Opinion: What ‘She Decides’ Means for the Global Gag Rule on Sexual Reproductive Health

By Johnstone Kuya and Michael Okun


Lillian Anyango is only 18 years old and is already a mother.  She became pregnant when she was 16 years old and had to put her dream of becoming a teacher on hold.

Before she delivered her child, Lillian had tried to terminate the pregnancy by herself using harmful concoctions like detergents. She couldn’t sit and just watch her dream go away. She wanted to continue with school and didn’t want to be seen as a disappointment by her parents.  She almost lost her life in the process but luckily she survived after she was rushed to the hospital by her parents.

Lillian was later forced to marry the father of her child who was 20 years old then.  She was only 17 years. Her parents gave her away because they couldn’t feed another mouth in their home. They had been struggling to feed 8 children and adding another member to the family would be disastrous.

At 18, Lillian is now on a long term method of family planning. She was introduced to contraceptives when she visited Kisumu Medical and Education Trust (KMET) outreach in Nyalenda slums located in Kisumu County. She was counselled on the full range of contraception, and she decided to have a contraceptive implant which would protect her from unplanned pregnancy for the next 10 years. She was referred to KMET health facility where she received the services free of charge.

Lillian is now in Form Two and is taking charge of her future. Thanks to the support of the Dutch government, thousands of girls here in Kenya can have access to life saving contraception and information on sexual and reproductive health and also safe abortion services.

However, the recent global gag rule is a huge set back to the gains made in reducing maternal deaths, unsafe abortions and unintended pregnancies in Kenya. Considering that over 60% of Kenyan women now have access to contraceptives, the global gag rule is putting the lives of these women at risk. Unintended pregnancy is one of the most critical factors contributing to schoolgirl drop out in Kenya as recent statistics indicates, up to 13,000 Kenyan girls drop out of school every year as a result of unintended pregnancy.

Marie Stope International has projected that without alternative funding to counter the global gag rule, there could be 6.5 million unintended pregnancies, 2.2 million abortions, 2.1 million unsafe abortions, 21,700 maternal deaths between 2017 and 2020 mostly in developing countries, Kenya included.

Every year, over 500,000 women in Kenya are so desperate to end their pregnancy and put their lives on the line by risking an unsafe abortion. Thousands of them die and more are left with life altering injuries. Agreeing to the global gag rule would mean accepting their fate and turning our backs on the very women who need us most.

According to Newman Williams, any attempts to stop abortion through restrictive laws or by withholding family planning aid will never work because they do not eliminate women’s need for abortion. The global gag rule (also known as the Mexico City Policy) only exacerbates the already significant challenge of ensuring that people in the developing world who want to time and space their children can obtain the contraception they need to do so.

The global gag rule denies people the right to make choices that could improve their living conditions, from the girl who could have avoided an unwanted pregnancy and continued her education, to the mother of five who could have averted the life-threatening risk of an unsafe abortion.

The impact of the global gag rule will be catastrophic and it is women in developing countries who will pay the price. We all remember while it was in effect between 2001 and 2009, the policy forced clinics to cut back on a range of critical health services that have nothing to do with abortion, such as family planning, obstetric care, HIV testing, and malaria treatment.

Women and girls have a fundamental right to decide freely and for themselves whether, when and how many children they have and what to do with their bodies.

To counter the global gag rule, the Dutch government through Dutch minister for Foreign Trade and Development Cooperation, Lilianne Ploumen, has rolled out a global initiative for funding and political support for sexual health and family planning called ‘She Decides’.

She Decides is a new global initiative on sexual health and family planning that aims to support this fundamental right. It aims to leverage financial as well as political support for sexual health and family planning worldwide and mitigate the impact of decreased U.S. funding for family planning.

She Decides will not set up a new organisational structure. Contributions and support will be channelled through existing mechanisms and frameworks. Financial contributions raised will be made available to affected organizations working on sexual and reproductive health initiatives in developing countries Kenya included.

She Decides includes contributions by governments, private sector, non-governmental organizations and citizens to ongoing initiatives that improve access to lifesaving contraceptives, family planning, sexuality education and/or safe abortion.

Governments are called upon to support the She Decides initiative, both financially and politically. Since the start of the initiative, many countries have already reacted in a positive way to the She Decides initiative.

Governments and foundations are also encouraged to increase their funding to organizations that are confronted with a reduction of funding due to the global gag rule. These contributions can be announced as a financial contribution in support of the She Decides initiative.

Lastly, government in the countries most affected are encouraged to step up the implementation of their policies on family planning and sexual health and increase SRHR budgetary allocations and commitment as the Global Gag Rule could undo previous achievements in realising Sexual Reproductive Health and Rights for all and sustainable development goals.

Investing in sexual reproductive health and rights especially family planning and safe abortion services has and will always be the smart thing to do.


Johnstone Kuya is the National Coordinator at the SRHR Alliance-Kenya and Michael Okun is a SRHR youth advocate at the SRHR Alliance-Kenya.


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