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Worries over increase in maternal mortality due to funds shortage

As U.S. Gag Rule Policy Frustrates Donor Agencies
Stakeholders Task FG On Special Budget For Women’s Reproductive Health
NGOs Denied USAID Grants, Seek Alternatives To Fund Operations

Following the take-off of the Global Gag Rule (GGR) policy of the United States of America, which blocks U.S. federal funding to non-governmental organisations (NGOs) with focus on women’s reproductive health and sexual rights across the world, stakeholders in the sector have expressed concern over likely increase in maternal mortality in Nigeria.

Their fears have been stoked by the gradual decline in activities of organisations that deal with women’s reproductive health and sexual rights in the country since the GGR policy took off, owing to difficulty in accessing grants from the US, a major donor nation.

The Gag Rule, also known as Mexico City Policy, is an Executive Order by the US government that blocks U.S. federal funding for NGOs that provide counseling on women’s reproductive health, including advocacy to decriminalise abortion.

The policy expects foreign NGOs to certify that they will not perform or actively promote abortion as a method of family planning, even with non-U.S funds, as a condition for receiving U.S. global family planning assistance.

But as lofty as the policy appears in the control of killings through abortion, health workers and other stakeholders in women’s health, including advocacy for birth control, population explosion, sexual violence, incest and rape, say the policy has started resulting in a spike in maternal mortality across the world.

This is because, according to them, the U.S remains the single largest donor country to global health efforts. “The policy is already having far-reaching effects on sexual and reproductive health and other health initiatives across the world even though it allows for exception in cases of rape, incest and life endangerment,” a leader of one of the NGOs in the country told The Guardian.
As it is, there are two sets of non-governmental organisations – the ones willing to sign up to the GGR and consequently, restructure their programmes, and those that declined to sign up and then forfeited their grants from the United States Agency for International Development (USAID) and have to seek alternative donors to fund theiroperations.
The implication is that some organisations whose activities were funded by USAID have to shut down because they refused to sign the GGR. Although some notable international organisations operating in Nigeria have signed up to it, as they had no options, such development is, however, impacting greatly on their operations, particularly as the Nigerian government does not fund activities of NGOs who work in the area of women’s health.

With the gradual shut down of grants due to GGR, it was admitted that the only way out is to consider special budget to cater for women’s reproductive health in the country.
Mr. Godwin Odemijie, a researcher on the impacts of the US policy on Nigeria, noted that the GGR is effective anytime the Republicans are in power.    
He stressed that the rule prohibits spending money on any programme that has to do with reproductive health, especially with regards to abortion and birth control.    
“But what is more difficult about the policy is the fact that even countries supporting reproductive health in terms of safe family planning or birth control advocacy will never receive any funding from America and that is the area it is affecting reproductive health issues across the world, especially in Africa that rely about 60 per cent on donors for their programmes.
“The problem with Nigeria in particular is that not much is coming from the government and that is the reason those working in the area of women’s reproductive health are crying out. Not necessarily because of what they intend to gain but because of the high maternal mortality rate consequent upon the policy.
“If we must move forward, we must budget rightly for the sectors that need the money most such as the health and education. We have a situation that is so lopsided. These few people that are so rich and are in custody of the national resources will rather take the money abroad. Their children are not here, their women are not suffering and their girl-children are not facing these issues we are talking about. It is the poor that are facing the problem and they are the people that need the care,” he said.
Speaking further on the implications of the GGR on Nigeria and Nigerians, Odemijie stated that some NGOs working towards reducing maternal mortality and gender-based violence can no longer fund their activities as they relied on funds from donor agencies.
“They are fast folding up. I know about Nigerian Urban Reproductive Health Initiative (NURHI), which was associated with a 10-percentage-point increase in the use of modern contraceptive methods and a similar increase in the desire of women to have fewer children. For whatever reason, they are leaving finally in December this year and I know that it is not unassociated with lack of fund.”
He added that with only N46 billion budgeted for the health sector in 2020, it would be difficult for the country to afford necessary facilities for reproductive health.
As the National Assembly scrutinises the 2021 budget proposal, he expressed the need for lawmakers to note that with the GGR strictly in operation, many more agencies handling women’s health-related cases are likely to fold up.
“Unless our government rises to the occasion, the nation is likely to witness loss of women and girls to unsafe abortions and other complications emanating from patronising quacks,” he said.
According to experts, the proposed N547 billion for health care, again, falls short of commitment made alongside other African nations about 19 years ago on health funding.

Consequently, Odemijie called on the media to use their platform in educating authorities on the seriousness of the issue.
“When people read about it in the papers, they will understand how the Gag Rule affects health care delivery, especially the aspect that involves women’s reproductive health. They will pay more attention to the issue of the meagre budget and the folding up of NGOs. They will understand the challenge at hand.”
On the issue of abortion and sacredness of human life, Odemijie stressed that every rule has an exception.
“The exceptions include where the life of a woman is threatened. In such circumstance, abortion is allowed.”He, however, stressed that even when a woman’s life is threatened or when the pregnancy is as a result of rape or incest, Nigerian doctors often decline to provide abortion services because of the law prohibiting it in the country. This, he noted, has resulted in several deaths as most women resort to patronising quacks.   
“To say the least, the law is long overdue for review. Even the British that handed the law to us have reviewed theirs three times. The law has to be reviewed in line with current reality.
“With the high rate of incest and rape across the country in recent times, there is tendency for increase in the number of unplanned pregnancies. In this circumstance, victims should be left to decide whether or not to keep such pregnancies. Many people are suffering today because certain things were imposed on them. Let people exercise their choice.

“There is a woman whose son got her two daughters pregnant during the lockdown. How do you address such issue? What do you do as a mother or father in that circumstance?”
Also speaking on the GGR and its consequences on Nigerian women, the Founding Director, Women Advocates, Research and Documentation Centre (WARDC), Dr. Abiola Akiyode-Afolabi noted that most of the health issues in Nigeria are reproductive health rights bill, family planning and population.
According to her, some of the NGOs working on women’s sexual and reproductive rights, gender-based violence and maternal mortality are affected.  
“In a way, the NGOs are majorly affected and because they cannot access the grant, it means that there would be limited grant to support the works in grassroots communities to reduce sexual and gender-based violence or the reproductive health challenges that we continue to have in Nigeria. 
“If you must know, Nigeria has the highest maternal mortality ratio when it comes to women giving birth, and most of the support they were getting before came from USAID. So, when they withdraw all these, it has a way of affecting the advocacy for that reduction. One should realise that abortion is one of the major factors that contribute to maternal mortality.”
Akiyode-Afolabi added that with the rule in place, advocacy against gender-based violence across the country would be grossly affected, as people will not have support to respond to such issues when they arise.
“For instance, when someone is gang-raped and needs an abortion, the law does not permit such since it does not fall under emergency, which the law stipulates. Also, in a case of incest, securing abortion for such a person will no longer be possible as the situation does not fall under emergency as well.
“Unfortunately, engaging in advocacy to reform laws that would be able to address these issues so that the exceptions would be recognised by our laws is also affected by the rule.
“The essence of the advocacy is to create awareness that there is also a way out and that it is not all about abortion but USAID will not support the advocacy. Yet, without the advocacy, we won’t be able to get that waiver of incest in our own law.
“Our extant law does not recognise this exception. We need to carry out advocacy for the reform of abortion law in Nigeria to accommodate those exceptions but unfortunately, the Gag Rule prohibits lobbying of any form or advocacy or reform of abortion law. It is an assumption that every society must have such exception for incest and rape for abortion. My argument is that such is not the case in Nigeria and some other countries.
“The Gag Rule gives with one hand and collects with the other. It does not allow for lobbying and as such, you cannot access their money for such through USAID which is one of the biggest donors for women’s reproductive health”, Akiyode-Afolabi said.
According to her, the way out for Nigerians is to increase its budget for women’s sexual and reproductive health, raise internal support while NGOs should devise more creative means of accessing the GGR funds.
She further warned that without the review of the law and the political will on the part of government to address the issue of sexual rights and gender-based violence, there may not be any way out of the impending explosion in maternal mortality.
On her part, Dr. Chito Nwanna, a consultant Obstetrician and Gynecologist and the Medical Director, Tabitha Medical Centre, Abuja, said since the issue of right to life and abortion remains controversial in Nigeria, the government should look inward with a view to solving its health challenges rather than depending on donor countries.
“I know in Nigeria that abortion is illegal unless where it threatens the life of the mother or the unborn child. That law has not changed. And sometimes, when you have this kind of law; it leads to high rate of unsafe abortions.
“Religiously, there is a prolife mandate too and most religions in Nigeria support Prolife, not giving consideration to people that were raped or incest.”
While she does not kick against the law prohibiting abortion, she stressed that the issue of birth control should be a priority so as to prevent unplanned pregnancy. “Going against the two at the same time is like contradicting yourself,” she said.
Nwanna stressed the need for government to fund those programmes without relying on other political views or countries to address such a vital issue, adding that funding birth control option remained the best in this circumstance.


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