With an influx of more than one million South Sudanese fleeing violence and conflict as of August this year, Uganda is now the largest host of refugees in sub-Saharan Africa. Over 85 percent of the forcibly displaced South Sudanese are women and children – 26 percent are women and girls of reproductive age.
Worldwide, an estimated 26 million women and girls of reproductive age live in humanitarian contexts. They face multiple sexual and reproductive health challenges, including high maternal mortality rates and vulnerability to unwanted pregnancy, unsafe abortion, and an acute increase in sexual violence. Adolescent girls are at especially heightened risk of sexual and gender-based violence and exploitation, including trafficking; transactional sex for survival; and early and forced marriage.
Humanitarian agencies and the Ugandan government have set up temporary health centers in refugee settlements to serve the large female population of reproductive age. Additionally, because Uganda has one of the most welcoming environments for refugees – freedom of movement, the right to work, and to access services – these women and girls also have access to the Ugandan health system.
However, refugees present a challenge to the overburdened Ugandan health services that regularly experience stock outs of life saving medicines and health supplies, including contraception. Uganda is one of the largest recipients of U.S. official development assistance in the world, and the United States has been the single largest provider of health assistance to Uganda. Additionally, the UN Population Fund (UNFPA) takes a leading role in delivering sexual and reproductive health services. UNFPA has supported the reproductive health needs of over two million refugees in settlements in Uganda, including through distribution of supplies. However, support to reproductive health in emergencies in particular has historically been inadequate, and UNFPA faces regular funding shortfalls. Trump’s Global Gag Rule threatens to put these critical services and supplies even further in jeopardy.
The U.S. government was once a leader in ensuring the inclusion of sexual and reproductive health services and programs on gender-based violence in humanitarian responses. In 2016, the Obama administration launched the U.S. Strategy to Empower Adolescent Girls, which recognized the threats to girls’ health and well-being during emergency situations, including needs for sexual and reproductive health services. However, while U.S. leadership is needed more than ever to protect vulnerable women and girls as global crises are on the rise, Trump’s expanded Global Gag Rule, as well as the administration’s defunding of support to UNFPA, risks unexpectedly impacting humanitarian emergencies. In Uganda, the Global Gag Rule will likely affect organizations that have traditionally served both national-level health supply needs and those in refugee settlements, creating even more barriers to access to reproductive care.
When the Global Gag Rule was previously in place, it reduced women’s and girls’ access to comprehensive sexual and reproductive health services and decimated health systems by undermining the most effective and experienced health care providers and putting their services out of reach. The policy also caused shortages in USAID-supplied contraceptives in 16 developing countries in Africa, Asia, and the Middle East. It is still early days of the implementation of Trump’s Global Gag Rule. But, with no end in sight to the conflict in South Sudan and as refugees continue to arrive in Uganda, the impacts of the Global Gag Rule on service providers will likely increase over time and Trump’s policy will most likely be disproportionately felt by vulnerable women and girls.