COMMENT: Uganda and Trump’s Gag Rule

COMMENT: By Joy Asasira & Dennis Jjuuko

Is American foreign policy to blame or poor prioritisation by the Ugandan government?

U.S President Ronald Reagan first invoked the global gag rule also known as the Mexico City Policy in 1984, followed by President George W. Bush in 2001. President Donald Trump has also invoked the same rule through an executive order within the first few weeks of his administration.

The gag rule imposes anti-abortion restrictions against the use of global health assistance. It bars U.S government and non-US government agencies from providing support to organisations that provide abortion services or related information, hence the term the “gag” rule.

This is a catastrophic policy for countries, including Uganda, whose budgets are greatly dependent on foreign aid. It will reduce access to family planning for most women who wish to limit or space the number of children they deliver, and accelerate a rise in the number of unplanned pregnancies, thus enormously contributing to incidences of unsafe abortions. For Uganda, this is a cause for alarm. Organisations that have been providing an integrated range of services from counseling to prevent un-intended pregnancies, to family planning and even post abortion care (abortion is highly restricted in Uganda) are bound to be affected.

Uganda has put in place a number of policies, plans and programs aimed at improving the Sexual and Reproductive Health (SRH) outcomes of its citizens. One such policy is the Costed Implementation Plan for Family Planning 2015-2020 (CIP) which indicates the government’s commitment to improve access to FP as a low cost, high dividend investment for addressing the high maternal mortality ratio, to improve the health and welfare of women, and ultimately the nation. The plan further emphasises that FP is an essential component if Uganda is to become a middle-income country by 2040.

Despite Uganda’s robust SHR policy framework that includes among others the CIP, the budget financing trends indicate major funding sources for FP and indeed most of other key sectors as donor contingent. The direness of the situation is further exacerbated by the fact that the allocation for the health budget is persistently low, fluctuating between 7% and 9% of Uganda’s National Budget in the last five years. This is considerably below 15% recommended by the Abuja Declaration. Indeed, WHO puts Uganda’s expenditure for health at only US$14 per-capita as opposed to the endorsed US$28 per-capita and up to US$40 when ARVs are included. In fact the current per-capita health expenditure stands at an average of US$56, contrary to the five-year Health Sector Development Plan (HSDP) that recommended a minimum of US$73 per-capita in the financial year (FY) 2015/16. This clearly indicates that government funding is still wanting.

Despite this persistent low funding to the health sector, there have been some modest improvements in SRH indicators due to interplay of other factors like the role of the private sector, including NGOs that have brought health services closer to the people. To this end, statistics indicate a decline in the risk of a mother dying in the health facility while giving birth from 168 per 100,000 live births in 2013 to 146 per 100,000 live births in 2015. Similarly, infant mortality declined from 87 deaths per 1,000 live births in 2002 to 53 deaths per 1,000 live births in 2014.