Médecins Sans Frontieres (MSF) has warned about the detrimental effect that US President Donald Trump’s "global gag rule" is having on organisations working in the area of reproductive health in Africa.
The Mexico City Policy, known as the global gag rule, blocks US federal funding for nongovernmental organisations that do any work related to providing abortions or abortion counselling, or even advocating a woman’s right to have access to pregnancy termination services.
MSF (Doctors Without Borders), which held a roundtable discussion on the issue in Pretoria on Tuesday, says the rule adds to the stigma surrounding abortion and has an indirect effect on research organisations working with pregnancy termination on the continent.
Sexual health research and advocacy group Ibis Reproductive Health’s senior project manager, Tshego Bessenaar, said although the organisation did not receive US government funding and was not directly affected by the gag rule, its partners were.
"We collaborate with a range of partners and most of them receive US funding for unrelated work, but since the legislation was brought back, we cannot work with many of them who receive Pepfar funding," Bessenaar said, referring to the US President’s Emergency Plan for AIDS Relief, established in 2008.
Since Ibis did not receive US funds, it would continue with research work to advocate for safe abortions.
Other funders of women’s healthcare and research on the continent include the William and Flora Hewlett Foundation, the Gates Foundation, and Amplify Change, which all continue to fund research and direct resources towards women’s healthcare programmes.
While abortion has been legal in SA since 1997, when the Choice on Termination of Pregnancy Act was passed, the stigma remains, and the gag rule has added to it.
Dr Tlaleng Mofokeng, a founding member of the Sexual and Reproductive Justice Coalition, said the obsession with the separation of services further stigmatised termination and reinforced the idea that abortion was not part of the overall package of healthcare.
Contrary to the stereotype of young women mistakenly falling pregnant, her practice in Hurlingham has a clientele of professionals and married couples who chose to terminate.
"Why should an abortion be in the back rooms on the other side of the clinic?" asked Mofokeng.
In a range of studies that Ibis has conducted, the key issues hindering women’s access to reproductive healthcare have been shown to be stigma and a lack of leadership.
Bessenaar said Ibis also felt young men were being excluded in the discussion and it was critical to include them in surveys. "Men get us pregnant so why are we not talking to them when we talk about abortion?"
While medical schemes claim that they will "always cover the procedure if the pregnancy is not viable or poses a threat to the mother’s health", they also require motivation from a doctor.
In the event that a woman opts to terminate the pregnancy with no indication of possible medical complications, some medical schemes may still agree to pay for the procedure, while others will decline.
Mofokeng noted the focus was on the morality of the termination and seldom on what had led to women needing abortions. She said contraceptive failures, which often led to unwanted pregnancy, were rarely discussed and women received very little counselling on the matter.
In the context of SA’s high incidence of gender-based violence, Mofokeng said reproductive coercion was also prevalent, with women being forced to have unwanted children because of the interception of culture and religion.
Rape is also a significant contributor to the need for abortion services. Africa Check cites South African Police Service statistics that 42,596 rapes were reported in 2015-16 — and experts agree that rape is underreported.
SA’s health system was sorely understaffed, and Mofokeng said there was a need for continuous training of health professionals and clinicians already in the system, especially on ethics.
She said even among healthcare professionals, stigma was rife — citing an example from a healthcare conference she attended where one doctor told another he would not shake his hand because "it was full of blood".
Lucy O’Connell of MSF called for support and care for healthcare workers who are often overworked. She said nurses across SA were feeling disempowered and were not compensated enough.
"If a healthcare worker is not supported by a system, they become irrational and it shows in their interactions with patients," said O’Connell.
Bessenaar said Ibis studies found women in SA and Ghana wanted someone to be held accountable when things went wrong, and many women preferred to travel to far-away facilities where they were less likely to find someone they knew working there.
"Women still feel stigmatised," she said "Yet male circumcision is never controversial."
She emphasised the lack of leadership at facilities, saying these individuals and facilities need to be named and shamed for the stigmatised behaviour.
Abortion provider appreciation day is celebrated on March 10.
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