This week President Trump revived a ban on providing foreign aid to health providers abroad that offer abortion counseling as part of their family planning services. Caitlin Parks, a family planning fellow at Washington University in St.
Louis, provides reproductive health services to women at clinics and a teaching hospital in western Kenya. Her clinics receive American funding, and she says that the ban, called by critics the global gag rule, could have a major impact on poor women and communities like the ones she serves.
This Q. and A., which is based on an online response and phone interview, has been edited and condensed.
What type of women do you serve in western Kenya?
Mostly impoverished, many with H.I.V. or other medical conditions that make pregnancy complicated or risky.
Many of the women rely on agriculture and small plots of land for both their food and their income. This is an area that has a high rate of H.I.V. and has for many years, and so there is quite a large population of H.I.V. positive women and families that have been greatly affected by H.I.V. There is a high rate of orphans and a need for extended family for support.
This week President Trump revived a ban on providing foreign aid to health providers abroad that offer abortion counseling as part of their family planning services. Caitlin Parks, a family planning fellow at Washington University in St. Louis, provides reproductive health services to women at clinics and a teaching hospital in western Kenya. Her clinics receive American funding, and she says that the ban, called by critics the global gag rule, could have a major impact on poor women and communities like the ones she serves.
This Q. and A., which is based on an online response and phone interview, has been edited and condensed.
What type of women do you serve in western Kenya?
Mostly impoverished, many with H.I.V. or other medical conditions that make pregnancy complicated or risky.
Many of the women rely on agriculture and small plots of land for both their food and their income. This is an area that has a high rate of H.I.V. and has for many years, and so there is quite a large population of H.I.V. positive women and families that have been greatly affected by H.I.V. There is a high rate of orphans and a need for extended family for support.
There are lots of women as the primary supporters of their children and their extended family.
What is their biggest maternal health need?
Their biggest need is full-spectrum reproductive health care, including contraceptive and sometimes abortion services, as well as full maternity care.
One of the things that is a challenge in the system of reproductive health care is that for many people they don’t necessarily know that they need it until they are faced with an unplanned pregnancy. One of the biggest killers in sub-Saharan Africa is maternal mortality, and lots of these people don’t necessarily know that they need to protect themselves from that. So they aren’t necessarily seeking out contraceptive care until it’s too late — they have an unplanned pregnancy that might affect their life.
Both to have healthy lives and economically to be able to support their families, limiting and spacing pregnancies is incredibly important.
Why might these pregnancies lead to a maternal death?
The major reason is lack of access to care. Here in the U.S., we take being pregnant as being much safer. In the U.S., we have a clinic and easy access to a facility if a woman needs it. There are no ambulances in large swaths of the area that we serve, so if someone does have a complication from a pregnancy they die much easier than in the U.S.
The same goes for abortion. We know, regardless of whether we agree or disagree with it, that they will occur. Here in the U.S., because it is legal and we have better access, we know that we can obtain a safe abortion. There, for women who do have an abortion, it is much more likely to be unsafe and lead to both health- and life-threatening conditions.
And we know certainly that the only way to prevent life- and health-threatening conditions from a pregnancy or an abortion is to make contraception available to all women.
How will the ban affect your clinics and the services you provide?
Abortion is illegal in Kenya. The biggest thing for us is the fact that there are certain conditions within Kenyan law that allow it to be performed – both health and life conditions. But the U.S. ban is not clear. Sometimes, there is an interpretation that we could refer for an abortion, if they are in a health-threatening condition. The other interpretation is only if life threatening. That difference between health and life threatening is problematic. It scares providers from talking about it at all, even in cases when it could be both health and life threatening.
Thank you for subscribing.
An error has occurred. Please try again later.
You are already subscribed to this email.
View all New York Times newsletters.
For other institutions, in countries where abortion is legally available, it prevents them from performing or referring for abortion services.
No matter where you are in the world, the most important thing is to be able to make these decisions with a woman and her doctors as to what they think is the most important and safest thing for a woman and her body, and not to be guided by blanket rules that are not guided by patient care.
When we have something, like the global gag rule, it doesn’t allow for some of the nuances that are important for making those individual decisions. Even if it would be allowed, no one will even discuss the possibilities because the entire topic is silenced.
Describe a patient who needed your services.
She was a young woman with a dangerous heart condition that requires medication that would pose risks to a developing fetus. She thought that she could not become pregnant because of her condition and had previously been unable to afford birth control. When she became pregnant, she was afraid of becoming sicker and dying, leaving her young children orphaned. She needed access for a safe, legal abortion.
We were able to provide her a referral for a safe abortion within our own organization.
This ban would mean that we would not even be able to give her information about where to go, leaving her to find some other unsafe means of obtaining her needed health care.
We’re interested in your feedback on this page. Tell us what you think.
