NAIROBI, Kenya - Nairobi's sprawling Kibera slum is far from America but not from America's battle over abortion.
Aid workers and experts say President Barack Obama's decision to allow aid money to flow again to international groups that offer abortion counseling will help restart programs desperately needed in Africa, the continent hardest hit by a so-called "gag rule."
Dr. Walter Odhiambo, the country director for Marie Stopes Kenya, said his family planning organization had been limping along on European aid because of the U.S. rule Obama overturned on Jan. 23 in one of his first presidential acts. Now, Odhiambo said, he would be applying for U.S. funds he hoped to use to expand counseling and other services, particularly in rural Kenya.
"Family planning was not given the prominence it needs," Odhiambo said.
The policy banned U.S. government money from going to international family planning groups that either offer abortions or provide information, counseling or referrals about abortion. Its critics call it the "global gag rule," because it prohibits funding for groups that lobby to legalize abortion or promote it as a family planning method. That can affect a range of services provided by private groups on a continent where governments can meet few of their citizens' health needs.
"The biggest impact has been in sub-Saharan Africa," said Wendy Turnbull, a researcher for Washington-based Population Action International, which lobbies on family planning issues and applauded Obama's move.
Turnbull applauded the Bush administration for spending millions to fight AIDS and other health threats in Africa, but said the gag rule undermined that effort.
For instance, she said, groups that could have helped distribute the condoms the U.S. was supplying to fight AIDS were denied funding because of their stance on abortion.
"When you are making rules, it's not right to just look at the immediate effects," said Nkandu Luo, a Zambian former minister of health who currently heads her country's independent Society for Women and AIDS. "It's important to look at the long-term implications."
A study by the Washington-based Center for Reproductive Rights said the policy hit hardest in Africa, the fastest growing and poorest continent. Latin Americans and Asians were more likely to accept the ban and keep funding, either because they embraced its intent or relied more on U.S. money, the study concluded.
Clinics serving over 1.5 million women closed in Kenya, homeland of Obama's father, said Marie Stopes Kenya and Family Health Options Kenya. Contraceptive availability in Zambia was reduced. AIDS programs run by family planning groups in Ethiopia were affected.
Even without the U.S. policy, abortions would be controversial here. They are illegal in almost all African countries, many of which have conservative Christian or Muslim populations _ one of the reasons women interviewed about their abortions declined to give their full names.
But the laws have simply pushed abortions into back rooms instead of ending the practice.
Marie Stopes Kenya, which does not offer abortions, closed two slum clinics after losing its USAID funding because of its association with Marie Stopes International, one of the world's largest family planning organizations.
Odhiambo, the country director for Marie Stopes Kenya, said it was likely that women who would have used his group's contraceptive services became pregnant instead and joined the 300,000 Kenyan women that Marie Stopes says seek dangerous, illegal abortions each year.
Two years ago, Joyce and her cousin Carolyne went to a Kibera slum clinic for a contraceptive injection. Because supplies were low, the doctor shared one between the two. Joyce, then a shy 18-year-old high school student, became pregnant. Her boyfriend deserted her and she had an illegal abortion.
"The fetus came out but she did not stop bleeding," recalled 29-year-old Carolyne. By the light of a small kerosene lamp, the two women used every sheet and towel in Carolyne's small house to try to stop the blood. Joyce spent the night twisting in pain on the floor, crying out for God to forgive her and screaming for her mother.
At dawn the two women went to a government hospital and had to plead with doctors to treat Joyce without informing police of the abortion.
Dr. Louis Machogo, the pharmacist for another Kenyan family planning group, said politicians may not understand the dilemmas that their policies forced on poor families.
"We are struggling with poverty, health issues, even hunger," he said. "We should let families decide for themselves how many children to have."
The U.S. ban was established by Republican President Ronald Reagan in 1984, ended by Democrat Bill Clinton in 1993 and reinstated by Republican George W. Bush in 2001.
"We now have a challenge, as the representatives of women's groups, (to) make sure that even if we have another president from the Republican party, we don't go back to this rule," said Luo, the ex-minister. "We shouldn't just sit back and celebrate. We need to go out and campaign and get the Republicans to realize the impact of these decisions."
Associated Press Writer Donna Bryson in Johannesburg, South Africa contributed to this report.