American politics have been a little crazy for the past 2+ weeks, and I’ve been swept up in it all. If you follow me on Facebook (I hope you do!), you may have even been a little annoyed about my prolific posting and commenting on the recent travel ban. This post is not about that, although I am passionate about refugees being able to find a safe and peaceful home away from war and conflict and genocide.
Instead, I have to write about another topic I’m passionate about which was a little bit swept up in the deluge of other issues: the reinstatement of the “Mexico City Rule.” I had to some research to figure out what exactly I was reading and how it might affect the work we do with Mama Maisha, and it turns out that the impact could be profound.
This issue starts with the Foreign Assistance Act of 1961(22 U.S.C. 2151b(f)(1)) which forbids the use of U.S. federal funds to pay for abortions. In 1984 President Reagan further restricted this policy by requiring that the United States Agency for International Development (USAID) not fund organizations which counsel or advise regarding abortions or advocate for legalized abortion as part of their activities. This is what is referred to as the Mexico City Policy or the Global Gag Rule. President Reagan put it into effect, President Clinton reversed it, President Bush reinstated it, President Obama reversed it again. Now President Trump has reinstated it again (Presidential Memorandum Regarding the Mexico City Policy).
This does not directly affect Mama Maisha’s funding, because:
a) Abortion is illegal in Tanzania, so we have nothing to do with performing, counseling or advising about abortion;
b) To date we are not receiving funding from USAID (although we have some contacts with USAID-TZ and hope to work with them one day).
However, this directly affects the clients that Mama Maisha is serving. There are only two providers of contraception in Rorya District where we are working: the government health facilities and Marie Stopes International. The government is supposed to offer six types of contraception, bilateral tubal ligation (aka “tubes tied”), IUD (copper only), implant, injections, pills and condoms, but in the rural areas particularly, the health facilities are often poorly stocked or it may be a prohibitive distance or expense to get the contraception desired. For example, in one of the villages in which we work, we have referred hundreds of women to the local health dispensary for implants, which are highly effective, discreet, three-year contraceptives. Almost none of those women received implants because the health facility was out of stock or because the health care worker on duty didn’t feel confident to provide the service, so they give our clients an injection (effective only for three months) and send them away. Other clients desperately want a tubal ligation to prevent any future pregnancy. Some of these women have more than twelve children. Some have had life-threatening complications during their previous pregnancies. Others are widows who have been “inherited” by in-laws and are used for sex regardless of consent. There are three health facilities in our target areas which provide tubal ligation, all for cost, usually upwards of $40, plus the cost of transport. This is more than a month’s income for many of our clients, and is completely untenable.
Marie Stopes International comes into our district once per quarter, rotating among rural health facilities to provide absolutely free contraception, including out-patient tubal ligation. This is a video filmed in another rural area in Tanzania about what Marie Stopes does.
We’ve referred women to the Marie Stopes clinics and we’ve paid for transport to attend the clinics. Their free clinics have helped over a hundred of our clients already, and will help thousands more in the coming years…except…
Marie Stopes offers abortion services in countries where abortion is legal (not Tanzania), so they are now disqualified from USAID funding, which will restrict their ability to offer contraceptive services in places like rural Tanzania. Lack of contraception leads to unwanted pregnancies. In a place like Tanzania, where access to health care is difficult, reported maternal mortality rates are actually higher in 2015 than in 2010 (partly due to better recording mechanisms). Most of our clients qualify as high-risk for pregnancy because of age or number of pregnancies, and lack of transport to health facilities makes safe delivery difficult. We see access to contraception as the most effective way to reduce the number of women who die in pregnancy and childbirth.
Without replacement funding (which may be forthcoming from The Netherlands and other nations), Marie Stopes would have to cut back on services, possibly in rural Tanzania or in places like it, and they estimate that 1.5 million women would lose access to contraception. Most of them would not have another good option for contraception.
I know many people who celebrated the reinstatement of the Mexico City Policy, probably without understanding all the implications. The truth is that government restricting the funding of an organization like Marie Stopes (or Planned Parenthood) does not reduce the number of abortions in the world, because their funding for that comes from private sources. It does, however, increase the number of women who have unwanted pregnancies, who may seek an unsafe abortion, or who maycarry a baby to term and suffer mortality or morbidity during delivery.
And the truth is that there simply aren’t global organizations offeringcontraception without abortion services (where they are legal), at least not in this part of the world. If we are holistically pro-life, let’s consider the lives of mothers also.