t’s been 10 years, but Melvine Ouyo remembers the girl well — a 15-year-old who came into the clinic on the verge of death. She was in shock, suffering from an infection developed after undergoing an unsafe abortion.
“They had to remove the whole uterus to be able to save the life of this girl,” Ouyo said.
Ouyo, 27 at the time, was a nurse-in-training. Now, she works at a sexual and reproductive health clinic in Nairobi, Kenya, which, for the past three years, has provided free health care — from family planning to malaria treatment — in one of the city’s poorest areas, run by an organization supported in part by money from the U.S. government.
Last week, she traveled from Kenya to the United States to make an appeal to lawmakers in Washington and Americans across the country: Don’t cut off our funding.
Ouyo works for Family Health Options Kenya, which provides health services to Kenya’s most vulnerable — and which lost over half a million dollars this year because of a memorandum President Trump signed at the end of January prohibiting foreign organizations that provide or promote abortion from receiving health funding from the United States government, representatives from the organization said.
Such a policy has been in place under Republican presidents since the Reagan administration, in a slightly different form. Previously, the policy prohibited foreign NGOs that provided or promoted abortion from receiving family planning dollars; now, such organizations cannot receive any health funding.
Democrats and family planning organizations were quick to criticize the policy, and it was praised by anti-abortion advocates.
The policy applies to as much as $8.8 billion in health funding. To help fill the gap, other governments along with private organizations pledged $300 million over the summer.
The policy means that Family Health Options Kenya can no longer receive health funding from the U.S. Agency for International Development. Ouyo said that the organization, whose budget last year was about $4 million, lost $620,000 from the agency this year, and that it expects to receive less money from the International Planned Parenthood Federation than it has in the past.
In response to a description of Family Health Options Kenya’s situation, a USAID spokesperson said that “all foreign NGOs remain eligible to receive global health assistance through the standard U.S. Government processes that govern the award of federal funds. However, to do so, they must indicate their agreement to abide by the terms of Protecting Life in Global Health Assistance by accepting these provisions in their award,” referring to the name of the State Department’s plan to implement what is known as the Mexico City Policy.
The spokesperson did not provide STAT with the total amount of assistance that Family Health Options Kenya has received through aid programs, but said that the budget for health programs in Kenya during the previous fiscal year was $582 million.
Ouyo and Amos Simpano, the organization’s director of clinical services, met with the staff of six Democratic lawmakers in Washington last week, before embarking on a multistate speaking tour.
In August, the organization closed a clinic in Mombasa, Simpano said. And since February, it has stopped sending health workers into rural communities, said Wilson Bunde, a project manager at the organization. Bunde said that these free outreach visits might reach as many as 200 people per week, providing them with more than just family planning resources — health workers would also screen for sexually transmitted diseases and provide general health services.
Bunde also said that between 15 and 20 employees of Family Health Options Kenya — from nurses and pharmacists to senior managers — have already lost their jobs because of the funding cuts.
Simpano worries about needing to shutter a promising, four-year effort to build trust and promote contraception in places like the coastal region of Malindi. Many in the predominantly Muslim community previously thought the Quran forbade modern contraceptives. Medical staff from Simpano’s organization worked with religious leaders and taught young Muslim women how to educate their peers about different methods of birth control.
“We have managed to really change a perception to be a positive perception, and we are just in the beginning of implementing a long-term intervention where they can freely choose services without any fear of religion, and all of a sudden we are withdrawing as Family Health Options Kenya,” Simpano said. “I think the communities will feel that we have betrayed them.”
Family Health Options Kenya’s reliance on United States funding has meant that its ability to do its jobs is dependent on the politics of the American president. During the Bush administration, it had to close six clinics throughout the country, Simpano said.
“The eventual impact will be that we will see mortalities,” Ouyo said. “Some may not be recorded at the time, but there are mortalities occurring in the communities as a result of the lack of services. And that is why we are saying signing into the [policy] is like committing suicide, because women will die as we watch.”
Last month, Ouyo said, a 15-year-old pregnant girl in Garissa hanged herself because she did not have access to medical care or counseling.
“This is one community that we have not reached because of lack of funding, of course,” Ouyo said.
Meanwhile, the organization is seeking funding from other sources. Bunde said that representatives have reached out to the governments of Sweden and Denmark, but so far to no avail.