Uganda is one of the largest recipients of U.S. global health assistance, including family planning, and will be significantly impacted by the Trump-Pence administration policy entitled “Protecting Life in Global Health Assistance.” The policy—commonly referred to as the Global Gag Rule by opponents—effectively prohibits organizations from using their private, non-U.S. funds to provide comprehensive, safe abortion services; offer information or referrals for abortions; or to advocate for the legalization or liberalization of safe abortion services. Importantly, this latest iteration of the Global Gag Rule applies to all U.S. global health assistance. Trump’s expanded policy not only undermines the effectiveness and efficiency of U.S. investments in global health, but has the potential to roll back progress made in improving health outcomes for women, girls and communities in Uganda.
To document the preliminary impacts of Trump’s Global Gag Rule on women’s sexual and reproductive health and rights, PAI conducted a fact-finding trip to Kampala, Uganda, in October 2017. While it is too early to understand the full effect of the expanded policy—especially across all health sectors—a picture of the most severe effects on sexual and reproductive health has begun to emerge. These impacts include: increasing commodity insecurity; chilling effects on advocacy for safe abortion and post-abortion care services; the dismantling of referral networks between compliant and noncompliant organizations; heavy administrative burdens for organizations; the disruption of donor coordination; and a bolstering of Ugandan opponents of sexual and reproductive health and rights. All of these are compounded by uncertainty of future U.S. global health funding and low domestic resource mobilization for health—including family planning and reproductive health, which remain under-prioritized and under-resourced by the government of Uganda.