Global Gag Rule Threatens Reproductive Health in Kenya: Study

August 26, 2020

The expanded Global Gag Rule (GGR) policy, implemented by the Trump Administration in 2017, threatens sexual and reproductive health and rights in Kenya by inhibiting heath system functioning, according to a research article published in the journal Sexual and Reproductive Health Matters by members of the Global Health Justice and Governance Program (GHJG) at Columbia University Mailman School of Public Health in partnership with the African Population and Health Research Center.

The Kenya research findings were published just days after the U.S. State Department released its second report on the implementation of the GGR. While the report finds that organizations that provide family planning, HIV, tuberculosis, and nutrition programs have lost funding because of the policy, it minimizes the extent to which delays or disruptions in health care delivery and access ensue. Counter to the State Department report, GHJG’s research in Kenya indicates that the policy collapses NGO partnerships and coordination, dismantles referral networks and integrated service delivery, and reduces financial support for health worker salaries and family planning commodities, all of which are critical for health systems functioning.

“All people, everywhere, deserve access to quality health services, including for sexual and reproductive health,” says Terry McGovern, JD, who is an author of the journal article and chair of the Heilbrunn Department of Population and Family Health at Columbia Mailman School and director of GHJG. “Research is fundamental to the understanding of the deep impact the Global Gag Rule has had around the world: It has torn apart health systems and harmed women and girls. Our research is vital for holding our leaders in the U.S. to account, so that future policy will no longer stymie SRH service provision and access.”

McGovern serves as the principal investigator of GHJG’s research on the GGR, which in addition to Kenya includes two additional countries: Nepal and Madagascar. Study results are being published on a rolling basis this fall in a special issue of the SRHM journal, entitled “Exporting Harm: impact of the expanded Global Gag Rule on sexual and reproductive health and rights.” McGovern and Anand Tamang, director of research at the Center for Research on Health, Environment, and Population Activities, are guest-editors of the issue. In addition to the research findings, the special issue will include a series of commentaries featuring the perspectives of legal experts, grassroots advocates, and public health program implementers from the research countries.

In addition to the country-level studies, the special issue features research at the global level by GHJG, including a new paper that found participation in global health coordination, as well as standard-setting meetings on public health practices, is often determined by an organization’s willingness to comply with the GGR, regardless of relevant expertise or a history of participation.

“Chilled debate, reduced transparency, and the widening chasm between compliant and non-compliant organizations also leads to the isolation and effective ‘ghettoization’ of sexual and reproductive health and rights work. This fragments health systems—running counter to decades of concerted effort by Ministries of Health, UN agencies, donors, and other stakeholders—and breeds damaging inefficacies that undercut patient-centered care,” the authors of the new journal article wrote.

Previous iterations of the GGR prevented U.S. Global Health Assistance from going to foreign NGOs that provide, counsel, refer, or advocate for legal abortion, even if they do so with other sources of funding. The expanded policy applies to an additional $8 billion foreign aid dollars, as well as to non-USG funds that flow through “gagged” organizations.

Columbia Mailman School co-authors of both Sexual and Reproductive Health Matters papers include Terry McGovern, Emily Maistrellis, and Sara Casey. GHJG research on the GGR is supported by the David and Lucile Packard Foundation and the William and Flora Hewlett Foundation.