SheDecides ensures free access to healthcare and contraception in Mali

Midwife

In 2017, the Association Malienne pour la Protection et la Promotion de la Famille (AMPPF), lost $1,500,000 of funding to be spent over three years as a result of the reinstatement of the Global Gag Rule (GGR). The UN Population Fund (UNFPA), a key contributor to AMPPF, also had its budget slashed, further depleting AMPPF’s resources.

AMPPF provides comprehensive sexual and reproductive health care to hundreds of thousands of women in Mali, a country with one of the highest rates of teenage pregnancy and early marriage in the world.

The Global Gag Rule (GGR), or Mexico City Policy, denies U.S. funding to organizations like IPPF if they use non-U.S. funds to provide abortion care, counselling or referrals in accordance with national law. It blocks critical funding for care like contraception, maternal health, and HIV prevention and treatment.

Loss of funding triggers clinic closures 

The results of the GGR policy change in Mali were immediate and devastating. AMPPF had planned an expansion to 50 service points and eight mobile clinics, which was immediately put on hold. Some clinics had to close temporarily, leaving Malians without safe places to obtain contraception and treatment for sexually transmitted infections. Outreach and educational activities ground to a halt.

As a result, AMPPF served 242,500 clients rather than the 505,000 it had planned to help in 2017. Staffing numbers fell from 98 dedicated personnel to just 41 in 2017, and dropped even further to just 29 employees in 2018. This included midwives serving some of the poorest communities in Mali. “I have worked at the Kalabancoro clinic in Bamako for almost six years, but there was a break when the funding stopped,” said Mariame Doumbia, a midwife with AMPPF who lost her job due to GGR funding cuts. 

Midwife, Mariame Doumbia at the Kalabancoro health centre in Bamako.
Midwife Mariame Doumbia at the Kalabancoro health center in Bamako

SheDecides renews hope and opportunity 

The situation turned around with Canadian government funds of $329,599 to the SheDecides project, which has filled the gap left by GGR. “I was able to go back to work with the SheDecides project,” Doumbia said. This money has also been used to target the most vulnerable clients who would otherwise be left without access to sexual health care from the Malian state or other NGOs.

“SheDecides has helped us a lot, above all in our work outside our own permanent clinics. When we go out in the community we have a lot of clients, and many women come to us who would otherwise not have the means to obtain advice or contraception,” explained Mama Keita Sy Diallo, a midwife and AMPPF board member. She runs consultations at community health centers in underserved areas of the Malian capital. “Everything is free for the women in these sessions. We also work in government clinics, where people are really in need.”

She Decides has allowed AMPPF to maintain three mobile clinics, travelling to more remote areas where transportation costs and huge distances separate women from access to family planning. The project also ensured that AMPPF’s Youth Action Movement could restart its outreach activities, raising awareness about sexual health in the streets, in schools, and in community centers.

Mobile clinic.
Villagers wait their turn outside the mobile clinic at Missala village outside Bamako

Targeting local youth 

“After the arrival of SheDecides, we intensified our targeting of vulnerable groups with activities in the evening, when domestic workers and those working during the day could attend,” said Mariam Modibo Tandina, who heads the national committee of the Youth Action Movement in Mali. “That means that young people in precarious situations could learn more about safe sex and family planning. Now they know how to protect themselves against sexually transmitted infections and unwanted pregnancies.”

The funding has also reinforced data gathering through new computer equipment, allowing AMPPF to better understand its client base and how they use its health care. Step by step, She Decides has reinforced the provision of family planning in Mali, and reached clients who were most in need of care when the global gag rule cut off their access. “SheDecides came at a crucial moment. The project has filled in the gaps after our funds disappeared. We needed a solution and SheDecides was that solution. We won’t see the impact immediately, but for the next few decades,” said Mamadou Bah, a young AMPPF volunteer.