She has five children and works as a farmer in Budadiri, Uganda, east Africa.
“I want to look after my children,” Mudua says. “But I am a woman alone, and any time a man could force me into sex and I could get pregnant.”
Women like Mudua, thousands of miles away from Washington and the White House, are the ones starting to feel the reverberations of US President Donald Trump’s Mexico City Policy, reintroduced in January amid a slew of executive orders from the newly inaugurated President.
Mudua currently receives her contraception from Marie Stopes Uganda, a non-profit that provides family planning advice and sexual health services across the country.
“I’m going to be OK because I will not have to give birth to a child I don’t want on my own,” she says.
But for Mudua and others like her, things are about to change.
Named after the venue of the conference where it was first announced by President Ronald Reagan in 1984, the Mexico City Policy, also known as the “global gag rule” withholds American aid (USAID) from any international non-governmental organizations that offer women advice on abortion.
Marie Stopes Uganda says that 94% of its outreach work, which aims to bring contraception to women in rural and remote areas, is funded by USAID.
It estimates that these funds will start to dry up around September, which over the next three years could result in an extra 1.1 million unwanted pregnancies in Uganda alone.
‘US funds never used for abortions’
Any criticism leveled at the President for the manner in which he signed the order (surrounded by a group of white men) or the potential impact on global health services was drowned out by the widespread condemnation and confusion that met Trump’s controversial travel ban announced three days later.
Meanwhile, governments, NGOs and health organizations on the ground have been coming to grips with the far-reaching consequences of the policy, which experts say will have little to no impact on the number of abortive procedures.
“United States government funds have never been used for abortions,” says Tewodros Melesse, director general of International Planned Parenthood Federation (IPPF).
“Even during the Obama administration or Clinton administration, it was not possible to use US funds for abortion.”
NGOs that performed the procedure could receive US funding for other programs, though, including those related to contraception and sexual health.
Now organizations that offer abortions as part of their family planning services — or even refer patients to other clinics that can perform abortions — will be prevented from receiving any assistance at all from the US Agency for International Development, one of the largest contributors to international development assistance.
Melesse says it’s going to have a huge impact. “We’re going to be losing around 100 million US dollars over the next three to four years.”
Major reproductive care NGO Marie Stopes International says complying and removing safe abortion from its services isn’t an option.
The evidence is “unequivocal,” says Marjorie Newman-Williams, Marie Stopes’ vice president and director of international operations, that doing so would expose women to increased potential dangers.
According to the latest WHO data, 21.6 million women annually are so desperate that they gamble with the risk of life-threatening injuries or even death to have unsafe abortions. Every year 47,000 women die from complications.
“Agreeing to the Mexico City Policy would mean accepting their fate and turning our backs on the very women who need us most,” says Newman-Williams.
In 2003, shortly after the policy was last introduced by George W. Bush, the Center for Reproductive Rights published a report highlighting horror stories from women who’d sought out surgery from the wrong practitioners.
In one example, a poor 17-year-old house help wanted to terminate her pregnancy.
The person she went to see “did not know the anus from the vagina,” one Kenyan NGO reported. “He destroyed her anus, rectum, uterus and some of the small intestine.”
Newman-Williams says that laws attempting to stop women from having abortions don’t work because they don’t stop the need for women to have abortions in the first place.
And, paradoxically, as NGOs lose funding and are less able to provide contraception, the number of unwanted pregnancies is only likely to increase, which drives up the demand for abortions.
Washington-based Impassioned Advocates for Girls and Women reports that after the last reinstatement of the policy in 2001, shipments of US-donated condoms and contraceptives completely stopped to 16 developing countries — mainly in Africa.
Family planning providers in another 16 countries (also mainly in Africa) lost access to condoms and contraceptives because they refused to accept the conditions of the Mexico City Policy.
One healthcare worker on the ground in Uganda told CNN she currently issues contraceptive injections to between 30 and 50 women a month.
“Women will walk for many miles to a health clinic and find that they cannot provide the services,” says Reproductive Health Uganda (RHU) volunteer Akiiki Jemimah Mutooro. RHU anticipates it will lose $420,000 in funding.
“If we are unable to continue this service, many women will lose out.”
The reduction in access to contraception will also have a profound impact on the spread of sexually transmitted diseases, including the battle with HIV, according to IPPF.
“All the effort the United States has made over the years to support funding for HIV Aids initiatives is going to be affected by telling organizations who have received funding … that they cannot inform the patient about abortion,” says Melesse.
Sub-Saharan Africa is likely to be one of the hardest-hit regions, says Marie Stopes International’s director of strategy, Maaike van Min.
It’s the largest recipient of American aid and already has more abortion-related deaths than any other continent.
She says a lot of work is being done on domestic financing, but social welfare systems are still in their infancy across much of the developing world and there are competing priorities for scarce resources. “It will be a challenge to try to meet the funding gap,” she says.
In February, dozens of governments and private philanthropists pledged hundreds of millions of dollars to a global fundraising initiative called She Decides, launched by Dutch Development Minister Lilianne Ploumen.
In 2002, the European Commission came forward and said it wanted to make up the shortfall after Bush’s reinstatement of the policy. This was an important move, says Melesse, because it proved “the US cannot tell the world how women’s health and sexual reproductive health should be handled.”
White House Press Secretary Sean Spicer says President Trump has always made it very clear that he’s pro-life and he’s staying true to his pre-election promises.
“He wants to stand up for all Americans, including the unborn, and I think the reinstatement of this policy is not just something that echoes that value, but respects taxpayer funding as well,” Spicer said in a press briefing at the time.
In January, Republican Congressman Chris Smith, chair of the Congressional Pro-Life Caucus, lauded the move in a press release.
“Organizations like Marie Stopes International and the International Planned Parenthood Federation have reported performing over 1 million abortions annually,” Smith said, citing a January 2017 poll where 83% of American respondents said they opposed US tax dollars being used to support abortion abroad — but omitting that in the same poll 52% of Americans also said they were pro-choice.
The deprivation of this choice for women in less-privileged circumstances is what jars with Melesse the most.
“This government is coming and telling the rest of the world: you cannot have the democracy that the United States has,” he says. “That’s really the most critical part.”