“Coercive” health agreements between the US and poorer countries could block them from spending their own tax money on things Donald Trump’s administration disagrees with, leading NGOs warn – risking already-fragile access to legal abortion collapsing.
After a complete freeze on foreign aid spending when Trump took office, the US is now in the process of striking new funding agreements with African governments. These promise aid money in exchange for certain conditions – from mining rights and access to valuable patient data, to agreements to spend national health budgets on priorities dictated by America. The deals replace a patchwork of previous health agreements under the United States Agency for International Development (USAID), which has been dismantled during Trump’s first year back in the White House.
“When a donor ties the continuation of HIV treatment, maternal and child health programmes, and [disease] outbreak response to unrelated political or economic concessions, that’s coercion,” said Liza Barrie, a campaign director for US advocacy organisation Public Citizen, “and it erodes sovereignty, trust, and lives.”
The agreements have been signed in 14 countries so far, all in sub-Saharan Africa. They have largely not been made fully public, leading to concerns about transparency.
This raft of new agreements makes the plan to put “America First” more explicit than ever – with aid coming not under the guide of altruism but as a clear bargaining chip, according to campaigners.
Sarah Shaw, advocacy director at reproductive health non-profit MSI says, “what’s really manipulative about the compacts is not really what they’re saying, it’s what they’re not saying. And there’s just lots of loopholes in the language that favour the US government”.
MSI is concerned that vague language leaves the door open to more rules and restrictions being imposed after governments are already locked into the agreements, for example saying they can’t use their own money from taxation for abortion services or risk losing US funding.
Since the mid-1980s, every Republican president has introduced the Mexico City policy, known as the “global gag rule”, preventing NGOs that receive US aid from providing legal abortion care, even with their own money. Trump reinstated it in his first week as president.
An expanded version of the rule is expected to be announced which could apply to governments as well as NGOs.
“Governments have signed up to these agreements…and then they get the expanded global gag rule put upon them and it’s like, ‘well oh so this actually impacts what I can do with all my other money that’s actually none of your business up until this point in time’,” Shaw said.
“So it will essentially prohibit any abortion provision in the public sector because they won’t be able to use any money regardless of where it’s come from. It means that public sector abortion provision will just disappear,” she said.
Dr. JE Musoba Kitui, Africa regional director for global reproductive rights charity Ipas, said that when Trump’s initial stop work orders came into effect, Kenya lost around half its health funding and more than 40,000 health workers overnight. As clinics closed and deaths rose, “the system was now very ready to sign any funding that they [could] get for whatever conditions,” he said.
“That’s what has been problematic with the [memorandum of understanding] MOU,” he said, adding that the government had agreed to, “sign away the rights of women and girls”, and others, in exchange for US funding.
The Kenyan government has agreed to, “provide the US Government with information needed to monitor compliance with applicable law…including to confirm no US Government funding is being used for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortions,” according to the agreement signed.
The agreements including in Kenya also prioritise the use of faith-based health providers. While these groups play an important role in the Kenyan health system, Dr Kitui said, they will not provide things like specialist HIV care for LGBT+ communities – which may lead to people being denied services.
One part of the agreement struck between the US and Kenya, seen by The Independent, said the deal was intended to, “strengthen the Kenyan health system so that it can become more self-reliant,” but crucially also to, “promote US interests abroad” – including giving the US access to valuable health data.
The plan is currently on pause, however, after a case filed by a consumer rights group said it would breach Kenyans’ privacy. The government has to respond by the end of this week with a verdict expected in mid-February.
Under the paused agreement, the US could use samples of viruses and bacteria taken from patients to develop, “the next great vaccines or the next great diagnostics,” Mitchell Warren, executive director of HIV advocacy group, Avac, explained. But, “it doesn’t provide any guarantees that Kenya or any other country would benefit from technologies derived from the samples and the data coming from that country”.
But, as well as samples from patient testing, there are fears the deal could give the US access to more comprehensive national data including patients’ medical records. “One could imagine an attempt to match the data with people applying for visas. ‘Oh we don’t want people with those conditions in our country,’” he added.
And women knowing their data can be accessed may be, “more likely to not even come to the public health facilities because they’re afraid of their pregnancy data being accessed,” Dr Kitui added.
Meanwhile in Zambia, a deal is yet to be agreed but the US embassy has made clear it will require “collaboration in the mining sector” in order to “unlock a substantial grant package of US support”.
A US State Department spokesperson said: “The United States plans to provide up to $1.6 billion over the next five years to support priority health programs in Kenya.
“In turn, the government of Kenya has pledged to increase domestic health expenditures by $850 million to gradually assume greater financial responsibility as US support decreases over the course of the framework. Faith-based healthcare providers will play an indispensable role in delivering care to communities in need”.
The spokesperson added that Kenya would retain “full ownership and control of all data under its laws” and that the agreement included, “provisions to help ensure compliance with applicable US law and policies”, including those which “[prohibit] United States funds from paying for abortions”.
This article was produced as part of The Independent’s Rethinking Global Aid project