Kenyan women are finding family planning more difficult
Family planning organisations in Kenya say they are being forced to close clinics in the slums after a cut in funding from the US Government.
Alice Njoki calls the receptionist at a busy clinic in the Eastleigh slum of Nairobi.
Alice, a fruit seller in Nairobi, steps up to the desk and hands over her appointment card.
She has been coming here for five years. Alice is not a rich woman, but she devotes her small income to giving her only child, Thelma, a good upbringing.
Her hope is that her daughter will grow up and leave their slum home.
Funding cut
This dream is unlikely to be realised if Alice gets pregnant again, as she cannot afford another child.
Once a month, she receives a contraceptive injection at this clinic. But a decision taken far away in America is about to have an impact on Alice's life.
"I'm sorry to tell you", says the nurse, as Alice rolls up her sleeve for the injection, "This is the last time you will be here."
"From the end of the month, we are closing down."
The clinic is one of five across Kenya to be shut because of a decision taken by George W Bush shortly after he became President last year.
He announced that the US Government would not fund international agencies which support abortion.
The move was seen as an attempt to appease the powerful anti-abortion lobby in the United States.
But the clinics run by pro-choice organisations in Kenya, mainly offer family planning services, not abortion.
Expensive alternative
The Eastleigh clinic is run by the Kenya Family Planning Association, which is part of the larger International Planned Parenthood Federation.
The nurse tells Alice of an alternative privately-run clinic where she can receive her monthly injection, but it will cost her three times as much.
Alice does not know whether she can afford it.
"I don't know what's going to happen now. I'm afraid I might get pregnant," she says.
The Family Planning Association's director is Godwin Mzenge.
He says his funding has been cut by 20%, and there may be worse to come.
"We may end up closing eight of our 14 clinics," he says.
"It means maybe three-quarters of the organisation will collapse altogether."
Poor affected
He points out that it is not just birth control services which are lost. Breast cancer screening and cervical smear tests will also go.
They have closed two clinics, one in Mathere slum in Kenya and another in Kisumu, Western Kenya.
Head of clinical services there, Martha Warratho, says the Bush administration's policy hits poor women hardest.
"Without family planning, you have unwanted pregnancies," she says.
"Some mothers end up doing abortion in the backstreets because they do not have any alternative."
Dangerous procedures
Technically, abortion is illegal in Kenya however the law is widely flouted and it can cost as little as $10 to have a backstreet abortion.
But it is dangerous, and many women die every year from these primitive procedures.
Dr John Nyamu, who runs a reproductive health practice, is blunt about the consequences of the Bush administration's policy.
"If you take away family planning services, the number of abortions goes up," he says.
But supporters say it is not the US Government which is closing down clinics in Kenya.
Grover Joseph Rees is an adviser to Congress.
He points out that organisations like Marie Stopes had a choice. "Marie Stopes had to make a decision if it wanted to keep on getting US Government funds," he says.
"It made the decision that it was more important for them to be in the abortion business."
Anti-abortionists approval
Privately, American officials argue the impact of the US policy in Kenya will be limited.
The bulk of US money for family planning is spent in the state sector.
This is not affected by the new rules on funding, because the Kenyan state does not sanction abortion.
Kenyan anti-abortionists also welcome the US intervention.
Dr Jean Kagia is obstetrician by profession. She is dismayed by the ease of access to abortion in her country.
Her view is that foreign, pro-choice organisations should not be allowed to operate in Kenya.
"Close them all down," she says.
"If a donor country has realised that this has actually made the population smaller by killing the population of that country, I say thank you very much indeed to the US government."
But American policy is forcing poor women like Alice make stark choices.
Ironically, if they cannot find the money to pay for more expensive birth control, some may choose the dangers of cheap abortion.