Trump's ban on global abortion funding has already hit healthcare in Africa

Doctors 'expect to see more injuries and more deaths as a result of this policy', says Human Rights Watch

'When the US imposes these restrictions it has a really disproportionate effect on the ground,' say activists (AP/Evan Vucci)

Donald Trump’s expansion of the Mexico City Policy to cover billions of dollars in global health assistance has already led to cuts in basic health services in Kenya and Uganda, a leading rights group has claimed.

State clinics have lost out on training and equipment they would usually receive from non-governmental groups, while there has been “widespread confusion” about how to comply with the rules, Human Rights Watch (HRW) said.

Earlier this year Mr Trump directed the State Department to widen the scope of the Mexico City Policy, a Reagan-era stricture that forces NGOs to “neither perform nor actively promote abortion as a method of family planning in other nations” if they want to apply for US federal funds.

The Protecting Life in Global Health Assistance rules now apply to groups that also receive US cash to fight HIV/Aids, malaria and other problems, and covers nearly $9bn (£6.8bn) in aid as opposed to the $600m (£455m) restricted by the original policy.

HRW has written to Secretary of State Rex Tillerson to warn him of health workers’ fears the policy will result in “increased unsafe abortions and associated maternal deaths”, having interviewed representatives of 45 groups across Uganda and Kenya.

Nisha Varia, HRW’s advocacy director for women’s rights, told The Independent: “Both Kenya and Uganda have really high maternal mortality rates, they have very high HIV prevalence rates.

“They rely on US health funds to provide basic health services throughout the country. When the US imposes these restrictions it has a really disproportionate effect on the ground.

“Even though these restrictions are meant to target NGOs they also have a harmful effect on government health services.

“Here are doctors, healthcare advocates, people who know the health service really well. Almost every single one of them told us that they’re really concerned and that they expect to see more injuries and more deaths as a result of this policy, because they think there will be more unsafe abortions.”

One organisation, Family Health Options Kenya, is planning to cut half its services and has already cancelled 100 outreach events for cervical cancer screening, HIV testing and family planning, HRW claimed.

Some groups rely on US aid for up to 80 per cent of their funding, Ms Varia said, and were forced to make difficult choices about whether to cut some services, or risk losing the ability to provide even more without US funds.

In its letter, HRW told Mr Tillerson: “We interviewed groups who had to choose between funds for lifesaving antiretroviral therapy for their members or lifesaving reproductive health services. Both are desperately needed.

“These programming shifts and choices undermine hard-won relationships of trust developed with a key population on the front lines of efforts to fight HIV.”

Ms Varia said the new rules were also preventing doctors from providing comprehensive medical advice to women.

She added: “It’s a shocking invasion into the doctor-patient relationship, not to be able to give complete health information about what a pregnant woman’s options are. This would be unconstitutional in the US, to limit and to gag what healthcare providers are able to tell patients.”

In May this year an Amnesty International spokeswoman told The Independent the new policy, dubbed the “global gag rule” by activists, meant that “any clinic, any hospital, any nutrition program that receives US foreign assistance dollars will now be required to certify that it doesn’t even give information about safe abortion or tell women where they can find out about abortion”.

The Independent has contacted the State Department for comment.

The department has previously said: “Protecting Life in Global Health Assistance does not reduce the amount of global health assistance the US government makes available, and funding previously obligated will not be affected as a result of this policy.

“Given the expansive nature of the new policy, the Department will undertake a thorough and comprehensive review of the effectiveness and impact of the policy’s application over the next six months, which could include identifying implementation issues, and any other new information affecting implementation going forward.

“Newly covered programs, including PEPFAR, the President’s Malaria Initiative, and other global health programs, will be given special attention under this review.”

HRW said six months was insufficient time to assess the policy’s impact. “Many organisations have not yet signed new grants or renewals and have not yet had to cut or shift their programs,” it told Mr Tillerson.