NAIROBI, KENYA — In a brightly painted house on the edge of the crowded slum of Eastleigh, teenage boys bicker during an energetic game of ping-pong, while girls compare patterns in a room cluttered with sewing machines.
Occasionally, someone slips away to a barren room upstairs where the real business of this center takes place: HIV testing and counseling for young Kenyans.
Just over a year ago, these rooms were packed with women, mostly poor and from the surrounding slums, who came for low-cost contraception, prenatal care, and general reproductive health services.
But funding for family planning has been drying up. Groups are starting to feel the effects of Bush administration regulations that ban aid to those who perform or advocate abortion. At the same time, the battle against HIV/AIDS - which includes prevention as well as issues like AIDS orphans - has taken precedence over more general family planning. And because the two efforts are not integrated, family clinics are finding they're losing ground.
For Africa, where a new United Nations report says 1 in 16 women dies during pregnancy - often of a failed abortion - women's groups warn that the results of such funding cuts could be devastating. "Everything now is about HIV/AIDS," says Linus Ettyang, program manager of the Family Planning Association of Kenya (FPAK), which turned the Eastleigh clinic into a youth AIDS center when it lost US funding in 2001. "The tragedy is that loss of that funding for family planning will lead to more abortions and more women dying in childbirth."
But many religious organizations hail the US stance, saying that family planning clinics are responsible for the high rate of back-street abortions in Kenya. "We have some abortion going on in the hospitals. That has been always been, but a good part of that is lack of counseling," argues Father Raphael Wanjohi, founder of a group called Pro-Life Kenya. "The counseling they get is since you are single and you have nobody to assist you, the best thing is to abort."
At a meeting in Cairo five years ago, UN member states developed a 20-year plan to slow population growth globally, arguing that poverty and the population explosion were linked. The plan's key objectives included boosting the availability and funding of family planning services, especially to the poor, and improving women's reproductive health and access to contraception.
But nine years later, contraception and abortion continue to be sharply divisive issues in many conservative African countries, especially ones where the Roman Catholic Church is strong, as it is in Kenya. More than 30 percent of Kenyans are Catholic, including the country's new president, and the church here has been vocal in opposing not only abortion, but also any sort of contraception, including the use of condoms to prevent the transmission of HIV/AIDS.
The Bush administration's conservative stand on abortion has also been influential. The US was once the largest source of funding for family planning in the world, but last year, it cut the UN Population Fund, a major donor to family planning organizations, out of the budget.
Local family planning groups around the world, like FPAK, have also lost direct funding from the US Agency for International Development for refusing to accept bans on abortions, even if they do not perform them themselves. Even those who advocate changes in their countries' abortion laws lose assistance. FPAK, for example, believes that Kenya's abortion laws should be reviewed - a stance that has cost them US funding and forced them to close five of their 15 clinics over the past two years.
Abortion, except when a mother's life is at risk, is technically illegal in Kenya, as it is in almost every sub-Saharan African country, except for South Africa. But the World Health Organization estimates that 75 percent of abortions occur in developing countries, where the practice, though largely illegal, is widely available.
The WHO says 40 percent of all abortions are unsafe, and claim the lives of some 78,000 women a year. Forty-four percent of those deaths are in Africa. In Kenya, botched abortions cause an estimated 30 percent of maternal deaths - at least twice the international average - and half of all admissions in gynecology wards.
"There are people here who don't even want to hear the words 'reproductive health,' '' says Solomon Orero, a doctor and one of Kenya's strongest advocates of the right to abortion. He is also head of an organization that trains rural health-care providers to treat victims of failed abortions, and, if they choose, to induce abortions safely. "And that is emanating largely from ... the Bush administration. "
Family-planning groups say the onset of the HIV/AIDS crisis, still in its early days in 1994 when the Cairo Action Program was developed, has, ironically, taken a toll.
According to the International Planned Parenthood Federation (IPPF), based in London, international funding for family planning fell 36.8 percent, to $356 million between 1994 and 2001. During the same period, funding for HIV/AIDS grew 300 percent, to $587 million.
AIDS has also made the number of orphans skyrocket, making it increasingly difficult for families to absorb additional unplanned children.
Adoption, advocated by groups like Pro-Life Kenya, is still rare. According to statistics from the United States government, only a few hundred African children are adopted by US families each year, most of them from Ethiopia.
The fundamental problem, say family planning advocates, is that HIV/AIDS work is not integrated into general family planning programs.
"Many governments and agencies are treating HIV/AIDS separately, as if it were not a sexual and reproductive health and rights issue," Steven Sinding, director general of IPPF told a conference earlier this year. "How can one view HIV/AIDS as anything but a fundamental sexual and reproductive health and rights problem?"