In “The Hard Truth About Reproductive Health under Obama” (Vol. XXXVI, No. 1), Jon O’Brien expresses what a disappointment Obama’s presidency has been for those of us who support women’s reproductive health and rights. The Helms Amendment was enacted in 1973, following the Supreme Court ruling in Roe v. Wade, which held that the US Constitution protects a woman’s decision to terminate a pregnancy. Since then, Helms has been wrongly interpreted by USAID grantees to mean that no US foreign assistance funds can be used for abortion services.
Helms assumes that women will seek an abortion whenever pregnant and that they will not use any method of family planning to prevent unintended pregnancy, hence using abortion care as a method of spacing their children.
This practice would not be possible in most of Africa, where abortion on request during the first trimester is only legal in South Africa, Tunisia, Ethiopia and Mozambique. This means the way USAID grantees interpret the Helms Amendment is wrong in the majority of African countries.
Through this erroneous interpretation of the Helms Amendment, USAID grantees fail to assist developing countries in reducing the rising cases of maternal deaths resulting from unsafe abortion, which is responsible for 30–36 percent of maternal deaths.
Initiatives to reduce unsafe abortion also touch on provider training in postabortion family planning and the purchase of quality equipment and supplies for postabortion care, all of which cannot currently be provided with USAID funds. The funds also cannot be used for abortion in cases of rape and incest, circumstances in which abortion should be legally available in many African countries.
Here in Kenya, we know that many in the US would like to devote resources to improving women’s reproductive services, rather than making them more inaccessible. Perhaps President Obama himself is among that number. As O’Brien wrote, “It’s not that Obama did not have the courage of his convictions,” but he hasn’t moved on Helms “out of fear of upsetting ultraconservatives.”
In 2013, the USAID mission in Kenya asked its grantees not to attend meetings that had been planned by the Ministry of Health to review the standards and guidelines on reduction of maternal mortality resulting from abortion. Helms has a pro-foundly undemocratic effect on us here in Kenya, and we will keep working to make abortion a choice that rests in the hands of women in the care of skilled providers.
DR. JOHN NYAMU
Consultant Gynaecologist, Reproductive Health Services