The Marie Stopes Ladies who drive from village to village in the remote north of Burkina Faso offering free contraception, advice on family planning, sexual health and sometimes abortion, may have to stop work in June.
The ten have been entirely funded by a $1.25 million grant from USAID but the US development agency cut all money for Marie Stopes International when it refused to comply with a rule reinstated by Republican President Donald Trump in January 2017.
It bans funding to any foreign NGO carrying out or offering advice on abortions anywhere. The goal is to please Christian conservatives who strongly oppose abortion and are a major part of Trump’s political base.
MSI and the International Planned Parenthood Federation are among only four to reject the conditions of the order. They offer abortion services, in accordance with local rules, and say it is a last resort in preventing unwanted or unsafe births.
USAID says 733 other NGOS still receive funding. But in Africa, MSI and IPPF are the two largest NGO providers of free contraception and family planning advice.
The NGOs say the contraceptive programs are crucial in Burkina, where the fertility rate is 5.5 births per woman.
In some villages the MS Ladies operate from government centres, supplementing the limited services on offer. The same grant also pays for training for health workers in 80 government clinics.
MSI says the cuts mean programs affecting thousands of people in Burkina Faso are under threat.
“All those women who’ve been receiving free contraception will have to stop using it because they can’t afford it,” said Georges Coulibaly, Marie Stopes’ Burkina Faso manager told Reuters in the capital Ouagadougou.
The US policy says foreign NGOs must certify that they will not “perform or actively promote abortion as a method of family planning in foreign countries or provide financial support to any other foreign ... (NGO) that conducts such activities,” as a pre-condition for getting global family planning aid from the US government.
This is the case even if the abortion care or advice itself is being funded by other donors.
The rule was first introduced by Republican President Ronald Regan in 1984. Republican presidents since have signed it, while Democrat presidents disagreed with the policy and reversed it.
This means funding for such NGOs has been volatile — the policy has been in force for 17 of the last 35 years.
A spokesman for USAID and an official for the State Department declined to say how much money the United States now provides for global family planning programs.
In 2015 when Democrat Barack Obama was president, it was $638 million. MSI received around $30 million a year, around 9 per cent of its total funding, before the cut, reports Reuters.