Source: Thomson Reuters Foundation
President Donald Trump's dramatic expansion of a policy blocking U.S. aid to organisations offering abortion services will have one sure result, say medical workers in this city: more abortions.
The United States reinstated the "Mexico City Policy" in January, cutting some $600 million in funds for family planning programmes overseas.
Last week its scope suddenly mushroomed. Trump expanded it to affect $8.8 billion worth of global health funding, including programmes on HIV/AIDS, malaria and child health.
The extension requires all health organisations receiving U.S. aid to guarantee they do not provide abortion services or discuss abortion policy, even if the abortion-related activities are funded by non-U.S. government sources.
The policy means cuts to programmes like the one run by Kenyan nurse Monica Oguttu, who founded the Kisumu Medical and Education Trust to help poor women get health care and education in the country's third largest-city.
The trust had been scheduled to receive a total of $2 million from USAID from 2017 to 2021, around 56 percent of its budget. It now expects to lose all its U.S. funding.
Oguttu founded the organisation after discovering that half of the women in her gynaecological ward in a Nairobi teaching hospital were there because of the damage done by backstreet abortions.
"One in five of them went home in a coffin," she said. "There was a 17-year-old girl who had lost her uterus and had damage to her rectum. She went home with a colostomy bag ... We would like to save these women."
The Mexico City Policy, started in 1984, has in the past been routinely rescinded under Democratic administrations and reinstated under Republican ones.
Oguttu said she remembered when President George Bush reinstated the policy in 2001. Aid groups had to shut eight clinics in Kenya and hike prices in others, according to a study by the Washington D.C.-based Population Action International.
"Suddenly there were no contraceptive methods," she said. "We had so many more complications having to do with post-abortion care from unsafe abortions ... We saw it happen last time and we dread it coming again."
Cuts will force Oguttu's trust to start charging for contraceptives which are currently free, she said.
The Kenyan health ministry, recently rocked by strikes in public hospitals and a major corruption scandal, did not return calls seeking comment.
AFRICA-WIDE STUDY
A 2011 Stanford University study looked at the effects of the Mexico City Policy on 261,116 women in 20 countries across sub-Saharan Africa.
It found a dramatic jump in abortion rates during 2001-2008, when the policy was in place, compared to 1994-2001, when it was rescinded.
Abortions went up, on average, from 10.4 per 10,000 women to 14.5 per 10,000. In poor countries most dependent on U.S. money for reproductive health services, abortions more than doubled.
Joyce, 24, had an abortion at the Kisumu clinic last year so she could continue her university studies. Afterwards, it gave her an IUD contraceptive.
"My life would have been miserable. It would have forced me to drop out of school," she whispered.
Sitting next to her at the clinic, bright-eyed Margaret Apiyo, 27, said she did not use its abortion services but came for check-ups and to give birth. Despite complications, she has had two healthy daughters.
"They took good care of me, together with the baby I was carrying," she said happily. "Finally I was safe."
The Trump administration says overseas aid for health programmes will continue, but might be redirected to different providers.
"Protecting Life in Global Health Assistance does not reduce the amount of global health assistance the U.S. Government makes available, and funding previously obligated will not be affected," the State Department said in a statement.
On a continent with hundreds of millions of Christians and Muslims, some African anti-abortion groups applaud the U.S. measures.
"If prevention information was given out widely then we could curb these abortion cases," said Joseph Peter Kamande, director of programming at charity Abstinence Kenya.
"We think pro-life is better for us in Kenya."
A U.S. government-funded study released in 2007 found abstinence-only programs to be widely ineffective.
In response to the reinstatement of the Mexico City Policy, the international campaign She Decides was launched in January with the goal of making up the initial $600 million shortfall in funding.
Led by Dutch development minister Lilianne Ploumen, it has since raised $181 million.
"The impact on millions of women and men will be huge," she said in a statement on the U.S. policy. "The number of abortions will not fall, as the U.S. wants, but will in fact rise."
Chimaraoke Izugbara, at the Nairobi-based Africa Population Health Research Centre, said that even if other donors replaced U.S. funding, the money would come at the expense of other health needs.
"While funding may go into the provision of safe abortion services, that will divert attention from other things that they are doing, like nutrition, like child health," he said.