Each day she sets out to speak to young girls about family planning, Elizabeth Akoth, 23, sees how myths about the use of contraceptives are entrenched in her western Kenyan community.

When she explains the various methods they can use to prevent unintended pregnancies, they ask searching questions such as, “Is it true drugs offered for family planning can lead to death?” and “Do they even work?”

Akoth and her fellow peer educators in Homa Bay, a town on the shores of Lake Victoria, have educated dozens of girls on the family planning options available to them, undoubtedly saving many from the unintended pregnancies that often force girls to drop out of school.

But their work may well grind to a halt following the re-imposition by the Trump administration of the global gag rule, a policy that cuts funding to foreign organisations if they provide abortion information, referrals or services, or if they engage in any advocacy on abortion rights with their own funds. Organisations are offered the choice to stop offering these services and still receive funding, or to continue and lose financial support.

Campaigners say the policy will have a devastating impact on millions in many developing countries.

“This blocks access to sexual and reproductive health services in the poorest and hardest to reach communities where we are currently changing lives,” says Tewodros Melesse, director general of the International Planned Parenthood Federation (IPPF). “We can’t support something which tries to restrict people’s choices or take them away. The global gag rule undermines those human rights, so IPPF cannot sign the policy.”

Ending this US aid, which currently stands at $600m (£474m), will result in cuts to funding for sexual and reproductive health services in at least 30 countries where IPPF partner organisations work.



Campaigners say this will have a negative effect on the most vulnerable groups that benefit from family planning advice: teenage girls.



About 16 million girls aged 15 to 19, and one million girls under the age of 15, give birth every year, according to the World Health Organization. The majority of these girls live in low- and middle-income countries. Globally, complications during pregnancy and childbirth are the second leading cause of death for girls aged between 15 and 19.

Girls who become pregnant in their teens face considerable stigma and are often forced to drop out of school, spelling a life marked by early marriage and low-skilled jobs. This has a larger economic cost to countries as they lose out on the income an educated young woman would have earned if she had finished school.

Babies born to adolescent mothers also face a substantially higher risk of dying young than those born to women aged 20 to 24, the WHO finds.

Bernard Washiaka, programme manager for Family Health Options Kenya, one of the country’s main providers of sexual and reproductive health services, says an end to its programmes would have a major effect on many women and young girls.

Family planning drive reaches millions of women and girls Read more

“We live in a patriarchal, male-dominated society and the advice and information we offer helps to empower girls,” he says. “They can enjoy their sexuality while avoiding unintended pregnancy and sexually transmitted diseases. The services are entirely voluntary and based on the decisions of the girls, but we have seen the impact they] have ... Girls are able to stay in school for a longer which opens up a world of opportunity.”

Washiaka, whose organisation’s primary outreach tool is deploying trained peer educators such as Akoth, said there is a risk of returning to the situation of the 80s and 90s, when the implementation of the global gag rule by successive Republican administrations caused the closure of numerous clinics in many underserved communities in Kenya.

Other programmes that may face closure include a pilot initiative in Uganda that distributes Sayana Press, a three-month injectable contraceptive that combines the drug and needle in one unit. The contraceptive can be distributed easily across communities and be self-administered at home.

Uganda has one of the highest fertility rates and youngest populations in the world; almost half of Ugandans are under the age of 15 and 78% of the population is younger than 30. Millions of Ugandans living in rural communities do not have access to family planning facilities and Jackson Chekweko, executive director of Reproductive Health Uganda, told the Guardian that the organisation would have to end many of its activities if USAid terminates financial assistance.

“As well as reaching more people with family planning services, we need to give women more choices about the form of contraception they want. Sayana Press does that,” he says.

Family Health Options Kenya is lobbying local government administrations to allocate funds for family planning from their health budgets. But, says Washiaka, they face a difficult battle because county administrators have to cater for numerous health challenges with a limited budget.

“We will also have to lobby non-traditional donors, such as the Japanese aid agency [Jica] and the Swedish aid agency [Sida]. The alternative is to leave our young children facing a bleak future.”