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A PARENTING PLAN: Global reproductive health goes where it will do the most good

By Latanya Mapp Frett

I’m writing from our new office in Nairobi. The furniture may be new and the paint fresh, but our work has a storied history here in this city and Africa as a whole. I’m the executive director of Planned Parenthood Global, the international arm of Planned Parenthood Federation of America. For more than 45 years, we’ve been working with partners around the world to break down barriers to health care. In August, I moved our headquarters from New York to Nairobi to bring our organization closer to the work that we do and the partners we support. Personally, I almost feel like I’ve come home.

I first visited Nairobi during a semester abroad as a law student. Soon after, I came back to Africa as a Peace Corps volunteer in Lesotho from 1996 to 1998. I didn’t live in a village like most of my colleagues. With degrees in law and public policy, I was accepted into the United Nations Volunteers program, which usually means placements in large cities. For me, that meant Maseru, Lesotho’s capital, where I worked for the United Nations Children’s Fund, UNICEF. Yet my work constantly brought me out to the field, quite literally.

I was a child protection officer and my work focused on the so-called “herd boys.” These are boys often between the ages of seven and 12 who would spend those years out on the lands taking care of their families’ cattle, leading them from place to place in search of pasture. When the boys reached adolescence, the next 7-year-old in the family would take over.

Years later, adolescents and youth continue to be an important focus of my work, though now with a greater emphasis on girls, women, and reproductive health.

As a global health organization focusing on sexual and reproductive health and rights, Planned Parenthood Global faces even greater challenges as we navigate cultural and societal ideas about gender, sex, and morality. With sensitive topics like this, the way information is delivered matters just as much as the information itself.

In places where talking about sex often remains taboo, using peer counselors to educate their fellow adolescents has been shown to increase access to and even efficacy of sexual and reproductive health education. Peer education programs reduce rates of unintended pregnancy and empower young people to control their lives and pursue their dreams. Through our Youth Peer Provider (YPP) program, our partners train young people as contraceptive counselors and take it a step further. Youth peer providers not only educate their peers, but are also equipped to provide friends, classmates, and peers with discrete and consistent access to contraceptives and STD prevention, including birth control pills and condoms.

Our YPP program sets us apart and has been adopted and adapted by partners across Africa and Latin America. And our unique sustainability model empowers partners to stand on their own. We partner with organizations that are working at the grassroots level and that know the culture and context in which they work far better than we could.

The global gag rule

This vital work is needed now more than ever as the strides we have made in the global reproductive health movement are threatened by dramatic shifts in U.S. foreign policy by the Trump administration. Most prominent of these changes is the global gag rule, also known as the Mexico City Policy, which has been reinstated by every Republican president since President Ronald Reagan first issued it by executive order.

While the Helms Amendment restricts U.S. foreign assistance funding for abortions “as a method of family planning,” the global gag rule goes a step further by blocking aid to foreign organizations who use their own non-U.S. funds to provide information, referrals, or services for legal abortions or to advocate for access to abortion services in their own countries. And in an unprecedented move, Trump not only reinstated the policy, but expanded it to apply not only to family planning programs—as past iterations had done—but U.S. global health funding writ large.

The global gag rule causes serious harm for the most vulnerable people of the world. The policy stands between doctors and their patients, and it restricts the medical information that health care providers are allowed to offer. It limits free speech by preventing local citizens from participating in debates. And the threat of lost funding coerces providers into censoring vital information and giving incomplete care, which can either mean substandard services or diminished access to a range of health services, including family planning.

U.S. foreign assistance should never be used as a wedge to censor free speech or to limit access to health care for the most world’s most vulnerable women, young people, and communities.

– Latanya Mapp Frett, Executive Director, Planned Parenthood Global

Each time the global gag rule has been in effect, the negative impact of the policy has been far-reaching: health infrastructures have fallen into disarray; clinics that once provided a range of reproductive, maternal, and child health care, including HIV testing and counseling, have been shuttered; outreach efforts to marginalized populations were eliminated; and access to contraceptives was severely limited, resulting in more unintended pregnancies and—contrary to the original intent of the policy—more unsafe abortions.

In the past, the U.S. has been a leader in promoting democracy, women’s health, and human rights around the world, and the Peace Corps has been a critical part of that humanitarianism. U.S. foreign assistance should never be used as a wedge to censor free speech or to limit access to health care for the world’s most vulnerable women, young people, and communities.

Some of the primary recipients of U.S. global health assistance are countries in Africa like Kenya, Nigeria, and Uganda where vital programs like PEPFAR, which has been instrumental in rolling back the tide of HIV/AIDS, are now at risk because of the global gag rule. By moving Planned Parenthood Global’s headquarters to Nairobi, we shorten the distance between our global team and those at the grassroots level who need us the most, because they are on the frontlines of experiencing the impact of harmful policies like the global gag rule. Ultimately, it will help us gain valuable insight, bolster cross-regional collaboration, and create options for new donors.

Protecting youth in Lesotho

Back in Maseru where I was serving with the Peace Corps, I was a human rights officer for UNICEF. I was tasked with looking for inconsistencies and violations of human rights treaties and reporting them, and I found that the herd boys were abused significantly in the search for grass. The boys themselves often didn’t have enough food to eat and they had no money. It’s a hard life out there, and so they would fight. With no supervision, the younger boys were susceptible to sexual violence from the older boys, and the cycle of violence would continue as the abused became the abusers. And when their stint was over, they would start school late, and many wouldn’t start at all. You have to think about it from their perspective—they’re starting school at 12 and sitting with four and five-year-olds; they’d hardly want to do this after working and roaming on their own since the age of seven.

Adolescence is a critical period of human development, and for these boys, that development was in some ways hastened, and in other ways halted. They felt like they were men. They had enjoyed autonomy and living out on their own. But because they were plucked from childhood at seven years old, their maturity and certainly their education level stalled. It was so clear to me that these boys needed two things from us: (1) We needed to educate their parents and communities about what was happening to them, and (2) we had to get actual resources to these boys—not just food to fill their immediate needs, but education to ensure their futures.

I did this work for two and a half years. I thought, if we couldn’t bring the boys to school, we’d bring school to them. They couldn’t enroll in one school because they had to travel for the cows. So, we needed schools that would move with them, or at least be there at each place they stopped. The more educated you are, the more you’re able to communicate your needs and what is happening to you. And with a school, these boys finally had someone to report those issues to. It’s about meeting people where they are and giving them a voice—a lesson I’ve carried with me throughout my career.

My work with the Peace Corps eventually led to 20 years of service with UNICEF and later the U.S. Agency for International Development, much of it here in Africa. Though I would eventually find my way from child protection to reproductive health, those couple of years with the herd boys left an imprint on me that continues to guide the work that I do, even now in my executive role with Planned Parenthood Global. Food and education—they’re certainly not the most controversial things to ask for, and yet I saw firsthand the challenges in delivering such basic necessities to kids in the countryside.

Like the roving schools teaching herd boys in Lesotho or youth providers delivering birth control in soccer fields and hair salons, Planned Parenthood Global’s move to Nairobi is about meeting people where they are.

Latanya Mapp Frett is the executive director of Planned Parenthood Global, the international arm of Planned Parenthood Federation of America, with some of the most innovative and sustainable health projects in Africa and Latin America. Frett is an adjunct professor at Columbia University Mailman School of Public Health.

This article originally appeared in print on pages 19-20 in the Winter 2017 edition of WorldView Magazine, a publication of the National Peace Corps Association.

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