1 February 2009

Uganda: Obama Restores Aid for Family Planning

Kampala — THE world has cheered US President Barrack Obama for moving fast to reinstate funds to family planning programmes worldwide.

On the second day of his presidency, Obama struck down the ban that former president George W. Bush had imposed on the first day of his first term - a policy popularly known as the 'gag rule' that banned US taxpayers' money from going to international family planning groups. The target groups include those that carry out abortions or provide information, counselling and referrals about abortion.

"It is clear that the provisions of the Mexico City Policy are unnecessarily broad and unwarranted under the current law, and for the past eight years, they have undermined efforts to promote safe and effective voluntary family planning in developing countries. It is right for us to rescind this policy and restore critical efforts to protect and empower women and promote global economic development," Obama said in a statement from the White House.

Obama remarked that for so long, international family planning assistance has been used as a political wedge, the subject of a back-and-forth debate that has served only to alienate the US. He said he did not 'desire to continue this stale and fruitless debate.'

"In the coming weeks, my administration will initiate a fresh conversation on family planning, working to find areas of common ground to best meet the needs of women and families at home and around the world," he said. Obama directed his staff to reach out to those on all sides of this issue to reduce unintended pregnancies.

He said he would promote safe motherhood, reduce maternal and infant mortality rates and increase educational and economic opportunities for women and girls.

"I look forward to working with Congress to restore US financial support for the UN Population Fund (UNFPA). By resuming funding to UNFPA, the US will be joining 180 other donor nations working collaboratively to reduce poverty, improve the health of women and children, prevent HIV/AIDS and provide family planning assistance to women in 154 countries."

Ray of hope

While sceptics digest it with pessimism, for many local leaders in reproductive health, the announcement brings sunshine to the struggling reproductive health programmes, particularly to family planning and contraceptive activities.

"It's a welcome move," says Dr Anthony Mbonye, the assistant commissioner of reproductive health in the Ministry Of Health. "The policy was unpopular and inconveniencing. When the US Agency for International Development (USAID) banned us from giving their contraceptives to Marie Stopes, we had to go to the National Medical Stores to separate their contraceptives. It was cumbersome, time wasting and unfortunate," he adds.

In October last year, the USAID issued a directive requiring several African countries to stop providing US-funded contraceptives to Marie Stopes International (MSI), one of the world's leading family planning NGOs.

Why the policy?

The Bush administration used the policy since 2002 to deny funding to UNFPA because of its work in China. "They were punishing MSI because of abortion-related activities in China, but abortion is illegal in Uganda. MSI does not conduct abortion here. It offers reproductive health services to our women," Mbonye says.

He says contraceptive pills were the most affected because their retrieval meant shortages, but whereas they cannot measure the impact of the ban quantitatively, it enormously jeopardised the ability to provide Ugandan women with choices in preventing pregnancies.

"We are now optimistic that funds for contraception will be guaranteed. We are holding onto that directive and can at least hold the USAID accountable because we know that the US government supports reproductive health," he says.

Thomas Mega, the MSI country director, says: "Our hope is that USAID can ultimately release the funds they otherwise held back to enable us procure contraceptives to enable Ugandan women be in charge of their sexual and reproductive health."

"UNFPA helped step-up our stocks but the ban had a big impact on our activities. It will take some time before we can stabilise our operations across the country, but this is a good gesture in improving maternal health," he adds.

Mega says the UNFPA has been 'handy'. "There are supplies already on the way. Our main problem was our inability to provide choice of contraception for mothers."

The change is timely

Elly Mugumya, the executive director of Reproductive Health Uganda, says the reversal of the gag rule could not have come at a better time. Mugumya, whose organisation could not access USAID funds, says Obama's announcement will go along way in reducing maternal deaths and re-igniting the debate on safe abortion.

"The ban saw a rise in the unmet need for family planning from 35% in 2002 to 41% in 2006. Institutions with the capacity to provide the services and the information were not getting the funds and the contraceptive supplies.

"You had to disguise or miss out on the funding, consequently suffocating public information and family planning choices because providing any information on abortion was seen in the wrong light. We pretended that abortion does not take place, yet it kills 13-16% of mothers every year," Mugumya admits.

"we cannot talk about safe motherhood without addressing the high fertility rate, unwanted pregnancies, teenage pregnancies and unsafe abortion; where family planning and modern contraception is key."

Unsafe abortions kill about 1,200 women every year. "We are now hopeful because we are guaranteed to direct access to funds and commodities which will trickle down to the grassroots," he says.

Women will be uplifted

UNFPA executive director Thoraya Ahmed Obaid says Obama's decision sends a strong message about his leadership and his desire to support causes that will promote peace, dignity and equality for women and girls.

Obaid says Uganda is more than halfway towards the 2015 target date for the Millennium Development Goals, but the goal that addresses improving maternal and reproductive health has made the least progress and is the most under-funded.

"Restoration of funding will allow us to maintain recent gains during the current financial crisis and provide support to women in some of the poorest countries in the world," says Obaid. "Progress for all will not happen without progress for women. This means working to promote, as an international priority, the advancement of women's health, rights and equality."

The US spends more than $400 million (sh760b) on overseas' family planning aid each year. The ban known as the Mexico City Policy was named after the 1984 conference where a former US presidenr Ronald Reagan devised it.

Reagan brought in the ban, but Bush's predecessor Bill Clinton threw it out. However, Bush brought it back, with a twist, wanting family planning to advocate sexual abstinence.

The USAID, the largest supplier of condoms in the developing world, also held them back from groups that did not sign an anti-abortion pledge. At a time when HIV/AIDS was spreading, US supplies of condoms were curbed.

Access to voluntary family planning is one of the most effective ways to prevent unintended pregnancies and reduce abortions.

Elizabeth Masaba, a midwife with the Kampala City Council clinic in Kawempe, says women and health providers should celebrate the news because they have been suffering with occasional stock-outs of contraceptive supplies.

Especially in the face of HIV, couples need family planning. Contraceptives are key for our prevention-of-mother-to-child-transmission of HIV/AIDS programmes. They help cut HIV infections in new-borns. But when mothers come for family planning and we have run out contraceptives, it is discouraging; they may only return pregnant," Masaba says.

But for Alex Masereka, a boda-boda rider, the news has no impact on him because he has always bought his condoms. "I even give my wife money to go for the injectaplan and she has always got her injections."

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