42—Vanguard, TUESDAY, MARCH 6, 2015 Trump’s Global Gag Rule: More cases of unsafe abortion imminent in Nigeria . By Sola Ogundipe WOMEN in developing countries were the first casualties as soon as President Donald Trump assumed office in January 2017. With a stroke of his pen, Trump declared war on women's health by reinstating and expanding the Mexico City Policy, an executive order also known as the Global Gag Rule (GGR). First introduced in 1984 by President Ronald Reagan, a Republican, the Mexico City Policy had earlier been suspended by former President Barack Obama, a Democrat, in 2009. Similar reinstement and suspension of the controversial policy had occurred earlier between George Bush and Bill Clinton. Obama’s suspension of the policy and the latest restoration by Trump, are in continuation of a long standing differentiation of political position between the Democrats and the Republicans. Traditionally, the Mexico City Policy required foreign NGOs particularly those working in developing countries, to pledge that they would not perform or actively promote abortion as a method of family planning even with non- US funds as a condition for receiving US global family planning assistance. While the GGR policy formerly applied only to cutting family planning assistance provided through the State Department and the US Administration for International Development, USAID, Trump adopted a more stringent version of the rule and expanded it to other US global health assistance under which NGOs that refuse to sign up are denied all categories of health assistance. One year after the reinstatement of the policy, access to contraceptive commodities and services, including provision of voluntary 10,000 lives at risk family planning information, education and services around sexual and gender-based violence like rape, Female Genital Mutilation, FGM, early and forced marriage amongst others, are adversely affected. But experts say this burden may further increase as a result of the GGR. “The result will be catastrophic,” notes Dr. Stella Aniston, a privately practising family planning counsellor. “Maternal death will increase, unintended pregnancy will increase and the number of unsafe abortions will rise. Huge cuts in family planning financing of up to $600 million a year are being recorded.” Nigerian experts generally describe the GGR as a restrictive, antichoice policy. They agree that by blocking funding to the world’s largest NGO providers of modern contraception, the gag rule is worsening an already bad global contraceptive funding gap and undermining women’s ability to prevent unwanted pregnancy. They say by restricting access to vital reproductive care services, the GGR is fuelling increases in unintended/unwanted pregnancies, unsafe abortions, maternal and newborn deaths etc. Findings by Good Health Weekly show that in Nigeria, contraceptives are generally underfunded and significantly covered by individuals through out of pocket expenses. Many states have no appreciably dedicated family planning or reproductive health financing, rather, they depend on major partners including USAID; the Department For International Development, DFID; United Nations Population Fund, UNFPA, among others. Funding shortfall It was also gathered that huge funding shortfalls are characteristic of the heavily donor-dependent National Family Planning and commodities procurement programme. For instance, in 2017, the UNFPA earmarked $12 million annually to be spent on contraceptives in Nigeria. Between 2011 and 2017, the Federal Government spent $2 million on family planning commodities and in January 2018, released $1 million for procurement of contraceptives - a far cry from the estimated $15 million to $20 million required annually. According to the Guttmacher Institute, among sexually active unmarried women in Nigeria, 22 per cent have an unmet need for family planning even as records show that 19 per cent of over 3.8 million married and sexually active adolescents (15-19) have an unmet need for contraception. At the 2017 London Family Planning Summit, Nigeria committed to increasing its annual allocation for contraceptives from $3 million to $4 million while expecting to take advantage of the Global Financing Facility and international development assistance loans. With access to reproductive health services to all women still hampered by financial gaps, pointers on ground indicate that with the expanded gag rule, the By eliminating access to contraception, the gag rule inadvertently caused more unintended pregnancies and more unsafe abortions *Cross section of women waiting to receive safe family planning services at an antenatal clinic. targeted 36 per cent Contraceptive Prevalence Rate, CPR, for 2018 set by the National Family Planning Blueprint may not be achieved. According to the Family Health Department of the Federal Ministry of Health, $603 million is required to enable 7.3 million women have access to contraceptive methods of their choice. Indicators show that the GGR is not just cutting support to reproductive health and increasing stigma around induced abortion but further causing a rollback on women’s rights. Fuelling abortion “The GGR does not reduce abortion, on the contrary, it fuels abortion. Implementation of the GGR under previous R e p u b l i c a n administrations did not in any way, reduce unsafe abortions,” noted Dr Ejike Oji, chairman of the Association for the Advancement of Family Planning, AAFP, and the President/CEO, Dr Ejike Oji Community Development Foundation. “By eliminating access to contraception, the gag rule inadvertently caused more unintended pregnancies and more unsafe abortions,” Oji noted. According to Guttmacher Institute, there are around 40,000 deaths from unsafe abortions in Nigeria every year. Marie Stopes International, MSI, a global organisation providing personalised contraception and safe abortion services, predicts additional 660,000 abortions in the country from now up to 2021 as a result of which about 10,000 women are estimated to die. In 2016, MSI said it administered at least one family planning method for 785,000 Nigerian women. Without restriction of the GGR policy, the NGO expects that it would have prevented about 1.8 million unintended pregnancies and more than half a million abortions and avoided more than 10,000 maternal deaths between 2017 and 2020. In a statement, Country Head of MSI, Effiom Effiom, described the US decision to pull funding on reproductive health as ill conceived. “They’ve been key in strengthening healthcare. It’s their funding that allowed us to reach 500,000 women in the past three years. Who will bridge that gap?” Giving a graphic picture of the economic burden of unsafe abortion in Nigeria, Oji related findings of a study Continues on Page 38
Vanguard, TUESDAY, MARCH 6, 2018—43 NAFDAC rejects plans to remove drug matters from exclusive list By Chioma Obinna THE National Agency for Food and Drug Administration and Control, NAFDAC, has rejected recommendation by Governor Nasir el- Rufai-led reform panel’s proposal to move drug matters presently on the Exclusive List (item 21 of part I of the second schedule of the 1999 Constitution) to the concurrent list. In a press statement signed by the Director- General of NAFDAC, Prof. Mojisola Christianah Adeyeye on the proposed decentralisation of drug regulation in Nigeria, the agency declared that such recommendation portends great danger for the nation. According to Adeyeye, the reasons for placing drugs and poisons on the exclusive legislative list by countries are to ensure firm control on drugs and drugrelated matters by the Federal Government. 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