18 and preg­nant as ma­ter­nal health cuts loom

In Nige­ria, the Trump ad­min­is­tra­tion’s roll­back of U.N. pop­u­la­tion agency fund­ing could leave moth­ers-to-be with­out a life­line

The Washington Post Sunday - - THE WORLD - BY SIOBHÁN O’GRADY for­eign@wash­post.com Re­port­ing for this ar­ti­cle was sup­ported by the In­ter­na­tional Re­port­ing Project

lagos, nige­ria — Supo Nofisat didn’t mean to get preg­nant. As a sin­gle, un­em­ployed 18-year-old liv­ing in Nige­ria, she knew that hav­ing a child could mean an even harder life. So when her preg­nancy test came back pos­i­tive in Jan­uary and a tra­di­tional mid­wife told her she was al­ready three months along, the as­pir­ing hair­dresser thought she had only one op­tion: abor­tion.

At the urg­ing of a neigh­bor, Nofisat vis­ited Hello Lagos, a youth-friendly clinic tucked in an in­con­spic­u­ous al­ley­way in the heart of one of Africa’s busiest cities. There, she learned that the Lagos state govern­ment, with the sup­port of the U.N. Pop­u­la­tion Fund (UNFPA), would cover the costs of her med­i­cal check­ups dur­ing her preg­nancy and con­nect her with pro­fes­sional train­ing that could help her land a job. Within an hour, she had de­cided: She would keep the baby.

“Be­fore com­ing to this clinic, I didn’t know how I would man­age the costs of my preg­nancy,” Nofisat said. “Now, I’m much less wor­ried about that.”

Last month, the Trump ad­min­is­tra­tion an­nounced it would elim­i­nate U.S. fund­ing for the U.N. pop­u­la­tion agency, say­ing that it part­ners with the Chi­nese govern­ment, which runs pro­grams in­volv­ing co­erced abor­tion and forced ster­il­iza­tion. The U.N. group said the de­fund­ing is based on an “er­ro­neous claim” and could have a dev­as­tat­ing im­pact on the health of women and girls.

“We pre­vent un­wanted preg­nan­cies, we pre­vent abor­tions, and we pre­vent ma­ter­nal death,” said Eu­gene Kongnyuy, deputy rep­re­sen­ta­tive for the U.N. agency in Nige­ria. “UNFPA has never and does not cur­rently sup­port abor­tion in any coun­try, in­clud­ing China.”

Last year, the U.S. govern­ment pro­vided a to­tal of $69 mil­lion to UNFPA. Trump is now fol­low­ing in the path of ev­ery Repub­li­can president since Ron­ald Rea­gan, who first raised the ques­tion of the U.N. agency’s in­volve­ment in the con­tro­ver­sial Chi­nese govern­ment pro­grams in 1985 and then stopped all U.S. con­tri­bu­tions. Demo­cratic pres­i­dents have al­ways re­in­stated the fund­ing.

A State Depart­ment spokes­woman who spoke on the con­di­tion of anonymity said that the most re­cent de­fund­ing is based on the fact that the Chi­nese govern­ment still pushes for in­vol­un­tary ster­il­iza­tion and abor­tions to limit pop­u­la­tion growth — and that “UNFPA part­ners on fam­i­ly­plan­ning ac­tiv­i­ties with the Chi­nese govern­ment agency re­spon­si­ble for th­ese co­er­cive poli­cies.”

She said that the $32.5 mil­lion bud­geted for the U.N. agency next year will be redi­rected to other ma­ter­nal-health pro­grams across the world.

Al­though the United Na­tions will try to raise funds to fill the gap, it is not yet clear it will suc­ceed.

In Nige­ria, health-care work­ers see a dis­turb­ing irony in the Trump ad­min­is­tra­tion’s de­ci­sion: It will cut re­sources for pro­grams that pro­vide con­tra­cep­tion, they say, and lead to more abor­tions.

Abor­tion is le­gal in Nige­ria only when it is needed to save a woman’s life. But the Washington-based Guttmacher In­sti­tute, a re­pro­duc­tive-health re­search or­ga­ni­za­tion, es­ti­mates that 1.25 mil­lion Nige­rian women un­der­went abor­tions in 2012, in the most re­cent study avail­able. Many were car­ried out by un­trained in­di­vid­u­als and in un­safe con­di­tions.

The sheer num­ber of peo­ple liv­ing in Nige­ria means man­ag­ing ma­ter­nal health here is com­plex. The West African na­tion is home to 182 mil­lion peo­ple, mak­ing it the con­ti­nent’s most pop­u­lous coun­try.

Health-care pro­fes­sion­als see a clear link be­tween fam­ily plan­ning and other prob­lems plagu­ing Nige­ria — such as an eco­nomic cri­sis that has prompted tens of thou­sands of res­i­dents to cross the Mediter­ranean on flimsy boats in search of a bet­ter life. Kongnyuy, the UNFPA of­fi­cial, said that sim­ply pro­vid­ing the re­sources for women to de­cide when to have a child can help lift fam­i­lies out of poverty from one gen­er­a­tion to the next.

“If we re­duce fund­ing to fam­ily plan­ning, it is go­ing to be cat­a­strophic,” he said. “No one wants to see more Nige­ri­ans cross­ing the Mediter­ranean.”

Nige­rian of­fi­cials have only re­cently em­braced fam­ily plan­ning, and the govern­ment now works with UNFPA to ex­pe­dite de­liv­er­ies of birth con­trol and train staffers at state health-care fa­cil­i­ties to safely pro­vide con­tra­cep­tion.

Cather­ine Ug­wuezuoha, the nurse who has coun­seled Nofisat through her preg­nancy, said her clinic tries to dis­cour­age women from re­sort­ing to tra­di­tional birth at­ten­dants or il­le­gal abor­tions, which of­ten re­sult in in­fec­tions or in­ter­nal in­juries.

“Through our work, we have pre­vented so many un­safe abor­tions, I couldn’t even count,” she said.

On a hu­mid morn­ing in April, Ug­wuezuoha sat at the cen­ter of a semi­cir­cle in her clinic’s wait­ing room, five teenage girls crowded around her. Four were preg­nant, and the other had her new­born baby strapped to her back. They beamed as she in­tro­duced them to one an­other and then jumped into the im­por­tance of main­tain­ing a bal­anced diet and avoid­ing street food dur­ing preg­nancy.

They nod­ded as she urged them to save the phone num­ber of a trust­wor­thy driver who could take them to the hospi­tal when the time came, point­ing to the one who had al­ready de­liv­ered as a suc­cess story. “We don’t want to lose you to a tra­di­tional birth at­ten­dant,” she said.

Those girls are among dozens of young, ex­pec­tant moth­ers who have passed through Ug­wuezuoha’s clinic since it opened a year ago. The Hello Lagos staffers are trained to of­fer med­i­cal and emo­tional sup­port to preg­nant teens, and they of­ten me­di­ate when it comes to shar­ing news of the preg­nancy with the pa­tient’s par­ents. They also pro­vide group coun­sel­ing ses­sions that help teenage moms feel less iso­lated in a con­ser­va­tive so­ci­ety that tends to stig­ma­tize women who give birth be­fore mar­riage. Each month, hun­dreds of other teenagers visit each of the four Hello Lagos clin­ics, whether to pick up con­doms, re­quest birth­con­trol pre­scrip­tions or be tested for sex­u­ally trans­mit­ted dis­eases.

In other parts of Nige­ria, the Trump ad­min­is­tra­tion’s fund­ing cut is ex­pected to af­fect ur­gent hu­man­i­tar­ian re­sponse ef­forts. In Oc­to­ber 2015, the U.S. Agency for In­ter­na­tional De­vel­op­ment pro­vided UNFPA’s Nige­ria of­fice with $3.2 mil­lion to im­prove ma­ter­nal health and re­duce gen­der-based vi­o­lence in ar­eas af­fected by the rad­i­cal Is­lamist group Boko Haram. Shortly be­fore the lat­est cut was an­nounced, UNFPA re­quested an ad­di­tional $1 mil­lion to ex­tend the pro­gram. Now, agency of­fi­cials are wor­ried they could re­ceive noth­ing at all.

In the Lagos state health min­istry, one se­nior of­fi­cial said the U.N. agency’s sup­port is crit­i­cal. But since the news broke of the U.S. fund­ing cut, she lives in fear that the pro­grams she has helped im­ple­ment will be dis­con­tin­ued. She spoke on the con­di­tion of anonymity for fear of ret­ri­bu­tion for crit­i­ciz­ing the Trump ad­min­is­tra­tion.

“We watched from Nige­ria as Amer­i­cans elected Don­ald Trump,” she said. “We just didn’t think it would have an im­pact on us here.”

“It is go­ing to be cat­a­strophic.” Eu­gene Kongnyuy, UNFPA deputy

PHOTOS BY RUTH MCDOWALL FOR THE WASHINGTON POST

ABOVE: Supo Nofisat, preg­nant with her first child, goes for a med­i­cal check at a small health cen­ter in Lagos, Nige­ria, that is sup­ported by the U.N. Pop­u­la­tion Fund. AT LEFT: Nurse Cather­ine Ug­wuezuoha ad­vises Seun Goji, left, Supo Nofisat, cen­ter, and Oyeleke Azeezat on healthy preg­nan­cies.

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