In 2017, the Trump Administration reinstated and expanded the Global Gag Rule (GGR). This policy requires non-governmental organisations (NGOs) not based in the US to certify that they will not provide, counsel, refer, or advocate for abortion as a method of family planning in order to receive most categories of US global health assistance. Robust empirical evidence demonstrating the policy's impacts is acutely lacking. This paper describes the effects of the expanded GGR policy in Kenya eighteen months after its reinstatement. We conducted semi-structured interviews with purposively selected representatives of US- and non-US-based NGOs, as well as managers and health providers at public and private health facilities, between September 2018 and March 2019. Organisations reported critical funding loss as they were forced to choose between US government-funded projects and projects supporting safe abortion. This resulted in the fragmentation of sexual and reproductive health and HIV services, and closure of some service delivery programmes. At public and private health facilities, participants reported staffing shortages and increased stock-outs of family planning and safe abortion commodities. The expanded GGR's effects transcended abortion care by also disrupting collaboration and health promotion activities, strengthening opposition to sexual and reproductive health and rights in some segments of Kenyan civil society and government. Our findings indicate that the GGR exposes and exacerbates the weaknesses and vulnerabilities of the Kenyan health system, and illuminates the need for action to mitigate these harms.

中文翻译：

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外援还是进攻？扩大的《全球禁毒令》对肯尼亚的性健康和生殖健康及权利的影响。

2017年，特朗普政府恢复并扩大了全球堵嘴规则（GGR）。此政策要求非美国境内的非政府组织（NGO）证明他们不会提供，建议，转介或主张人工流产作为计划生育的一种方法，以便获得美国大部分的全球卫生援助。急需缺乏强有力的经验证据来证明该政策的影响。本文介绍了恢复的GGR政策恢复后的18个月对肯尼亚的影响。在2018年9月至2019年3月之间，我们对有目的的美国和非美国非政府组织代表以及公共和私人医疗机构的经理和医疗人员进行了半结构化采访。由于被迫在美国政府资助的项目和支持安全堕胎的项目之间进行选择，组织报告了严重的资金损失。这导致性健康和生殖健康以及艾滋病毒服务的分散，并终止了某些服务提供方案。在公共和私人卫生机构，参与者报告说人员短缺，计划生育和安全堕胎商品的库存增加。GGR扩大后的作用超越了堕胎护理，它还破坏了合作和健康促进活动，在肯尼亚民间社会和政府的某些部门中加强了对性健康和生殖健康以及权利的反对。我们的研究结果表明，GGR暴露并加剧了肯尼亚卫生系统的弱点和脆弱性，