Ex-Trump official and abstinence advocate strikes secretive health deal in Uganda

Valerie Huber has had a busy couple of years. Since leaving her senior post in the US government, the former Trump official has spent months travelling across Africa, from Burkina Faso to Uganda, meeting officials and heads of state from at least nine countries. Social media posts show her gladhanding ambassadors and smiling with politicians, making public her commitment to promote women’s wellbeing and health.

At the heart of her latest project is the Protego Women’s Optimal Health Framework, a public health initiative that was the subject of an agreement signed in May by Janet Museveni, Uganda’s first lady and minister for education. The programme’s launch was attended by prominent doctors, women’s groups, politicians, even groups of schoolchildren. And it was heralded as an exciting opportunity for Uganda’s public health.

Protego is run by Huber’s charity, the Institute for Women’s Health (IWH), which says the project aims to offer, “evidence-based interventions to support the health and wellbeing of women and their families”. One of its more ambitious goals, according to a senior source in the Ugandan health ministry, is to roll out clinics that deliver a significant range of reproductive health services to women, as well as cancer screenings.

The background, however, is that Protego is Huber’s latest project in a 25-year career spent promoting ineffective abstinence-focused sex education and so-called “natural” contraceptive methods. As a senior adviser within Trump’s Department of Health and Human Services, Huber made sweeping changes that led to the closure of some evidence-based family planning programmes. She was also the driving force behind the Geneva Consensus Declaration, a statement signed by 34 countries saying that there is “no international right to abortion”.

Now TBIJ can reveal that Huber and her charity, the IWH, have entered into a secretive agreement with the Ugandan government to find public money to spend on her Protego programme.

What’s more, key documents relating to the project are being kept away from the public eye in a manner described by one lawyer as “unconstitutional”.

Rolling back progress

In Uganda, women’s health rests on shaky foundations. Teen pregnancies are high. Girls and young women between 15 and 24 account for almost a third of all new HIV infections. And for every thousand babies born, around three of the mothers die.

It is also a country where the issues of contraception and sex education remain deeply controversial. Religious leaders and conservative politicians have pushed back against increasing access to contraception, focusing instead on abstinence and “purity”.

However, the scale of HIV-related deaths and unplanned pregnancies have forced the government’s hand. Recent pledges have been made to increase the use of modern contraceptives, including for young people. But any advances on this front are fragile, and in constant danger of regressing.

Huber, meanwhile, has spent almost three decades promoting schemes that teach young people that the best way to avoid infections and unwanted pregnancies is to forego sex altogether. After running abstinence initiatives in Ohio, she took over the state’s abstinence-only education programme, which were found by one study to contain “false and misleading information” under her tenure. She then spent a decade leading the not-for-profit National Abstinence Education Association (later renamed Ascend), before Trump appointed her into government.

Extensive research supported by major medical institutions has found abstinence-only education does not significantly delay the initiation of sexual activity in young people – it simply leaves them ill-informed and unprepared. Some previous research has shown some young people in abstinence-based programmes are similarly likely to use condoms. But leading experts have criticised them for both withholding accurate information and including inaccurate information, as well as promoting harmful gender stereotypes.

In a statement, Huber said the IWH and the Protego project drew on “science-based concepts”. She cited a number of studies which showed people undergoing abstinence education delayed their “sexual debut”, were “no less likely to use a condom” and had “improved academic success”.

While the full details of the Uganda agreement are unknown, Huber has met with representatives of at least one women’s hospital in the run-up to Protego’s implementation.

And her track record suggests abstinence-focused education is likely to be at the forefront of the scheme. A copy of the project’s framework and accompanying document seen by TBIJ mentions abstinence and “natural family planning” (having unprotected sex while trying to avoid the fertile part of a woman’s cycle) as well as modern evidence-based methods. It also states any discussion of contraception should include education about avoiding “sexual risks”, terminology used by Huber to describe abstinence-based education.

Gillian Kane, director of global policy at the reproductive rights charity Ipas, told TBIJ: “There are existing programmes [in Uganda] that are vetted, they’re implemented by professionals in the field,” she said. “There are technicians who know how to provide health services.”

She said that Huber’s project “really raises a lot of questions [about] their area of expertise and what they're replacing.”

Uganda’s Ministry of Health told TBIJ that Protego will supplement, not replace, existing services. It also said the concept of abstinence is “integral to Uganda’s moral fabric” and has been used in the past to combat HIV transmission, as part of a strategy also involving contraception.

Huber’s charity, the IWH, told TBIJ the Protego framework is “culturally sensitive” to local populations and “does not force beliefs, values, or doctrines upon a country and its people”.

TBIJ has repeatedly asked the relevant ministries, the Organization of African First Ladies for Development and Huber’s IWH to see the agreement and has made formal requests for information about what it contains. But with no success.

Kane said that people she has spoken to with access to Huber have been been met with a “vacuum of detail about what it is”.

Sources in ministries working on the project, as well as via those providing reproductive health services in Uganda, have told TBIJ that Protego is being coordinated by the office of the first lady – which is also where key documents relating to the project are being held. The office has no formal standing in the constitution.

A constitutional lawyer familiar with the situation, and who did not want to be named for fear of backlash, explained that the first lady’s office does not have the same status in Uganda law as a government ministry and therefore cannot be scrutinised or challenged in the same way. He described the situation as “unconstitutional”.

Finding the money

Although official details on the project are scarce, it seems clear that Museveni, Uganda’s first lady and minister of education, has thrown her full weight behind it. A commissioner in the health ministry and a member of parliament who helped set up the project have confirmed to TBIJ that there is an agreement to find the Protego money in some form from within the existing budgets of three government ministries.

The IWH said no money would be exchanged between the charity and other parties.

Dr Richard Mugahi, assistant commissioner at Uganda’s Ministry of Health, told TBIJ that not all aspects of the plan may be able to go ahead within existing budgets. But asked whether there was a path to money coming in the future, he said: “Of course. Our chief mobiliser is the first lady, who is very passionate about this.”

Museveni took up the cause after Huber was introduced to government figures by Sarah Opendi, a member of parliament and chair of the Uganda Women Parliamentary Association. Opendi, who also attended an early meeting about the project, is a backer of Uganda’s extreme anti-LGBT bill.

She told TBIJ she believes Protego should advocate abstinence for adolescents, rather than contraceptives, as a way to address the country’s high teen pregnancy rate.

Dr Sabrina Kitaka, a paediatrician who attended the launch event in May, seemed cautiously optimistic about the programme. Kitaka told TBIJ she “did appreciate their vision and goal to support the girl child, to empower her, to make sure she doesn’t become pregnant before she finishes school and also to promote women’s health in general”.

But she added that “we have to not put our head in the sand” when it comes to the burden of teenage pregnancy and that contraception should be given to “those who need [it]”.

“The data shows that abstinence-only programmes do not work,” said Ophelia Kemigisha, an activist and human rights lawyer. “A return to this strategy will lead to a loss of the progress made.”

Project 2025

Huber’s ideas on the subject, however, appear unwavering. When she was appointed to the US Department of Health and Human Services in June 2017, she promptly cancelled the contracts for all 81 providers of Teen Pregnancy Prevention programmes, which had been independently judged as effective. She then issued various funding opportunities that favoured both providers advocating abstinence-only education and “natural” family planning over medically approved contraception. One of the results was almost a million fewer people serviced by federal family planning programmes.

Now Huber is listed as a contributor to Project 2025, a radical 900-page blueprint for the next US government, drawn up by the ultra-conservative thinktank the Heritage Foundation. It says the next administration should remove all references to “gender equality”, “abortion” and “sexual and reproductive rights” from foreign aid policies, contracts and grants. It also recommends the removal of references to “controversial” sexual education materials.

When the US makes changes to its aid policies, for example excluding abortion from funding, it has a direct effect on the availability of wider reproductive health services in countries receiving US funding, including Uganda.

Nana Darkoa Sekyiamah, co-founder of the Institute for Journalism and Social Change, told TBIJ Huber’s career and involvement in Project 2025 appeared to “point to her true agenda – to limit the sexual health and rights of girls, women and young people”.

“The outcome of her activities on the health and wellbeing of young people are dire.”