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In Kenya, Reproductive Clinics Fear Trump Policy's Detrimental Effects


President Trump last week reinstated what's known as the Mexico City Policy or, to its critics, the global gag rule. It cuts off funds to any aid group that provides abortions overseas or even counsels women on abortion. And without that money, reproductive-health clinics in some of the poorest countries in the world may have to close. NPR's Eyder Peralta visited a clinic in Nairobi, Kenya.

EYDER PERALTA, BYLINE: Just outside the Family Health Option Kenya building in Nairobi, there is a golden plaque. It says the headquarters for the reproductive-health organization was built with assistance from the U.S. Agency for International Development - or USAID. As executive director Edward Marienga sees it, the funding has been a blessing and a curse because when Democrats enter the White House, they up funding. But when Republicans take power, they reinstate the Mexico City Policy. When George W. Bush took over after Bill Clinton, for example, the clinic was devastated.

EDWARD MARIENGA: We closed a number of clinics, five out of - by that time, we were only nine.

PERALTA: That's more than half their clinics. The most frustrating part, says Marienga, is that this all has to do with domestic American politics that Kenyans can do little about.

MARIENGA: But, you see, sometimes, this continuous change - it's like playing a football match with people's lives.

PERALTA: Critics say that there are two big problems with the policy. It's too broad. It cuts funding for organizations that simply try to educate women on abortion laws in their country. And, secondly, in many poor countries, U.S. aid is monumental. Moreen Majiwa of the Center for Reproductive Rights Kenya.

MOREEN MAJIWA: Four percent of Kenya's GDP goes to health. A large part of that is donor-funded, and a large part of that is U.S.-funded.

PERALTA: So sexual and reproductive health services become scarce, especially for poor women, says Majiwa. Back in 2011, a Stanford University study looked at how the Mexico City Policy affected African countries during the Bush administration. It found that as counseling services went away, abortions in some of those countries doubled.



PERALTA: Back at the clinic, I meet the head nurse, Alice Nyaboke Mmonyi. She takes me to the clinic's maternity ward. The clinic, she says, does pride itself on providing contraceptives and abortion counseling for women. But they also do much more. They offer HIV counselling. They test and treat STDs. And in a country with a high rate of maternal mortality, they offer a safe place to give birth. This month so far...

MMONYI: Eighteen deliveries - normal delivery being 15 and cesarean section being three.

PERALTA: All those services, she says, are in danger now because the clinic says it's impossible to comply with a policy that would interfere with medical conversations with patients. Downstairs, I am introduced to Chaila Maya, a patient at the clinic. She's 24, the mother of a 3-year-old girl. The clinic has been a lifeline for her. It's the place that taught her about sex and family planning.

CHAILA MAYA: From where I comes from in the slum, actually, they don't talk about family planning.

PERALTA: At all?

MAYA: Not even, like, the simplest - like, you should use a condom. They believe it's, like, a taboo. They shouldn't do that.

PERALTA: Every month now, Chaila comes to the clinic to receive free contraceptives. Public hospitals don't offer them. And the nearest other clinic that might is easily a two-hour bus ride away. Chaila says she doesn't know what she'll do if the clinic closes.

MAYA: Me personally - first, I'll be broken down. Maybe you can try to find a way to talk to Trump. I don't know how you can do it.

PERALTA: Maybe, she says, there's a way for President Trump to see how his actions affect the everyday lives of poor women an ocean away. Eyder Peralta, NPR News, Nairobi.


Eyder Peralta is NPR's East Africa correspondent based in Nairobi, Kenya.