Supo Nofisat didn't mean to get pregnant. As a single, unemployed 18-year-old living in Nigeria, she knew that having a child could mean an even harder life. So when her pregnancy test came back positive in January and a traditional midwife told her she was already three months along, the aspiring hairdresser thought she had only one option: abortion.
At the urging of a neighbour, Nofisat visited Hello Lagos, a youth-friendly clinic tucked in an inconspicuous alleyway in the heart of one of Africa’s busiest cities. There, she learned that the Lagos state government, with the support of the UN Population Fund (UNFPA), would cover the costs of her medical checkups during her pregnancy and connect her with professional training that could help her land a job. Within an hour, she had decided: She would keep the baby.
“Before coming to this clinic, I didn't know how I would manage the costs of my pregnancy,” Nofisat says. “Now, I'm much less worried about that.”
Last month, Donald Trump’s administration announced it would eliminate US funding for the UN population agency, saying that it partners with the Chinese government, which runs programmes involving coerced abortion and forced sterilisation. The UN group said the defunding is based on an “erroneous claim” and could have a devastating impact on the health of women and girls.
“We prevent unwanted pregnancies, we prevent abortions, and we prevent maternal death,” says Eugene Kongnyuy, deputy representative for the UN agency in Nigeria. “UNFPA has never and does not currently support abortion in any country, including China.”
Last year, the US government provided a total of $69m (£53m) to UNFPA. Trump is now following in the path of every Republican president since Ronald Reagan, who first raised the question of the UN agency's involvement in the controversial Chinese government programmes in 1985 and then stopped all US contributions. Democratic presidents have always reinstated the funding.
A State Department spokeswoman, commenting on the condition of anonymity, says the most recent defunding is based on the fact that the Chinese government still pushes for involuntary sterilisation and abortions to limit population growth – and that “UNFPA partners on family planning activities with the Chinese government agency responsible for these coercive policies”.
She says the $32.5m budgeted for the UN agency next year will be redirected to other maternal-health programmes across the world.
Although the United Nations will try to raise funds to fill the gap, it is not yet clear it will succeed.
In Nigeria, healthcare workers see a disturbing irony in the Trump administration's decision: it will cut resources for programmes that provide contraception, they say, and lead to more abortions.
Abortion is legal in Nigeria only when it is needed to save a woman’s life. But the Washington-based Guttmacher Institute, a reproductive-health research organisation, estimates that 1.25 million Nigerian women underwent abortions in 2012, in the most recent study available. Many were carried out by untrained individuals and in unsafe conditions.
The sheer number of people living in Nigeria means managing maternal health here is complex. The western African nation is home to 182 million people, making it the continent's most populous country.
Healthcare professionals see a clear link between family planning and other problems plaguing Nigeria – such as an economic crisis that has prompted tens of thousands of residents to cross the Mediterranean on flimsy boats in search of a better life. Kongnyuy,the UNFPA official, said that simply providing the resources for women to decide when to have a child can help lift families out of poverty from one generation to the next.
“If we reduce funding to family planning, it is going to be catastrophic,” he says. “No one wants to see more Nigerians crossing the Mediterranean.”
Nigerian officials have only recently embraced family planning, and the government now works with UNFPA to expedite deliveries of birth control and train staffers at state healthcare facilities to safely provide contraception.
Catherine Ugwuezuoha, the nurse who has counselled Nofisat through her pregnancy, says her clinic tries to discourage women from resorting to traditional birth attendants or illegal abortions, which often result in infections or internal injuries.
“Through our work, we have prevented so many unsafe abortions, I couldn't even count,” she says.
On a humid morning in April, Ugwuezuoha sat at the centre of a semicircle in her clinic's waiting room, five teenage girls crowded around her. Four were pregnant, and the other had her newborn baby strapped to her back. They beamed as she introduced them to one another and then jumped into the importance of maintaining a balanced diet and avoiding street food during pregnancy. They nodded as she urged them to save the phone number of a trustworthy driver who could take them to the hospital when the time came, pointing to the one who had already delivered as a success story.
Those girls are among dozens of young, expectant mothers who have passed through Ugwuezuoha's clinic since it opened a year ago. The Hello Lagos staffers are trained to offer medical and emotional support to pregnant teens, and they often mediate when it comes to sharing news of the pregnancy with the patient's parents. They also provide group counselling sessions that help teenage moms feel less isolated in a conservative society that tends to stigmatise women who give birth before marriage. Each month, hundreds of other teenagers visit each of the four Hello Lagos clinics, whether to pick up condoms, request birth-control prescriptions or be tested for sexually transmitted diseases.
In other parts of Nigeria, the Trump administration's funding cut is expected to affect urgent humanitarian response efforts. In October 2015, the US Agency for International Development provided UNFPA's Nigeria office with $3.2m to improve maternal health and reduce gender-based violence in areas affected by the radical Islamist group Boko Haram. Shortly before the latest cut was announced, UNFPA requested an additional $1m to extend the programme. Now, agency officials are worried they could receive nothing at all.
In the Lagos state health ministry, one senior official said the UN agency's support is critical. But since the news broke of the US funding cut, she lives in fear that the programmes she has helped implement will be discontinued. She spoke on the condition of anonymity for fear of retribution for criticizing the Trump administration.
“We watched from Nigeria as Americans elected Donald Trump,” she says. “We just didn't think it would have an impact on us here.”
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