Kigali — A gag rule imposed by President Donald Trump that bans U.S.-funded groups around the world from discussing abortion has sown confusion and fear in developing nations, risking the health of millions of women, experts said on Thursday.
The policy has forced the closure of health clinics, outreach programmes and refugee services that rely heavily on U.S. aid, according to experts meeting at an international conference on family planning in Rwanda.
Under the so-called global gag rule - a key focus at the meeting of policy makers, researchers and advocates - U.S. non-governmental organisations working abroad must accept the restriction or reject it and lose funding.
The policy is used by U.S. presidents to signal their stance on abortion rights, a touchstone issue in U.S. politics.
Trump, positioning himself as an abortion opponent, signed it on his fourth day in office in January 2017.
The impact is being felt worldwide.
From clinics for HIV-affected sex workers in Ethiopia to programmes aimed at curbing teen pregnancy in remote Uganda, health initiatives have been slashed, experts said at the four-day International Conference on Family Planning.
The gag rule has put at risk more than $8 billion of annual funding, which is used by aid groups around the world to help everyone from refugees to rape victims.
Organisations anxious to keep their funding are confused and fearful, so opt to curtail their work, said Jonathan Rucks, senior director, policy and advocacy at PAI, a Washington-based group promoting reproductive health care.
"The fear of losing all your funding furthers this self censorship," he told the Thomson Reuters Foundation. "By design, this policy is meant to disrupt and create confusion."
PAI has investigated its impact in Ethiopia, Nigeria, Senegal, Nepal, Kenya, India as well as in Uganda, where it said reproductive health services in refugee camps had been cut.
COMPLY- AND THEN SOME
Running scared, aid groups are shying away from services they could be providing, said Rebecca Brown, global advocacy director at the New York-based Center for Reproductive Rights.
"They're so nervous that they may be found non-compliant that they're over-complying," she told the Thomson Reuters Foundation.
Asked for comment, representatives at the White House and U.S. State Department were not immediately available.
Republican presidents since 1984 have backed the policy - which bans groups getting U.S. aid from promoting abortion as a method of family planning - while Democrats have revoked it.
Under Trump, it has been expanded beyond family planning to funding for all global health assistance, including programmes for HIV, tuberculosis, malaria and immunisations.
That amounts to more than $8 billion a year, Rucks said.
Up to 26 million women and families will lose access to contraceptive services, said Leila Hessini, vice president of programmes for the Global Fund for Women, a rights group based in California.
"It affects the whole of women's and girls' health care around the world," she told the Thomson Reuters Foundation.
And the full impact is still to be felt, said Margaret Giorgio, senior research scientist for the Guttmacher Institute, a reproductive rights organisation in New York.
It could take five to seven years to assess the fallout on aid facilities, she said.
"Then, to see impacts among women themselves, again, that's going to take a lot longer to trickle down."
In Uganda, health workers have scaled back visits to distant regions where teen pregnancy is high and families have up to seven children, aid Carole Sekimpi, country director for aid group Marie Stopes Uganda.
The group has recouped two-thirds of its lost U.S. funding from Britain, she said.
"Whereas the global gag rule is meant to gag, it has had the positive effect of putting the discussion of abortion on the table," she added. "Everyone's talking about it."
- Reporting by Ellen Wulfhorst, Editing by Lyndsay Griffiths