Safe Abortion For Adolescents And Implications Of GGR
There is no doubt that the reintroduction of the Mexico City Policy, also known as the ‘Global Gag Rule,’ (GGR) by President Donald Trump of the United States is increasingly having widespread deadly toll on adolescents seeking for reproductive health services.
GGR is an executive order by the US government that blocks U.S. federal funding for non-governmental organisations that provide abortion counselling or referrals, advocate to decriminalise abortion or expand abortion services.
However, reproductive health advocates and experts say by criminalising abortion, the GGR ends up exposing vulnerable women and girls to potentially fatal and illegal abortion.
According to them, President Trump with the Order signed a campaign against women and female adolescent healthcare globally via his reinstatement of the GGR.
They insist that Trump’s willingness to undermine the quality of women’s health care worldwide is threatening lives.
In past versions of the policy under Presidents Ronald Reagan and George Bush, foreign non-profit organisations that provided or even discussed abortion lost access to millions of dollars in U.S. family planning funding.
But, Trump expanded the scope of the Global Gag Rule to cover about $9.5 billion of any kind on global health funding, more than a 15-fold increase.
Health groups believe that the effect of this cruel policy extends far beyond abortion as clinics in developing countries that provide a range of health services, like treatment for tuberculosis or vaccinations for babies are seeing their funding slashed.
It’s a move, they say, that is as devastating as it has left impoverished women around the world without treatment for HIV, malaria, and other diseases.
A Kenyan healthcare organisation that has already been forced to close one of its clinics, said with the expanded rule: "We’ve been given a death sentence."
As if that was not bad enough, Trump’s latest budget proposal slashed funding for global health and reproductive rights, including contraception that prevents unintended pregnancies and maternal deaths around the world.
In 2017, the Trump's administration selected figures from virulently anti-choice organisations to represent the nation at what the State Department called "the most important annual meeting on women’s issues at the United Nations."
According to UN Foundation, without the US contribution to UNFPA, the world may witness: 947,000 more unintended pregnancies, 295,000 more unsafe abortions, 2,340 more maternal deaths during pregnancy and childbirth, 1, 251 fewer life-saving surgeries during childbirth.
UNFPA used U.S. contribution to reach nine million people in crisis environment programming including; HIV/AIDS prevention services, domestic violence counselling, pregnancy checkup, safe child birth as well as mid wife training, pre- natal care and safe delivery services.
According to the Guttmacher Institute, researchers estimate that in 2008 (the most recent estimate available), about 3.2 million adolescent women in developing regions underwent unsafe abortions, an annual rate of about 16 unsafe abortions per 1,000 women aged 15–19.
With the GGR in place, unsafe abortions among adolescents is imminent as record shows that 19 percent of over 3.8 million married and sexually active adolescents (15-19) have an unmet need for contraceptives.
In most developing countries, stigma against sexual activity among unmarried adolescents is pervasive, unmet need for contraception among women in their teenage years is high, and abortion is highly legally restricted, constraining access to safe services for adolescents and majority of women.
Accurate and complete information about sex and provision of contraceptive methods are first-line defenses against unintended pregnancy, but many adolescents in developing countries lack access to these essential services.
The Guttmacher’s estimates tally with that of the World Health Organization, (WHO), which shows that every year, some 3.9 million girls aged 15 to 19 years undergo unsafe abortions. Adolescent mothers (ages 10 to 19 years) face higher risks of eclampsia, puerperal endometritis, and systemic infections than women aged 20 to 24 years, and babies born to adolescent mothers face higher risks of low birthweight, preterm delivery, and severe neonatal conditions than those born to women aged 20 to 24 years.
WHO also states that 23 million girls aged 15 to 19 years in developing regions have an unmet need for modern contraception. As a result, half of pregnancies among girls aged 15 to 19 years in developing regions are estimated to be unintended and the expanded GGR on contraception will only fuel unintended pregnancies among adolescents.
Adolescent pregnancy remains a major contributor to maternal and child mortality, and to intergenerational cycles of ill-health and poverty. Pregnancy and childbirth complications are the leading cause of death among 15 to 19 year-old girls globally, with low and middle-income countries accounting for 99 percent of global maternal deaths of women ages 15 to 49 years.
Speaking on adolescents Sexual and Reproductive Health and Rights (SRHR), the co-coordinator of The New HIV Vaccine and Microbicide Advocacy Society (NHVMAS), Dr. Morenike Folayan, said, "all stakeholders in Nigeria should engage with family planning, SRHR, and HIV and AIDS response to join forces to press for change in the way adolescents' sexual right is being managed.
"Adolescent-friendly centres should be established and include rape prevention strategies in their training programmes. These strategies should not exclude safe spaces for the provision of abortion for girls as many girls become pregnant from rape."
Dr. Folayan strongly denounced Trump's Global Gag Rule (GGR) that pushes to silence organisations that provide abortion counselling or referrals, as she advocates the decriminalisation of abortion and expansion of abortion services to address the needs of adolescents.
"It is disheartening. The result of a study conducted in Nigeria showed that as high as 31.4 percent of sexually active female adolescents had experienced forced sexual initiation,” she said, stressing that "in Nigeria, adolescents have a history of forced sex initiation and were more likely to engage in unprotected anal sex and in transactional sex. They also were more likely to adopt mental and emotional avoidance strategies and religion to cope with the stress of rape due to negative labelling and stigma of rape survivors.
“They are a lot more concerned about pregnancy than HIV. Yet, the risk of rape increases the adolescent’s risk for both pregnancy and HIV infection."
The advocacy society also asks for continued global investment in research and development of multipurpose technologies that reduces the risk of female adolescents to pregnancy, sexually transmitted infection and HIV infection.
Speaking in the same vein, Dr. Laila St. Matthew-Daniel, founder of ACTS Generation, a gender based organization focused on zero tolerance against any form of violence, abuse or attempt at trafficking of the woman and the girl-child, said, with the Global Gag Rule, a lot of women will be denied access to Reproductive Health care particularly those who may be survivors of sexual violence.
The impact of GGR, She said, would include increased number of women and girls faced with the risk of Sexually Transmitted Diseases (STDs) as well as alleged new HIV infections; increase in number of unwanted and un-planned pregnancies resulting from sexual violence.
Dr. Matthew-Daniel added that there would also be an increase in number of survivors that develop Post Traumatic Stress Disorder (PTSD), and mental illness that may be linked to ill-managed trauma resulting from their abuse experience. “Also, there may be an increase of ‘rejection’ of babies born in such emotional experiences further creating a dysfunctional society.”
"There is need for the existing laws to be revisited with ongoing realities. Stifling the environment for women and girls from making decisions about their reproductive interest does not have the capacity to reduce unwanted pregnancies.
Allowing room for more access to information and services related to their SRHR has the potential to arm them with knowledge, which can prevent unwanted pregnancies.
Also there is need for more advocacy meetings with relevant legal agencies and bodies as well as enlightenment campaigns on the need for recognition of SRHR for women and girls.
Giving her thought, the Director, Family Planning and Nutrition, Lagos State Ministry of Health, Dr Folashade Oludara, calls on adolescents to embrace family planning as this would deter them from visiting quacks to terminate any unplanned pregnancy with dire health implications.
Oludara explained that the family planning department is currently working on health workers bias in terms of not attending to young adolescents who come to seek FP services.
She added that Trump's GGR will awaken Nigerians to embracing family planning as Nigeria's domestic law does not encourage abortion, unless it endangers the life of the woman or female adolescent.