Women's and Girls' Health in South Asia: Challenges for Global Policy

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A woman suffering from HIV/AIDS uses a stick to walk back to her bed in hospital. Cambodia. (© Masaru Goto / World Bank)

In 2001, we had a very difficult situation, when we were asked by our American friends, that either we sign the provision that is in the Global Gag Rule and abide by the restrictions. Or we were to be denied the support or the partnership, which we have had for almost 25 years. And it was a very difficult decision and very painful decision for the non-governmental organization like Family Planning Association to just say no to the Global Gag Rule and to refuse US money in exchange for signing the provision. One of the very surprising things about the GGR is that it does not affect the government. It only affects non-governmental organizations outside the United States of America. Those non-governmental organizations, if they are to receive US federal funds, cannot advocate or promote abortion or abortion-related activities, even with their own non-US money. That is very much a double standard in the GGR.

With the result of this GGR, a poor non-governmental organization like mine lost about $600,000 per annum, that is program funding plus contraceptives like condoms. You can imagine the proportion of that money to an organization like mine, which has a core budget of only $1 million.

This has substantially reduced or degraded our capacity to provide basic reproductive health services like antenatal care, like post-natal care, immunizations, basic care for newborns. Those services were also affected adversely.

We had to lay off about 200 trained services providers including management staff and in some facilities, the position of full time doctor had to be replaced by part time doctor, affecting the quality of care. While working with youth and adolescents, we have quite a successful experience in reaching the youth in terms of providing reproductive health and information to them and also preventing them from having STI and HIV/AIDS. We have Youth Information Centers in different parts of the country. And we have found it to be a very effective vehicle to reach youth. In 2001, when that rule was in place, we had planned to have an additional 30 outlets. But due to the cut, we had to restrict (our growth) to half of that. This way we had to downscale our activities relating to youth, gender, women's empowerment and also prevention of HIV/AIDS. And as our previous speaker has pointed out about the HIV/AIDS situation in India, we share a long, unregulated border with India and people come and go freely. That means we are very near the HIV/AIDS epi-center. With the fund cut, our activities addressed to HIV/AIDS are also adversely affected.

I have come to the point as to why FPAN did not sign the GGR. Because for us, it is a matter of principal for an organization working for last 44 years and always championing the cause of women's rights, women's health and taking the lead role in doing advocacy for liberalization of abortion law for 23 years. It was a matter of principal and that is why we did not sign. By complying with the GGR, we cannot work with government, NGOs, INGOs, health professional who have reached a consensus that decriminalization of abortion will reduce maternal mortality rates in Nepal. Fortunately now the law is liberalized. Had we signed the Global Gag Rule we could not have, together with the government and other NGOs, (worked) for the provisioning of services and advocating to eliminate unsafe abortion in Nepal. As the pioneer nongovernmental organization, our view on the Global Gaga Rule is it will definitely increase unwanted pregnancies and therefore more abortion and in many rural areas more unsafe abortion and then more maternal deaths. It will jeopardize the effort to combat the HIV/AIDS pandemic. Though it is meant to limit abortion, in practice it is affecting the whole range of reproductive health services, denying the services to those who need it most. And of course it is against the fundamental right of a woman to make decisions about herself and her body.

Ladies and gentlemen, I would like to request all of you to speak, to write and to take a step against this destructive policy that is affecting the health and life of developing countries like mine. Thank you very much.