Conservative US policies hit health aid in Africa

A US government directive to stop supplying contraceptives to a family planning organisation could cost African women their lives.

Jenny Dakowah, manager of the Marie Stopes reproductive health centre in Freetown, Sierra Leone, checks a patient's blood pressure.

FREETOWN // A US government directive to stop supplying contraceptives to a family planning organisation that provides health services in poor countries could cost African women their lives, said the organisation's executive director. "This senseless decision is likely to have only one clear consequence: the death of African women and girls," said Dana Hovig, head of Marie Stopes International (MSI).

The US Agency for International Development (USAID) has instructed staff to prevent several African governments from providing US-bought contraceptives to MSI, which is often one of the few organisations offering family planning services in the regions where it operates. Kent Hill, the assistant administrator for global health at USAID, issued the order, which stated that MSI was targeted because it works with the Chinese government. The US state department accuses China of implementing policies of "coercive abortion and involuntary sterilisation". Under US law, organisations that support or participate in such programmes are barred from receiving government funding.

Mr Hovig denied MSI works with the Chinese government, and rejected the accusation it supports coercive abortion or involuntary sterilisation. "Only the Bush administration could find logic in the idea that they can somehow reduce abortion and promote choice for women in China by causing more abortion and gutting choice for women in Africa," he said. The decision will affect family planning programmes in at least six African countries - Ghana, Malawi, Tanzania, Uganda, Zimbabwe and Sierra Leone.

According to MSI, preventing women from receiving contraception will lead to deaths, as women undergo unsafe illegal abortions to rid themselves of unwanted pregnancies. Maternal mortality rates are predicted to increase as well. In an interview from Washington, David Snider, a USAID spokesman, said the agency would continue to provide contraceptives to African countries, but will require governments in those countries to work with alternative family planning organisations.

"Any assertion that the USAID decision regarding MSI will likely increase abortions and maternal deaths is false," he said. Martin Smith, the Sierra Leone director for MSI, said his organisation is the main provider of family planning services. It has been operating in the country since 1986 and stayed throughout the decade-long civil war when most other international groups pulled out. He said MSI is now scrambling to meet the demands of about 12,000 women who depend on it for birth control pills and other contraceptive devices.

"It's created a danger that we're working very hard to reverse," Mr Smith said of the USAID decision. He said MSI's plan to expand services throughout Sierra Leone is now under threat. While about 20 per cent of the sexually active population in the capital, Freetown, use some form of contraception, MSI estimates the rate is only four per cent in rural regions. Mr Smith said there is a great demand for contraception in remote areas. Poor families often do not wish to be burdened by the financial costs of raising too many children, but without access to contraceptives they are forced to rely on traditional methods that do not work.

Sierra Leone also has one of the highest maternal-mortality rates in the world - a statistic MSI is trying to lower by providing options for women to avoid unwanted pregnancies. Worldwide, the organisation says it prevented as many as seven million unwanted pregnancies last year, thus preventing about one million abortions. In countries where it is legal (Sierra Leone is not one of them) MSI also performs abortions - a fact that may have rankled the staunchly pro-life administration of George W Bush, the US president.

It would not be the first time the White House has targeted international non-governmental organisations with pro-choice leanings. On Jan 22 2001 - two days after his inauguration - the US president banned funding for international family planning groups that fight for the availability of abortion. "It is my conviction that taxpayer funds should not be used to pay for abortions or advocate or actively promote abortion, either here or abroad," Mr Bush wrote at the time in a memorandum to the head of USAID.

The law became known as the "global gag rule", but it was repealed last year in a US Senate ruling that was widely seen as a blow to Mr Bush's foreign aid objectives. Despite changing political currents, Mr Bush still has bureaucratic allies in Washington, possibly including Mr Hill, who gave the order for USAID to stop providing contraceptives to MSI. Mr Hill comes from a similar evangelical Christian background as Mr Bush, having served as the president of Eastern Nazarene College, an evangelical institution near Boston, before joining USAID.

Mr Hill also once headed the Institute on Religion and Democracy, a conservative Christian think tank in Washington. In its mission statement, the institute accuses many mainstream churches of taking up "leftist crusades - radical forms of feminism, environmentalism, pacifism, multiculturalism, revolutionary socialism, sexual liberation and so forth". Although Mr Hill's directive was ostensibly aimed at China's draconian reproductive policies, Mr Hovig, of MSI, claimed the move was "purely political".

Mr Smith, MSI's representative in Sierra Leone, said the organisation considers coercive abortion and involuntary sterilisation "repugnant," adding, "MSI is all about choice". Mr Snider, of USAID, insisted the decision was based on law, not politics. "MSI is the major implementer of the United Nations Population Fund's (UNFPA) family planning programme in China. UNFPA's programme in China was found by the state department to support or participate in the management of a programme of coercive abortion or involuntary sterilisation."

The White House banned government funding for UNFPA's China programme in 2002. @Email:[e-mail]