Mali’s Crisis of Care: Can the Biden Administration Make a Difference?

Mali’s protracted conflict, which began with a secessionist movement in 2012, has plunged the country into a humanitarian crisis. As of January 2021, an estimated 322,957 Malians were internally displaced. The majority of these internationally displaced people (IDPs) are women and girls. In rural areas, they are in urgent need of sexual and reproductive health services—a situation aggravated by the COVID-19 pandemic.

To make matters worse, humanitarian aid for Mali remains woefully underfunded. The Biden administration has already made progress towards expanding access to sexual and reproductive health (SRH) worldwide. It has issued a memorandum rescinding many of the restrictive actions issued by the Trump administration and reinstated funding for the United Nations Population Fund (UNFPA). However, much more needs to be done in order to translate this promising start into tangible improvements in the lives of displaced women and girls on the ground in countries like Mali. To this end, the Biden administration and other donors should increase its financial support for SRH services for women and girls in Mali, including those who are internally displaced.

The most pressing SRH needs in Mali include access to family planning, pre- and postnatal care to address the high infant and maternal mortality rate, support for survivors of gender-based violence (GBV), and access to abortion. Unfortunately, health centers in many regions have been partially or completely destroyed due to conflict—93 percent in northern conflict zones and 26.3 percent throughout the country.

Additional barriers to care include a lack of autonomy for women in making their own healthcare decisions and traditional attitudes about pregnancy that delay care. Furthermore, stigma can deter women and girls from seeking family planning and for many, the cost of long-acting contraceptives are prohibitive. Finally, abortion is illegal in Mali except in cases of rape or incest. IDPs and rural women rely heavily on non-governmental organizations (NGOs) and community health centers. Yet visits by NGO staff are often inconsistent, and community health centers are often undersupplied and understaffed. This prevents women from reliably obtaining contraception, especially long-acting contraception, which must be administered by skilled healthcare personnel.

Furthermore, there is no formal SRH education in the school system in Mali. People rely on informal conversations or the media to learn about SRH. The private sector has established some alternative SRH education programs. However, the lack of funding, ongoing violent conflict, and limited capacity has curbed these efforts.

Women who have been forced to flee their homes face even greater challenges in receiving meaningful sexual and reproductive health services. IDPs generally lack the means to pay for such services and cannot travel to healthcare centers because they are too far or they cannot afford the transportation. Furthermore, the COVID-19 pandemic has affected services and operating times at community health centers and has prevented NGO workers from traveling to populations in need. Reports of widespread fears of contracting COVID-19 at hospitals has kept many Malians from seeking formal care. All of these challenges are likely to increase unintended pregnancies and reliance on self-care, which can be lethal in the case of home-deliveries or self-induced abortion without the proper supplies.

Overshadowing these issues is a funding crisis for general humanitarian response and SRH services specifically. In 2020, international donors only provided  3.6 percent of the budget requested by the UN Office for Coordination of Humanitarian Affairs (OCHA) for non-COVID-19 related health matters, amounting to a mere $715,684, of which SRH was just one sub-category. The UNFPA was also drastically underfunded in 2020, disrupting a vital provider of SRH services in Mali. Of the $492.82 million that the U.S. Government spent on aid to Mali last year, only $15 million went to SRH and maternal and child health combined, and the United States provided zero funding for UNFPA. Although the United States is now reinstating funding for UNFPA, prospects for Mali in the coming year are not much brighter considering how little has been requested for SRH services in the 2021 budget.

 As the largest humanitarian donor in Mali over the last five years, the U.S. government has real influence on these issues. Therefore, it must increase immediate targeted funding for SRH and also create long-term and flexible funding strategies that prioritize SRH care.

One way President Biden can prioritize SRH is by encouraging the United States Agency for International Development (USAID) to include support for local SRH organizations as a benchmark within its new 2021-2025 Mali Country Development Cooperation Strategy. This benchmark would fit naturally within the current strategy’s transition objective to provide essential health services to those in need and elevate the status of reproductive health alongside other development priorities.

The Biden administration must also pressure Congress to permanently overturn the Global Gag Rule, which prevents organizations that provide broad SRH work, including HIV/AIDs treatment and maternal healthcare, from doing their lifesaving work. Permanently removing this rule will allow humanitarian organizations in Mali to make long-term plans to provide SRH care, without fear of the Rule being reinstated and cutting off their funding. Long-term planning is essential to creating a more sustainable and stable SRH system in Mali.  

For the Biden administration to fulfill its commitment to strengthening women’s rights and sexual and reproductive healthcare worldwide, there is a lot of work to do. It has taken the first and necessary steps of revoking the Global Gag Rule and providing new funds to UNFPA. Now, it needs to ensure that access to SRH for women and girls around the world actually improves. It’s time for the United States to take the lead in developing fully funded, comprehensive, and aggressive plans to bolster the empowerment and protection of women and girls around the globe, including promoting their sexual and reproductive health and rights. Women and girls in Mali should be at the top of the list.

About the Authors

Jessica Margolis has worked at the Carnegie Endowment for International Peace and the Guttmacher Institute, and recently graduated with an MA from Georgetown University where she concentrated on the Women, Peace and Security agenda.

Ndeye Radia Mbengue has worked as Gender-Based Violence consultant for organizations such as the World Bank and has experience in Sub-Saharan Africa, the Middle East and North Africa.

Emma Dorshimer has worked as a GBV research consultant for organizations such as UNICEF and recently graduated with an MA from Georgetown University, concentrating on Gender, Peace and Security and youth advocacy.

PHOTO CAPTION: A woman plays with her baby in a camp for IDPs in Sevare, Mali on March 02, 2020. Photo Credit: MICHELE CATTANI/AFP via Getty Images.