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<DIV><FONT face=Verdana size=2><A
href="http://www.feministe.us/blog/archives/2007/12/13/the-impact-of-the-global-gag-rule-on-healthcare-in-kenya/">http://www.feministe.us/blog/archives/2007/12/13/the-impact-of-the-global-gag-rule-on-healthcare-in-kenya/</A></FONT></DIV>
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<H2>12.13.2007</H2>
<DIV class=post>
<H3 id=post-6412><A
title="Permanent Link: The Impact of The Global Gag Rule on Healthcare in Kenya"
href="http://www.feministe.us/blog/archives/2007/12/13/the-impact-of-the-global-gag-rule-on-healthcare-in-kenya/"
rel=bookmark>The Impact of The Global Gag Rule on Healthcare in Kenya</A></H3>
<DIV class=meta>Posted by Anne @ 9:25 am </DIV>
<DIV class=entrytext>
<P>I have been reading a really interesting publication produced by The Crowley
Program in International Human Rights (part of Fordham Law School). Titled
‘Exporting Despair – The Human Rights Implications of U.S. Restrictions on
Foreign Health Care Funding in Kenya’, the project examines both the impact of
the Mexico City Policy (popularly known as the Global Gag Rule) on Kenya’s
healthcare system, as well as the legal ramifications of it for both the Kenyan
government as well as the U.S. For anyone interested in the legal issues of the
Global Gag Rule, I highly recommend obtaining a copy.</P>
<P>The report starts out by examining international laws and treaties in order
to assess whether or not Kenya’s government can be held responsible for
violating international human rights, as well as assessing what legal role donor
nations, particularly the United States, has in requiring countries to violate
their own human rights laws in order to receive funding. Using the International
Covenant on Economic, Social and Cultural Rights (ICESCR), Committee on
Economic, Social and Cultural Rights (CESCR), The International Covenant on
Civil and Political Rights (ICCPR), Convention on the Elimination of all Forms
of Discrimination Against Women (CEDAW), the Beijing Platform and the Cairo
Program, they conclude that there are three main areas that can be violated: the
right to health, freedom of speech, and gender discrimination.<BR><SPAN
id=more-6412></SPAN><BR>The report then goes on to examine the historical and
current healthcare situation in Kenya. While the Kenyan government has attempted
to improve the healthcare system, funding problems and the burden the AIDS
crisis has placed on the healthcare system has caused minor improvements and in
many cases retrogression. In 1991 the government switched from a free healthcare
program to a cost-sharing one, which has created barriers in access for the
poor. When the research for this report was being done (2004) the following are
some of the frightening statistics that illustrate the problems Kenyan women
face:<BR>- Despite abortion law only allowing the procedure to save the life of
the mother, 45% of hospital admissions for women in Kenya are because of
complications from botched abortions.<BR>- 20% of all pregnancies in Kenya are
unwanted.<BR>- By age 19, 45.6% of Kenyan girls have begun childbearing.<BR>-
Only 39.8% of women have the final say in decisions relating to their own health
care.<BR>- 24.6% of men felt that a woman’s refusal to have sex was a
justification for wife-beating.<BR>- Life expectancy for people in Kenya in 2002
was 45.2 years</P>
<P>The Kenyan government has heavily relied on donor funding to provide
healthcare to its citizens. The report states: “reproductive health, including
family planning and HIV/AIDS, depends entirely upon the support of donors,
including USAID… [who is] the single most significant donor [for reproductive
health]. </P>
<P>While I know Jill has blogged significantly about what the Global Gag rule
is, I thought I would recap its impact on the US Agency for International
Development (USAID) funding. The Global Gag Rule (formally known as the Mexico
City Policy), “prohibits foreign non-governmental recipients of U.S. family
planning funds from, among other things, promoting or advocating abortion as
either a means of family planning or, in all but potentially fatal cases, as a
procedure to safe-guard a woman’s health. These restrictions bind USAID, the
principal conduit through which US bilateral funding for healthcare flows to
Kenya.” </P>
<P>The report then uses two case studies of clinics that refused to accept USAID
funding, The Family Planning Association of Kenya (FPAK), who lost 60% of its
annual budget, and Marie Stopes International – Kenya, who ultimately had to lay
off about 1/5th of its staff, cut salaries, increase user fees, and closed 2
clinics that served some of the poorest communities in Kenya. The impact of the
Global Gag rule on individuals in Kenya has been huge. Education and outreach
programs have been slashed, a reduction in the number of clinics means women
have to travel farther to obtain services, higher user fees hinder the poor,
fewer healthcare professionals means that even when a woman can travel to a
clinic she can’t always see the correct person on that day, and poor training
means many women do not receive adequate information about the contraceptives
that are available. Additionally, a lack of medicine/supplies resulted in the
Kenyan government issuing a statement in January of 2004 stating that they had
run out of stock of Norplant, progesterone-only pills, and female condoms in May
2003. The lack of available resources results in increased numbers of unwanted
or ill-timed pregnancies as well as an increase in the spread of AIDS/HIV.</P>
<P>Finally, the report looks at the Kenyan government’s legal responsibility for
human rights violations. They conclude that the government: </P>
<P>- Failed to fulfill the right to health under CESCR<BR>- While not
responsible for deliberate retrogression, they are responsible for a backslide
and therefore violate their obligation under the ICESCR<BR>- The Kenyan
government has not fully met its obligation to ensure the freedom of expression
of NGOs within the state.</P>
<P>It then goes on to examine the United State’s role as the donor nation in
violating international law (aka third party responsibility). The conclusion is
that the US does not bear any responsibility for the human rights violations,
despite the fact that they stem from the Mexico City Policy. </P>
<P>After reading the report I came to two conclusions. The first, which the
report itself states, is that there is an important and critical area of
international law that needs to be examined. In an age of globalization and
international policies, we need to establish rules that hold more powerful
nations accountable for violating either and/or both international laws signed
by recipient nations as well as individual state’s national laws. </P>
<P>The other is how much can we hold a recipient state responsible for
violations and/or retrogression? The report says: “Although the Kenyan
government is not responsible for imposing the Mexico City Policy, it does
exercise control over the structure of its healthcare delivery system and the
funding of private providers.” </P>
<P>They go on to give three arguments:<BR>1. The government relies too heavily
on donor funding and as a result makes the healthcare subject to the priorities
of donors;<BR>2. Because of USAID funding rules, while NGOs can’t receive
funding if they promote abortion, the government can receive funding as long as
the funds are contained in separate accounts. As a result, they argue the Kenyan
government could have used USAID funds more heavily in some areas, using other
government funds to support clinics that lost funding under the Mexico City
Policy; and<BR>3. The Global Gag Rule has been in place off and on since 1984.
As a result the Kenyan government should have anticipated the impact it might
have in the future and therefore better planned for resource allocation. </P>
<P>I agree in part with these arguments, but I have to also question the reality
of the level of control the Kenyan government has. Misallocation of funds and
corruption aside, what do you do if there just is not enough money for
everything? Since healthcare is an area that receives large amounts of funding
from foreign donors, how realistic is it to refuse it? If you do refuse it, or
limit it, what alternative crises are individuals facing beyond simply the whims
of donors? In the short run, is it better to be subject to the whims of donors
and receive some funding, or cut off funding entirely and just not have enough
money for healthcare in general?</P></DIV></DIV></DIV></BODY></HTML>