Charlotte Ryan reports from Malawi 

ANGELA SOUZA CAREFULLY unwraps a large box of condoms, individually packaged in silver foil. There is no branding on each one, though the red-blue-and-white USAID sticker on the side of the box suggests their origin.

In this context, they appear as valuable as silver coins. Rodney Chalera, the programmes manager at the advocacy group where Angela also works in Lilongwe, Malawi, explains that there are times “when the whole country runs out of condoms”. Indeed, by the close of the afternoon, two women had asked for some for the road. Just in case.

In the effort to suppress the spread of HIV and AIDS in Malawi, success can depend on something as fragile as a government-issued condom. According to data from USAID – the body responsible for the issuing of foreign aid from the US – from 2018, there were one million people living with the virus in 2017, making Malawi one of the most HIV-prevalent countries in the world.

While 71% of those infected were receiving treatment, only 25% of married females and 30% of sexually active unmarried females from this age group were using any form of modern contraception.

Cultural biases, political hurdles and misconceptions about condoms – such as they limit a man’s libido, or that they are a marker of affairs in marriages – have long hindered uptake. But in the two years since the global gag rule, an American policy limiting US funding to overseas NGOs, has been in place, access to all forms of contraceptives, sexual and reproductive healthcare and information has been gravely diminished.

What is the ‘global gag rule’?

The rule, officially known as the Mexico City Policy, blocks overseas NGOs from providing or promoting abortion if they receive US foreign aid funding, even if such practices are legal in the countries the NGOs operate in. US President Ronald Reagan introduced the policy in 1984 and since then it has swung in and out of use, with each Republican president reinstating the policy, and each Democrat president rescinding it.

In 2017, President Donald Trump signed the policy on 23 January, three days into his term, expanding it in unprecedented ways to restrict all healthcare assistance to NGOs who provide abortion-related services, including family planning, counselling and referrals. This also applies to non-US funds.

In a report released by the International Women’s Health Coalition in June, this order corresponds to $9 billion (€8 billion) in US foreign assistance, and has led to a widespread decrease in access to healthcare.

Buckling NGOs

The Centre for Youth Development (CYD) is one such organisation suffering through funding cuts. An ambitious organisation, the Centre’s remit includes influencing government policies, mobilising youth people to access sexual reproductive healthcare, and providing employment for Malawian youths. It is also emblematic of the titan workload shouldered by Malawi’s buckling NGOs.

Resourceful to the extreme, the CYD succeeded in bridging the trenches of stigma and misinformation among younger generations by building online networks that offered information and privacy. Using WhatsApp, Facebook and email, the Centre bypasses stigma to reach vulnerable individuals, share information and even establish links between them and service providers.

Despite this, however, Weston Msowdya, the executive director of the CYD, says the organisation has been “severely hit” by funding cuts. Reluctant to share details on which avenue the cuts came down, he says “we were failing to even reach 50% of our target, just because of resources”.

“We have seen [the] mushrooming of a lot of unwanted pregnancies. And even the unsafe abortion is increasing because of that. Because we are not able to prevent [it].”

Moreover, the CYD has fallen victim to one of the more pernicious consequences of the global gag rule: self-gagging. Fearing the loss of prospective donors, who themselves may be wary of receiving funding cuts, CYD has stopped posting on its website, with the last entry published in October 2018.

“It also affects other prospective donors. So, we want to be neutral, we want to be seen as if we are not doing anything in this area. Which is a problem.”

This is not mere paranoia. In the past year, CYD has lost a partnership worth $100,000 (€88,000)  due to their activities.

On a Sunday just outside Lilongwe, Msowdya sighs into the red, swirling dust. “It is very frustrating.”

‘Having fun’

Malawi is a young country, both in population and history: independent since 1964, the most recent census – released in January – revealed that 51% of the population is under 18 years of age. Reaching the youth, particularly in rural areas, is an uphill battle.

Young women are among the most high-risk individuals, with 50% of new transmissions among 15-17 year-old women. Sexual violence and people becoming sexually active at a young age play a role in this, but as with young people the world over, much of it is down to misinformation.

Tikhala Itaye, chairperson for the global She Decides movement – the international donor organisation established in the immediate aftermath of the global gag rule – notes: “[Girls], especially the girls in the rural areas, they don’t know how their body works.” She adds:

Sexual activity is very high among young people, especially adolescents, because they’re just doing it, they’re having fun. They’re enjoying without understanding that, “Oh, we need to protect ourselves.

The Family Planning Association of Malawi (FPAM) understands the need for cohesive information and outreach, and since its inception in 1989 has established a network across all 28 districts of Malawi providing access to family planning services. Despite not providing abortion care, their funding was cut in the aftermath of the global gag rule, leading to a reduction in staff, withdrawing to just 11 districts and a dramatic reduction in services.

“The most painful thing is that whatever decision we make mostly doesn’t affect people like us, who are decision makers. It affects the people who are helpless and very vulnerable, who are looking up to us for protection”, says Tazirwa Chipeta, the director of clinical services at FPAM.

A perverse form of breadwinner

Due to the constraints of a life lived in poverty in Malawi, young girls are among the most helpless, pushed by gender biases to become a perverse form of breadwinner. Chipeta says: “They are sent out by parents, or married off by the parents, so that they reduce the burden to the family, and because they went out as a source of income, the other person marrying them will look at them as a slave.”

Itaye recalls hearing of such stories: “We spoke to some girls that we interviewed, and they were literally saying … ‘We’ve heard the information, but when you’re in my situation where at home there’s no food and there’s these issues. My mom will literally tell me, ‘Go sleep with someone to get soap.’”

The global gag rule allows such abuses of power to persist, with young girls further restricted and lacking agency over their own bodies.

More than this, the global gag rule exacerbates the existing hurdles facing healthcare providers and NGOs, and agitates an already-raging appetite for change in laws. Abortion is illegal in Malawi and punishable by a 14-year prison sentence, except when used to save the life of a woman. Definitions on what constitutes saving a life remain unclear, and advocates are calling for a broadening of the exceptions to allow for greater choice among women.

As Chalera says, “we are now making that [law] stronger by that policy, which is now affecting women in their reproductive age”.

Black hole of legislation

The legacy of the global gag rule is unfolding in real time, as the black hole of legislation continues to devour NGOs and their strategies. With a rising younger population needing ever more guidance, the stakes are even higher.

Among those on the ground, the prognoses are manifold: Chipeta welcomes the challenge of culling the growing prevalence of HIV among adolescents, saying “Personally now, I am thinking that it’s also a blessing in a way. It’s opening up our thinking capabilities in the line of testing a community.”

“This is a generation we are building for Malawi, so we feel there is a lot that we need to work with.”

Meanwhile, Msowdya is pragmatic, acknowledging that just as the global NGO community was blindsided by President Trump’s expansion of the rule, a more ambitious, hardline Republican may be elected in years to come.

“The way things are going, it may go worse.”

Read the second part of Charlotte’s series on the global gag rule in Malawi tomorrow 

 This article was supported by the Simon Cumbers Media Fund.