Since 1965, the United States has been the leader in international family planning assistance. Over the past half-century, American funding and technical expertise have prevented millions of unwanted pregnancies and maternal deaths around the world. But the religious right’s fixation on abortion has prompted every Republican president for the past three decades to curb U.S. funding for international family planning programs, with devastating consequences.
Known by opponents as the Global Gag Rule (and by supporters as the Mexico City Policy), this ban on funding first took effect in 1984 under President Reagan, at the United Nations International Conference on Population in Mexico City. The repugnant policy held throughout the George H. W. Bush administration. It was reversed on President Clinton’s first day in office in 1993, but once again became a central tenet of the United States’ approach to international family planning during the George W. Bush administration. President Obama reversed the Gag Rule as one of his first presidential actions. On Trump’s first full day in office, he signed an executive order imposing the Global Gag Rule. What soon became apparent, however, was that the Trump Gag Rule is actually a radically expanded version of the already atrocious policy.
The Gag Rule bars any U.S. funding for foreign non-governmental organizations (NGOs) that use their own, non-U.S. funds to offer abortion services, counseling or referrals related to abortion, or political advocacy around the issue of abortion. It’s a cruel, counterproductive policy that has cut off funding to some of the most experienced, effective aid groups in the world. And Trump made it worse. In the past, the Gag Rule has been applied to U.S. family planning funding; Trump’s version, however, expands the restrictions to all global health funding.
Groups working to fight HIV/AIDS, tuberculosis, malaria, the Zika virus, and other emerging threats are all at risk. Even global nutrition and child survival programs will be faced with the same dilemma family planning providers have always confronted under the Gag Rule. Will they refuse the restrictions and lose their funding? If they do agree to the restrictions, can they even function effectively? Global health experts are still evaluating the potential impact of the expansion, but it’s already clear that billions of dollars in U.S. aid will be affected. The results will be devastating.
Aram Schvey, Policy Counsel at the Center for Reproductive Rights, argues, “this policy would be patently unconstitutional if applied to U.S.-based groups.” Schvey contends, “It is un-democratic and un-American for Congress to decide that foreign community and health groups are not worthy of the same free-speech rights as Americans.”
Conflict of Interests
When it’s in effect, the Gag Rule creates a major dilemma for foreign aid-receiving organizations that work to empower women by providing comprehensive sexual and reproductive health education and services. By forbidding any mention of abortion, it forces organizations to choose between accepting much-needed funds at the expense of censoring their programs, and refusing to comply and going bankrupt. In both situations, women suffer the consequences.
During the Bush Administration, The International Planned Parenthood Federation (IPPF), an organization recognized for its comprehensive sexual and reproductive health programs around the world, had to choose between receiving the funds necessary to sustain its services, and upholding the mission of the organization. Ultimately, IPPF refused to submit to the Gag Rule, and as a result lost more than $100 million in funding over the course of Bush’s eight years in office.
During that same period, 20 developing countries in Africa, Asia, and the Middle East saw their shipments of U.S.-donated contraceptives end. Many organizations and clinics were forced to reduce services and staff, and some were forced to close their doors, restricting public access to family planning, sexually transmitted infection (STI) services, and maternal and child health care.
In Zambia, refusal to adhere to the Gag Rule caused one organization to close three of its nine rural outreach programs and lose $100,000 worth of condoms.
In Kenya, where more than half of all pregnancies are unwanted or mistimed, the Family Planning Association of Kenya, (the IPPF affiliate in that country), was forced to close three of its clinics (which served a total of 56,000 clients), cut outreach staff by half, and raise fees at the remaining clinics, effectively withdrawing from communities that had come to depend on the clinics for essential health services.
In Nepal, FPAN lost American funding for family planning services and contraceptive supplies. As a result, 60 health workers were laid off, mobile reproductive health clinics were eliminated, and its ability to provide steady access to contraceptives withered. After President Obama lifted the Gag Rule, Nepal’s maternal mortality rate fell by a third.
Marie Stopes International estimates that the loss of their services under Trump’s Gag Rule could result in 6.5 million unintended pregnancies, 2.2 million abortions (2.1 million of them unsafe), and 21,700 maternal deaths around the world.
Even when it’s not in place, the Gag Rule poses significant challenges. According to Latanya Mapp Frett, Vice President of Planned Parenthood Global, it takes about two years to establish a program once Congress has appropriated funding. “And there’s possibility that, after investing those two years in what you hope will be a sustainable program, you’re faced with a policy that changes your direction. That can be a significant challenge.”
This challenge is compounded by the fact that most U.S. government-funded projects have life spans of five years, and thus extend beyond the next presidential election. Organizations therefore risk an immediate cut-off of funding in the middle of their projects, should an administration hostile to family planning be elected. Many NGOs and government officials are understandably reluctant to enter into partnerships with organizations that may be abruptly defunded.
“The challenges are maintaining the resources and understanding that development happens over decades,” Mapp Frett said. “You have to be there for the long haul, and [U.S. policy changes] make that difficult.”
By blocking U.S. funding for many of the world’s most experienced and reputable providers of family planning, “the Gag Rule has done immense harm and caused untold suffering to millions around the world,” said Dr. Gill Greer, former Director General of IPPF. “It has undermined health systems and endangered the lives and health of the poorest and most vulnerable women on the planet by denying access to life saving family planning, sexual and reproductive health and HIV services and exposing them to the dangers of unsafe abortion.”
NGOs that acquiesce to the Global Gag Rule in order to continue receiving U.S. assistance are prohibited from discussing even the negative consequences of unsafe abortion with women. Unable to counsel women who are contemplating an unsafe abortion, the professionals at these organizations are forced to withhold guidance that may mean the difference between life and death.
More than 21.6 million unsafe abortions occur each year, almost all in developing countries. Approximately 47,000 women die annually of complications from unsafe abortion, including infection, bleeding, and organ damage. Education and modern contraceptive services can reduce the incidence of unsafe abortion by helping women in developing countries make responsible decisions about their sexual and reproductive health—decisions that could help them avoid an unwanted pregnancy in the first place.
However, health clinic closures prompted by the Gag Rule have meant that women often have nowhere to turn for answers to their family planning questions. Indeed, a 2011 Stanford University study found that abortion rates more than doubled in the African countries that were most reliant upon U.S. family planning aid during the years the Gag Rule was in place (2001-2009).
Offering aid on conditions that hinder the quality of family planning programs limits the ability of NGOs to serve every potential client. Several countries whose family planning assistance was severely cut have revised their population projections upward. Kenya is perhaps the most jarring example: before the Gag Rule, Kenya’s population in 2050 was projected to be 44 million. In the latest revision, however, that figure rose to 97 million. This example illustrates the time sensitive nature of compounding population growth. Each generation creates a larger base upon which the next generation grows.
The Global HER Act
In response to Trump’s Gag Rule, Sen. Jeanne Shaheen (D-NH) and Rep. Nita Lowey (D-NY) immediately introduced the Global Health, Empowerment, and Rights (HER) Act. The Global HER Act would repeal Trump’s Global Gag Rule and prevent a future president from unilaterally acting to impose it. Follow the bill’s progress in the Senate and in the House and sign our sister organization’s action alert to demand that your members of both houses of Congress support it!