I am a nurse at a reproductive health care clinic in Kibera, the largest slum in East Africa. My clients support their families on less than one dollar per day. Their children play in open sewers. They live in 100 square foot mud or tin sheds, congested with up to eight people.
Every day, I serve desperate young girls and women. Girls like Ann. At 13, still a child, thin with tired eyes, she sat down in my office. After a pause, I asked, “How can I help you?”
Ann’s parents had died when she was 10 years old. Since, she had lived in the slum with her uncle. He repeatedly raped her. This time, she became pregnant.
First, she tried suicide via herbal mixture. The attempt failed. Then, friends told her about our clinic. She was clear: I would rather die than bear this pregnancy. I counseled her, and provided her a referral to secure safe abortion care in accordance with the Kenyan law.
Desperate girls who don’t have access to care and referral resort to “quacks” in “curtain clinics,” known to use everything from IV needles to give puncture wounds, to inserting crochet needles to terminate unwanted pregnancies.
In 2009, the United States greatly expanded funding to organizations like mine, allowing us to reach and serve desperate girls and women like Ann who would otherwise die. My clinic was opened up during this period in addition to six other clinics. My organization, Family Health Options Kenya (FHOK), provided more than 3 million reproductive health services in 2016, from HIV medication to cervical cancer screenings, free contraceptives to skilled delivery.
From 2009 to 2014, FHOK contributed to Kenya’s massive gains in reproductive health indicators. According to the Kenya Demographic Health Survey, maternal mortality was cut by 26 percent from 488 deaths per 100,000 live births to 362. This rate is still among the highest in the world. Contraceptive prevalence rate increased from 39 to 53 percent, and the HIV infection rate dropped from 7.2 to 6 percent of the population.
Today, Trump’s global gag rule stands to gut this progress, and by extension, it will gut Kenyan families, women and girls. This policy extends to require organizations abroad who receive U.S. global health aid to sign a statement that, regardless of funding source, they will not mention abortion to clients, provide abortions, or refer clients to legal abortion services. Trump’s policy extends restrictions to funding for family planning and reproductive health, maternal and child health, nutrition and HIV/AIDS.
Though I am not directly responsible for signing the gag rule — my organization made the decision to decline — as a frontline practitioner, the choice is clear: I am a medical professional. I took an oath to save lives. I provide comprehensive care. To allow a funder to dictate the services I can or cannot provide, would be malpractice.
I would be accepting money to effectively commit suicide on behalf of the young girls and women I serve.
Approximately 98 percent of the services we offer at my clinic are unrelated to abortion. Nonetheless, because of the global gag rule, FHOK is losing U.S. funding.
It’s been one year since Trump signed the global gag rule and the impact is already evident on the ground. FHOK has terminated outreach services which would have helped us reach 76,800 women. Our Mombasa clinic has closed. In Kibera, my clinic has laid off four staff members and will close in coming months.
We recently ran out of contraceptive stocks. As a result, young women are already coming in with unplanned pregnancies and complications from unsafe abortions.
As someone who has looked in the eyes of suicidal 13-year-old rape victim, delivered and cuddled HIV-positive newborns, and held women as they weep over late cervical cancer diagnoses, I know these costs of what we are losing all too well. Most nights, I cannot sleep. My blood palpates loud. I see their faces.
Because of this policy, I know they will die.
But they don’t have to. Eliminating restrictions on U.S. aid will provide access to comprehensive healthcare that can save and transform countless lives.
I am haunted by the last words of 15-year-old “Mwende.” Turned away when she sought a safe abortion at a public facility that could not provide her one based on the global gag rule, she resorted to a curtain-clinic quack. Five days later, septic and dying, “Mwende” was brought back to the clinic that first rejected her.
When she spotted the nurse who turned her away, she said her last words: “If you had only helped me the day I came, I would have lived.”