Monica Oguttu is the CEO of KMET, a Kenya-based organization that works to ensure that underserved communities can access quality reproductive health care services. When rape victims come to KMET clinics in need of assistance, the doctors there provide them with numerous resources: emergency contraception, post-exposure prophylactics, and counseling. But if a patient returns later saying she's pregnant, there's nothing Monica or her colleagues can do.
"I [have to tell] these women that we can't help them, even knowing their pregnancies are due to rape," she told Broadly in a Skype call. "It's really frustrating, seeing a woman crying in front of you, and later you meet her in a hospital [suffering from] unsafe abortion complications."
A woman dies every 11 minutes from unsafe abortion; every year, millions more sustain serious injuries because they cannot access safe and legal services. Despite this, the US government continues to impose several restrictions on overseas funding for abortion. One of the most onerous regulations in place is the Helms Amendment, first enacted in 1973. On paper, it prohibits US foreign assistance from supporting abortion "as a method of family planning." For years, though, it's been interpreted as a complete ban funding for on all abortion-related services—even in cases of rape, incest, and threat to the mother's life.
This has serious repercussions for women around the globe—according to Jonathan Rucks, the director of advocacy at PAI, "US government-funded reproductive health programs serve millions of women in over 45 countries." In all of these countries, abortion is legal to save a woman's life; in "about half," abortion is permitted in cases of rape and incest. "In countries where abortion is legal or is permitted in the cases of rape or incest, the current interpretation of the Helms Amendment serves as a direct barrier to critical care for survivors of sexual violence," Rucks said.
What's perhaps most appalling about the Helms Amendment is the fact that it even applies to women in conflict areas, who are often subjected to rape as a form of torture. Because of Helms, humanitarian groups cannot use federal funding to provide safe terminations to pregnant victims of wartime rape. This seems, objectively, wholly contemptible. And the policy is especially malignant in light of recent reports that the Islamic State considers rape central to its ideology and that some Boko Haram sect leaders "make a very conscious effort"to impregnate the women they subject to sexual violence.
The Washington Post has called Helms "inhumane," citing the "horror and prevalence of rape as an instrument of war" as proof that the policy must change. The New York Times, too, has condemned the law, and the United Nations Human Rights Council recently asked the US government to "explain its failure to address its misapplication of the Helms Amendment." Still, executive inaction remains the norm.
"President Obama has the power to save women's lives and end the unnecessarily broad interpretation of the Helms Amendment," said Rucks. "Unfortunately, despite the president's track record on women's rights—and the urging of numerous US and international NGOs—he has chosen not to act on Helms."
In addition to forcing victims of rape to carry unwanted pregnancies to term, the Helms Amendment prevents NGOs from providing proper medical attention to women who've undergone unsafe, illegal abortion procedures. According to a 2013 Guttmacher report, the US government's "overly restrictive interpretation" of Helms has resulted in a general ban on "the purchase of equipment and drugs to aid in post-abortion care." This has devastating effects on women's health, especially in rural areas where women have little to no access to safe abortion services. According to the report, the current interpretation of Helms "has contributed to shortages in life-saving resources, and an incomplete and inconsistent approach to addressing unsafe abortion injuries."
"[The US Agency for International Development] USAID offers funding to train in family planning and post-abortion care, but you cannot use the funding to buy the supplies," said Oguttu. "Everybody knows that training alone is not enough. You need to equip the providers to offer the services."
Although the providers at KMET clinics are thoroughly trained in post-abortion care, Oguttu said, that training is essentially "meaningless" without the proper equipment. Reproductive health organizations operating in areas with high rates of unsafe abortion need manual vacuum aspiration (MVA) kits in order to treat incomplete abortions, as well as access to misoprostol, a medicine used to treat postpartum hemorrhage. Without MVA kits, providers have to "digitally evacuate the product," Oguttu said, meaning they must use their hands to in place of medical equipment—which is far less safe, obviously, and far more likely result in potentially life-threatening side effects, including heavy bleeding and septic shock.
47,000 women die per year of complications from unsafe and illegal abortions; the most common causes of death are hemorrhage, infection, sepsis, genital trauma, and tissue death of the bowels. "With the recommended MVA kit, within fifteen minutes you are done, you have saved that life, and she's stable," said Oguttu. "This is what we are not allowed to buy with the USAID funding."
But Oguttu is optimistic that things can change. If the US simply changes its interpretation of Helms, she noted, humanitarian organizations overseas would immediately be able to offer significantly improved services to women in need. "There would be access to safe abortion, there would be destigmatization of abortion, and we'd have supplies and equipment in place to offer these services," she said.
In Kenya, as everywhere else, restricting abortion access does not prevent abortion from happening: It simply puts safe abortion out of reach for those who can't afford it. "If you have money anywhere in Africa or Kenya today, you can access safe abortion because you can buy the services," Oguttu said. "But what about the poor women who have no money? That is why we keep fighting: Because these poor voiceless women are dying silently without anybody listening to their cry."