FRED DE SAM LAZARO: Per capita income is $300 a year in Zambia, barely enough to feed and clothe a family, which is usually large.
The average Zambian woman bears six children. It makes it easier to understand why women in the village of Naluyanda celebrated the arrival of Justin Kapila, the contraceptive man. ( Crowd singing ) "Our bodies will shine and glow because we won't get pregnant," they sang. ( Crowd singing ) Kapila works for Planned Parenthood of Zambia, the country's largest nongovernment family planning agency. Among contraceptives it distributes are condoms, aimed at bringing down the high rates of HIV and other sexually transmitted diseases.
The U.S. government, which is the leading donor to family planning programs worldwide, has long supported such services. However, Planned Parenthood of Zambia lost its U.S. government funding two years ago, about a quarter of its total budget, because of its support of abortion rights. Its clinics do not offer abortions, but do refer women to providers that do.
The Zambian program is one of several in Africa, Asia, and Eastern Europe that have run afoul of U.S. policies, which have increasingly clamped down on family planning service providers that support abortion.
Under what opponents call the gag rule, non-government providers are not allowed to even counsel abortion, even if it's with their own funds.
President Ronald Reagan first signed the abortion restriction, known as the Mexico City policy since that's where it was signed. It was reversed by President Bill Clinton and then reinstated by President Bush.
REPORTER: Are you going to reverse the executive order allowing abortion funding and counseling ... federal funds for abortion counseling and funding overseas?
PRESIDENT GEORGE W. BUSH: Yes, I am.
FRED DE SAM LAZARO: Brian Atwood, head of the U.S. Agency for International Development under Clinton, says abortion politics are hurting USAID's family planning programs.
J. BRIAN ATWOOD: There's no question that when you ... when you change the program and reduce the number of organizations that can actually work with you on it, you're basically creating more unwanted pregnancies. And what this Mexico City policy does, in essence, is to say to people of the developing world, "We don't believe you should have a choice."
The consequence is that you're going to have more unwanted pregnancies. It's just natural inclination of human beings that it's going to happen. And we're going to have more pregnancies and more abortions as a result.
FRED DE SAM LAZARO: But supporters of the anti-abortion rule say doesn't hinder family planning programs. Colorado Republican Tom Tancredo serves on the House African Affairs Subcommittee.
REP. TOM TANCREDO: When President Reagan put into effect the Mexico City language, about 350 agencies that work in Africa, and throughout the world as a matter of fact, were fine with that, continued to do everything that they were doing. Really, the only organization that said, "No, I won't abide by that," is international planned parenthood. I think there might be one or two others, but relatively few.
FRED DE SAM LAZARO: Planned Parenthood of Zambia is affiliated with the international organization and defends its rejection of the U.S. government conditions for aid. Director Dr. Fwasa Singogo says it's critical that pregnant women who come in for counseling know all their options.
DR. FWASA SINGOGO: We do counsel them the possibility of still keeping the pregnancy and be able to pursue whatever career or school they're in, but you'll definitely find those that will just say, "Sorry, I just want an abortion." Then we tell them, "Sorry, we don't provide such services here. You could go to the hospital."
FRED DE SAM LAZARO: Abortion is legal in Zambia, but in practice it's extremely difficult to obtain one. A woman must first consult with and then get the approval of three physicians before she can go to one of the few facilities that perform the procedure.
At the capital's largest hospital, where most legal abortions are done, Dr. Francis Chanda says about a dozen patients seek abortion services each day. Very few have the required legal referrals. Many, he says, are recovering from illegal abortion procedures.
DR. FRANCIS CHANDA: Maybe I would put it at 60 percent. Part of the reason why women may be having unsafe induced abortions is ignorance. Some of the women don't know where they can have a safe service. And I think...
FRED DE SAM LAZARO: Where they can have a safe service?
DR. FRANCIS CHANDA: Yes, a safer service.
FRED DE SAM LAZARO: Safer medical services of any kind are even more rare in Zambia's vast rural areas, hard to reach even by four-wheel drive. Planned Parenthood's outreach to these areas has been sharply curtailed due to the budget cuts.
That means monthly, instead of weekly visits by the lab techs to remote, spartan clinics. It also means fewer supplies for so-called community-based distributors of contraceptives, or CBD agents, like Justin Kapila. Charity Mwenifumbo is his supervisor.
CHARITY MWENIFUMBO: So with the cutting of the funding, it can really affect a lot of people, and we can have a lot of pregnancies, unwanted pregnancies.
FRED DE SAM LAZARO: Are you seeing that happen, anecdotally? Are you seeing many more unwanted pregnancies being reported?
CHARITY MWENIFUMBO: Yes, yes.
FRED DE SAM LAZARO: And contraceptives include condoms, which Planned Parenthood says are critical in country where one in five adults is HIV-positive. But Planned Parenthood's critics say those fears are overblown. Joshua Banda is a bishop in the Assembly of God Church in the capital, Lusaka.
BISHOP JOSHUA BANDA, Assembly of God Church, Lusaka: Just concluding that where there is less condom promotion, there may, in fact, be more infections. I'm not so sure that that is a credible way to go.
FRED DE SAM LAZARO: Bishop Banda and many religious leaders in this largely Christian nation are promoting abstinence education, which they say has reduced the rate of HIV in Uganda. It's a view that echoes from many conservative organizations in the U.S.
BISHOP JOSHUA BANDA: Our concern is that an unguarded promotion of condoms tends to cause people to relax their ability to say no. We are not animals. We can say no. We can increase young people's ability to actually postpone sexual involvement until they are married.
FRED DE SAM LAZARO: And despite criticism that the U.S. policy is outlawing activity that is legal in Zambia and in the United States, Banda strongly supports the abortion rule.
BISHOP JOSHUA BANDA: There are conservative movements here in Zambia that are, in fact, working to repeal that law that legalizes abortion, and we would feel that there would be nothing wrong if the American government, in specific reference to this area of abortion, begins to require that if they give aid, that that aid does not go to support abortions. I think they are in their rights to do so.
FRED DE SAM LAZARO: The U.S. anti-abortion rule is a sensitive issue in official circles in Zambia. Twice our appointments made to interview Zambia's health minister were canceled at the last minute.
Our request for comment officially from anyone at the ministry or from the U.S. embassy or USAID officials were also denied. That makes it hard to verify or dismiss the assertion from opponents of the gag rule that it is hurting anti-AIDS campaigns, increasing the number of unwanted pregnancies and, by extension, the number of abortions.