Melvine P. Ouyo is a student at the John F. Kennedy School of Government at Harvard University and former Kibera clinic manager at Family Health Options Kenya.
First, do no harm.
It’s a principle that has stood the test of thousands of years of practicing medicine. A principle that transcends politics and partisanship and cuts to the core of what medical providers do every day: provide. Help people.
For years, I applied this principle daily, proudly providing safe, affordable reproductive health care to the people who needed it most. I served as a nurse and clinic manager at Family Health Options Kenya, the largest, oldest reproductive health-care provider in the nation. I prescribed birth control. I screened women for cervical cancer. I held crying infants as they took their first breath. I held grieving parents and tried to help as best I could. Even during the worst of times, it was an honor to serve my community.
In order to keep our operations afloat and provide patients with this crucial, low-cost, high-quality care, Family Health Options Kenya relies on funding from external sources, including the United States. But two years ago, newly elected President Trump signed the global gag rule, which requires organizations abroad, such as mine, that received U.S. aid to sign a statement indicating they will not mention abortion to clients, provide abortions or refer clients to legal abortion services.
Family Health Options Kenya, along with many other organizations, was faced with a choice: either sign the policy and stop providing comprehensive sexual reproductive health-care services or decline to sign and lose desperately needed U.S. funding.
Signing this policy would have been a violation of our ethical duty to do no harm, protect our patients’ safety and save lives. We declined. As a result, we lost about $2.2 million in funding. In the two years following our decision, Family Health Options Kenya has been forced to close clinics in poor areas and terminate free services and mobile outreach that provided care for more than 76,000 people annually.
One of those clinics was in Isiolo, one of the hardest to reach and most underserved communities in Kenya. Maternal mortality rates are high in Isiolo; 790 mothers die per 100,000 live births. Women and girls from this community experience every kind of abuse and reproductive-health issue, ranging from early marriages and childbearing to female genital mutilation and unsafe abortion. More than 1 in every 10 girls age 15 to 19 in Isiolo give birth every year.
Behind every statistic, there is a story. I remember Esther (a pseudonym), who was rushed into the emergency room in company of her husband and neighbors in shock. Esther was bleeding heavily due to retained products of conception. It was an incomplete abortion. My team managed to resuscitate her and save her life. Had she not landed in the hands of qualified and well-trained providers, Esther would have died.
Not long after Trump’s global gag rule went into effect, I left Kenya to pursue a master’s degree in public administration at Harvard University. Recently, I learned that the clinic I once led in Kibera, Africa’s largest slum community, may soon be forced to close. People like Esther will be left with no options and no help. Trump’s global gag rule is rapidly destroying health-care access in my home country, eating away at every last resource.
Fortunately, Family Health Options Kenya does not stand alone against the gag rule. Elected officials in many countries, joined by reproductive rights advocates and fellow medical providers, have spoken out against the global gag rule.
Just this week, Sen. Jeanne Shaheen (D-N.H.) and Rep. Nita Lowey (D-N.Y.) reintroduced the Global Health, Empowerment and Rights Act to Congress. The bill would permanently repeal the deadly rule and protect health-care services and rights around the world. This would lead to improved financial support for reproductive-health organizations locally and abroad and, in turn, improved maternal and child health. By once again offering support to organizations working on the front lines of reproductive-health care, it would reduce unmet needs for contraception, unplanned pregnancies, unsafe abortion and HIV/AIDs prevalence.
The Global Her Act and other initiatives to fight back against the gag rule give me hope for the future. The leaders of tomorrow understand that we must build a world where everyone — including disadvantaged children, poor men and women, young girls and boys, slum dwellers, the homeless, members of the LGBTQ community, the HIV-infected and -affected, sex workers, and women suffering from reproductive organ cancers — has access to equal rights and resources. Those are the patients I served. That’s the world I am fighting for.
That world begins with abolishing cruel, vindictive policies such as Trump’s global gag rule. That world begins with healing the damage that those policies have caused. First, do no harm. Then we move forward.