EDITORIAL | Reproductive Health after the US Elections: Implications for subSaharan Africa

Abstract

The winning of the 2016 US Presidential election by Donald Trump has implications for reproductive health policies and programming not only globally, but has specific concerns for sub-Saharan Africa.  For the first time after Cairo 1994, we now have an American President who clearly says he would ban safe abortion practices, punish women who seek abortion, repeal the affordable care act, and remove funding for Planned Parenthood¹. The International Conference on Population and Development (ICPD, 1994) was a major event in global development. It shifted emphasis from an earlier focus on a narrow family planning to one that puts women at the centre of the process, which recognizes, respects, and responds to the needs of women. In particular, “choice” became the buzz word, recognized internationally as capable of providing women the agency to deal with their reproductive health and family planning concerns from positions of their best knowledge, and without external influences.  The debate as to whether women should be allowed choice or not has dominated international scientific literature on sexual and reproductive health, family planning and women’s health over the past decade^2,3. The United States of America has featured prominently in this debate and has oscillated variously between “choice” and “anti-choice” policies.

The pendulum swung from “choice” when Bill Clinton was President to “anti-choice” when President Bush represented the Republicans as President, and then back to “choice” when Obama held sway over the past 8 years. Now, with Trump winning the Presidency and judging from his campaign vitriolics on the matter, the period 2017-2021 promises to be the most testing and difficult for pro-choice campaigners. Despite the anti-choice policies of President George Bush, he surely still had a human face on population and development, but with Trump, no one can be so sure.

The changing US population and development policy can be considered daunting for the African region in many respects.  Firstly, many African countries have never been able to develop policies on population and development without the influences of international organizations and lead countries such as the United States.  Whatever has happened in the US have had resonating effects in many African countries, and it is clearly possible that any new reproductive health policies put in place in the United States will be upheld by many African countries.  Secondly, the funding of reproductive health has always been led by the US government or its agencies, and also by donor agencies based in the United States. It is also possible that any changed policy in the US that moves from “choice” to “anti-choice” will have dwindling effects on donor funding, which many African countries rely on to drive their own reproductive health programming and activities.  Thirdly, and most importantly, the last 20 years have witnessed several progressive global policies relating to population, and social development.  These led to the development of several international agreements and protocols such as the Millennium Development Goals and now the Sustainable Development Goals. The US government was very prominent in the evolution of these global development agenda, many of which were designed to improve the social development in low-income countries, especially sub-Saharan Africa.

We worry that any reversal of the US progressive policies will have hindering effects on the implementation of the Sustainable Development Goals, three of which were specifically designed to promote gender equality and social equality around the world. Social inequality being the bane of many African countries, and women being the main victims of inequality, African countries will be most badly hit by the current Trump offensive against reproductive choice and women’s rights.

The long term solution is for African countries to develop their population, reproductive health and development policies without external influences, and to find ways to use their own resources to implement the policies rather than rely on external or donor support. A few African countries, notably South Africa and Ethiopia have gained international respect by developing and implementing country-led population policies and programs.  The others need to do the same, with emphasis on driving their countries to meet the international benchmarks outlined in the Sustainable Development Goals. Such achievement will eventually attract power, agency and pride to the African continent.

Clearly, the forthcoming Trump administration in the United States presents both a challenge and an opportunity for African countries.

Knowing that resources will likely be restrained for development in Africa, it provides the opportunity for African countries to begin to think creatively in an “outside-the-box” manner and to learn to manage their resources purposefully in ways to ensure their self-sustainable future development, outside the gambit of the often fluctuating American political scenario.