Trump and the Global Gag Rule
In Donald Trump’s presidential campaign, he promised to wage a war on abortion rights. He did indeed keep that promise; one of his first executive actions in office was reinstating the Global Gag Rule, which defunds international nongovernmental organizations (NGOs) that provide abortion services or even discuss abortion with their patients.
This rule has been through a kind of political rollercoaster since its inception in 1984. That year, the Reagan Administration implemented it at a population conference in Mexico City. Known as the Mexico City Policy, Reagan declared any NGO that includes abortion or abortion consultation among their family planning services ineligible for U.S. funding.
This policy is different from the Helms Amendment, which prohibits the use of U.S. aid directly for abortion services. The Gag Rule prohibits funding organizations that have anything to do with abortion–which includes a majority of family planning programs. As a result, it is not just abortion that will be affected but every aspect of sexual and reproductive health.
Republican administrations since Reagan have upheld the gag rule, while the Democratic administrations of Bill Clinton and Barack Obama have renounced it.
But this time, Trump did not merely reinstate this policy. He intensified it by a factor of 15, according to Population Action International. Historically, the gag rule has applied to $575 million in family planning and reproductive health funding. Trump’s Global Gag Rule applies to all global health funding, which amounts to $9.5 billion. This cuts funding from the National Institutes of Health, Centers of Disease Control, the Food and Drug Administration and various agencies of the United Nations.
In the past, international NGOs could still receive funding from the United States Agency for International Development and the U.S. State Department under the Mexico City Policy. Not anymore. Trump offers no exceptions.
This extreme cut in U.S. funding could destabilize health organizations worldwide. HIV prevention and treatment, maternal health care and Zika prevention programs will suffer as a result.
Northwestern Professor Sarah Rodriguez, who is a medical historian specializing in women’s reproductive and sexual health, said other aspects of women’s health will be affected. “A NGO, for example, can provide services beyond those that pertain to pregnancy. It can be doing mammograms, cervical cancer screening, pap smears and more.”
The NGOs that received U.S. funding from the Obama Administration now have to face a choice: cut funding and limit the scope of their care, or receive funding but cut the abortion services they provide.
What It Means for Abortion
The Gag Rule aims to cut down abortion rates, but a 2011 study by Stanford researchers found that it actually results in the opposite. Examining the policy’s impact in 20 sub-Saharan African countries from 1994 to 2000, they found that the rate of abortions actually increased. Unsafe abortions, that is.
This correlation could be due to a number of reasons. The researchers suggested that NGOs contributing to contraceptive distribution lost the funding to do so, leading women to become pregnant without wanting to.
Out of desperation, women will still seek abortions, whether they are safe or not. Reducing the availability of abortion services will not change a woman’s desire to terminate her pregnancy. In fact, it makes sense that making abortion illegal–criminalizing it–forces women to turn to harmful practices. In Kenya, women will resort to drinking battery acid, using wire coat hangers and asking others to stomp on their stomachs until they are no longer pregnant.
One of the most frustrating global health issues is the high rate of unsafe abortions; they hugely contribute to the maternal mortality rate even though they are the only entirely preventable cause. 47,000 women die from childbirth-related causes every year, almost exclusively in developing countries.
There are areas in the world where abortion rates have sharply declined: rich countries where abortion is legal. This includes the United States. Since abortion was legalized in 1973, the number of total abortions performed every year has been on a steady decline.
The Gag Rule is a way to satisfy anti-abortion supporters in America, but it is those in remote rural areas of developing countries who suffer most. The policy limits the ability of organizations to increase birth control access, resulting in more unwanted pregnancies. Combined with a ban on abortion, women face horrifying realities.
Response and Reparation
“When the policy was first installed in 1984, only a handful of groups refused the money,” Rodriguez said. “By and large in the past, most groups continued to receive funding and chose to limit the kind of services they offered.”
Shortly after Trump put the gag rule in order, the International Planned Parenthood Federation (IPPF) confirmed that they will not abide by these conditions. Their U.S. funding will be cut off, meaning that the organization will lose about $100 million in the next four years for sexual and reproductive health services. When the Gag Rule was in effect under the Bush administration, IPPF said their partners in Nepal, Kenya and Ethiopia had to close clinics and offer fewer contraceptives.
The Netherlands openly opposes Trump’s decision. Lilianne Ploumen, the Dutch international development minister, said they plan to fund family planning programs with about $600 million over the next four years to help fill the financial gap Trump’s Gag Rule will cause. As many as 20 other nations indicated that they plan to do the same.
However, this additional funding may not have as much impact as it seems. Historically, aid from foreign governments tends to fail without serious political pressure from the countries that need it. And with Trump’s version of the gag rule, $600 million would only fill a small portion of a vast gap in funding. To weather the storm of this new administration, civic engagement and commitment to public health advocacy will be more important than ever before.