eroded.

As she said that the global gag rule becomes a threat to this slow-growing movement, “all organisations working in the family planning space that receives funding from the US government cannot provide or discuss abortion services. This is not about them using US funds to fund abortion. They cannot use any other source of funding they access to do work on safe abortion, also simply because they access US funding.”

“This is the major threat to the work with adolescents in Nigeria. Abortion currently remains the main form of contraception for many adolescents who sadly cannot get access to modern contraception at healthcare clinics because of stigma from healthcare providers. They resort to myths and misconceptions to prevent pregnancies. When pregnant, they then resort to abortion. More than 50 percent of the adolescents’ unwanted pregnancies are terminated by abortion. Nigeria has one of the highest rates of female adolescent abortion in the world. Making abortion safe is critically important for adolescents in Nigeria. Creating safe abortion spaces for adolescents as part of the comprehensive sexual and reproductive health response for the adolescent is non-negotiable. The global gag rule will shrink our ability to create that space in Nigeria,” she lamented.

NHVMAS does not do direct service delivery, but referral, and as a recipient of funding from international agencies advancing safe reproduction services it has started feeling the heats of the effects of GGR.

Dr Folayan recalled that NHVMAS indirectly received PEPFAR funding through a project it had. “Before we signed the contract for the 2017/2018 grant, we were informed about the global gag rule and its implication. We did write back to the organisation that we shall not sign to the rule and were ready to drop the grant if we had too.

“They did not come back asking us to sign for it. We did get our grants. So, yes at NHVMAS, we can continue to advocate for the sexual and reproductive health and right of adolescents, even to safe abortion, with some fears and concerns about the global gag rule limiting what we do. However, NHVMAS is one of the many organisations that can continue to work in the space, because we are resilient. A large number of organisations working in the space may otherwise be affected by the GGR. So in effect, the number of NGOs working in creating safe abortion spaces may just shrink with time.”

Dr Folayan is not too happy with this reality as she can tell of stories of adolescents who have had to deal with abortion, and how abortion was their safe way out, as she explained, “Many adolescent girls do things that make them have incomplete abortion. Those safe abortion spaces provide them the needed help to get their lives back, and have the chance to make good success of their lives.”
“There are adolescent boys and girls in committed relationships also need those spaces, they have sex, the girl gets pregnant but they both are not ready for commitment. They both come to such created safe abortion spaces to procure abortion so they both can continue with their lives together. It is not all just about illegal abortions.

She explained, and added, “I can tell of stories of adolescents who have had to deal with abortion, and how abortion was their safe way out. Many adolescent girls do things that make them have an incomplete abortion – many, many, many, many, many. Those safe abortion spaces help them handle the incomplete abortion.
In low-income countries, complications from pregnancy and childbirth, including unsafe abortion, is one of the leading causes of death for young women ages 15-19. Each year at least two million women undergo unsafe abortions, and tens of thousands die from them. The country’s restrictive law on abortion is responsible for this.”

Dr Folayan recollected how she met Sade (not her real name) who had attempted an abortion using local herbs. The abortion was incomplete. She had gone to a private clinic to seek help but the cost was too exorbitant. “I met Sade during one of my project visits to a site that creates safe spaces for adolescents to accept contraception. Sade was able to access cost-free safe abortion services to prevent her coming down with septic abortion – a condition that increases her chances of not being able to have babies in future. With the application of the global gag rule, such safe abortion spaces will not be available to a large number of girls like Sade who need such safe spaces to provide services to prevent septic abortion.

Also, during one of her monitoring visits, she learnt about Tosin and Taofeq (not their real names) who were sexually active adolescents, committed to one another, but could not access contraception at any health care facility because of fear of stigma. Tosin became pregnant. Taofeq came with Tosin to one of those safe abortion spaces to procure an abortion. They were not ready for any children. They both had their education to deal with. The space not only helped procure an abortion for this adolescent couple, but also introduced them to contraception so they could prevent further pregnancies. So as an organisation, and as advocates we see GGR taking reproductive rights away from women, especially youths.

“The problem extends far deeper than access to abortions. It also means that these organisations who offer so much more than abortion, for example, sexual health education, regular STI screenings, and all other sexual health-related services, will be denied funding simply because they offer abortion as a choice.”
Won’t there be a rescinding of this stifling policy? Live and let live.

The Nation

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