The Global Gag Rule Is Back - Again - and It's Bigger Than Ever

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Family planning education in Ethiopia, 2006 (Public Domain)
April 12, 2017

Two recent, major changes in U.S. policy will radically alter the fate of women and girls around the world. On January 25, 2017, President Trump signed an executive order reinstating the “Global Gag Rule”—a policy that bars United States foreign aid from going to any non-governmental organization that provides abortion services or even discusses abortion with their patients. On April 4, 2017, the Trump Administration announced that the U.S. would be ceasing its contributions to the United Nations Population Fund (UNFPA), an agency dedicated to creating a world where every pregnancy is wanted, every childbirth is safe, and every young person's potential is fulfilled. The net effect of these policies is a dramatic reduction in access to contraceptives in the developing world.

The Global Gag Rule was first implemented by President Ronald Reagan in 1984. It has since been repealed by President Bill Clinton, reinstated by President George W. Bush and then repealed again by President Barack Obama. While many are already familiar with past versions of the Gag Rule, it is important to note that the executive order signed this past January is more expansive than any of the previous iterations. This version applies to all global health funding, approximately $9.5 billion in total, rather than just the $575 million of family planning funding disbursed through the United States Agency for International Development or the State Department. A separate measure passed in 1973, known as the Helms Amendment, already prohibits any U.S. funding from going directly to the provision of abortion services. The Global Gag Rule, “denies foreign nongovernmental organizations (NGOs) that receive U.S. government global health assistance the right to use their own, non-U.S. funds to provide information, referrals, or services for safe, legal abortion, or to advocate for the legalization of abortion.” For example, funding could not go to services such as HIV treatment/prevention or maternal health care, if the organization providing those services also offers pregnancy options counseling that includes information about abortion.

In the past, this policy has had a chilling effect on the global health community. There is even more uncertainty and concern in the face of this expanded version of the gag order. As Ann M. Starrs, President and CEO of the Guttmacher Institute, writes:

“When last in effect, the gag rule crippled family planning programmes. Many foreign NGOs as a matter of principle and out of dedication to the patients they serve, refused to let the US Government muzzle their abortion advocacy efforts or dictate what services or counselling they provided using their non-US funds. These health providers were forced to reduce staff and services, or even shut clinics. As a result, many thousands of women no longer had access to family planning and reproductive health services from these clinics—sometimes the only provider of such services in the local community.”

Given this knowledge, it cannot be surprising that while ostensibly intended to reduce abortion rates, the Global Gag Rule has been shown to have the exact opposite effect. A study conducted by Stanford University found that the induced abortion rate in sub-Saharan Africa actually rose during the time frame the order was in place due to reduced access to contraceptives. They concluded that reduced access to family planning services “may have led women to substitute abortion for contraception.”

Established in 1969, the UNFPA is the lead international agency working to improve maternal health and reduce unintended pregnancy globally. Improvements in global health outcomes over the past forty years serve as a testament to its effectiveness; since its founding, the global rate of women dying from complications of pregnancy or childbirth has been halved. In addition, the overall rate of unintended pregnancy worldwide has declined. However, there is still more work to do. Over half of all pregnancies in developing regions are still unintended and only about half of the 123 million women who give birth each year receive antenatal, delivery, and newborn care. Additionally, there are still an estimated 215 million women worldwide who want to avoid pregnancy but do not have access to an effective method of contraception.

For every $100 million the U.S. puts into family planning, 5.2 million more couples gain access to contraception and 1.5 million unintended pregnancies are avoided. There are 700,000 fewer abortions and 4,000 fewer maternal deaths. The UNFPA helps enable 27 million women and couples to receive contraception annually, helping them avert approximately 6 million unintended pregnancies and preventing 2.3 million induced abortions. As with the Global Gag Rule, if the implied objective of the current administration is to reduce the instance of abortion, ceasing funding to the UNFPA will have the opposite effect.

Healthy women help build healthy societies. Empowering women and girls to make full, free, and informed choices about if and when to have children leads to more successful economies, prosperity, political stability, and increased social harmony. The World Health Organization writes, “sexual rights embrace certain human rights that are already recognized in international and regional human rights treaties, supported in consensus documents and found in national laws.” The best path forward for the United States is to cease treating international family planning as a political football. Efforts which seek to permanently repeal the Global Gag Rule, such as the Global HER Act, would ensure that the international health community does not continue to be subject to arbitrary changes in funding availability. Not only continuing, but increasing the level of support the U.S. provides to the UNFPA and to international family planning as a whole, would help create a more stable world.

In a recent article, Melinda Gates poignantly recounted a story that vividly illustrates why access to contraceptives is so important:

“I’m still thinking about the high school student whose name I didn’t get but whose words I will always remember. She said she plans to use contraceptives in her future because of something her parents told her: ‘This is a developing country. It’s your job to develop it.’ Like so many of the Indonesians I met, she is not merely hopeful her country will continue to rise — she is determined to do her part to lift it. Foreign aid helps make sure that more young people have that chance.”

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