Jan. 31 2017

The Global Gag Rule Returns, And Could Be More Harmful Than Ever

Among his first acts in office, President Trump reinstates and expands the scope of a policy preventing foreign aid from going to organizations that promote abortions

The same year the Roe v. Wade decision struck down anti-abortion laws in the United States, American policy toward abortions beyond our borders took major steps in the opposite direction. In 1973, Sen. Jesse Helms (R-NC) lobbied hard to secure the passage of a law that remains in force today: The Helms Amendment to the Foreign Assistance Act forbids the U.S. government from funding abortion procedures abroad.

left to right: Carolyn Westhoff, Terry McGovern, Wendy ChavkinIn 1984, at an international conference on family planning in Mexico City, President Ronald Reagan imposed further restrictions on U.S. funds and international abortion-related activities through a regulation known as the Mexico City Policy or the Global Gag Rule. As originally written, it prevents any family planning foreign aid funds from going to hospitals and NGOs that perform or “actively promote” abortions—even if the organizations use non-U.S. funding to carry out such activities as informing patients of medically indicated options or working to reduce unsafe procedures.

Because it’s an executive order, the White House doesn’t have to go to Congress to change its stance on the Global Gag Rule. As a result, “it’s a policy that ping-pongs every time the party in power at the White House changes,” says Wendy Chavkin, professor emerita of Population and Family Health and Obstetrics-Gynecology and co-founder of Global Doctors for Choice. In place under Reagan and both President Bushes, the Mexico City Policy was rescinded by Presidents Clinton and Obama; on January 23, one of new President Trump’s first actions in office was to sign an executive order putting it back in place. 

Impact of the Global Gag Rule

The back-and-forth nature of the policy’s history allowed public health researchers to understand the Global Gag Rule’s impact on women’s health around the world. The World Health Organization analyzed abortion rates across 20 countries, comparing datasets from the Clinton Administration with the following eight years under Bush, when the policy was reinstated. Their findings, published in 2011, are stark: in countries where the Mexico City Policy had the most impact, the number of abortions—both safe and unsafe—rose, while contraception use fell.

Research has shown that where abortion is illegal or highly restricted, the number of unsafe abortions increases, leading to higher maternal and infant mortality rates. Currently, according to WHO, there are an estimated 21.6 million unsafe abortions a year, and unsafe abortions account for about 13 percent of global maternal mortality rates. Marie Stokes International, an international NGO and one of the biggest recipients of USAID’s family planning funds, has projected an additional 2.1 million unsafe abortions annually with the Global Gag Rule back in place. The organization is one of several to refuse to sign onto the policy, almost surely leading to a significant drop in funding for their programs.

In the face of such compelling evidence of harm, the Mailman School, as part of a coalition of 138 organizations, academic institutions, and advocacy groups, has signed onto a statement opposing the Global Gag Rule because it “seriously hinders the effectiveness of U.S. global health investments and the growing global progress that we, as a global community, have made in expanding access to family planning for couples worldwide and in reducing maternal mortality.”

An Expanded Scope?

Another worrying aspect of the revived version of Global Gag Rule is the fear that—due to new wording in the executive order—the policy could now apply not just to foreign aid to dedicated family planning programs, but to all global health programsthat receive U.S. funding. The United States, currently the largest donor to international family planning programs, is also a top contributor to global efforts to fight Zika, cancer, HIV/AIDS, or malaria. As the global health community waits for clarity from USAID, the fear among many is that the Mexico City Policy will restrict effective, life-saving programs that receive any of the estimated $8.5 billion dollars the country contributes.

In the more than 30 years since Reagan first instituted the Global Gag Rule, many countries have liberalized their abortion laws, contraception use has advanced both scientifically and in social acceptance, health systems have grown and modernized, and the global health field has expanded dramatically. But with the world more interconnected than ever before, the consequences of the Mexico City Policy could be more far-reaching.

Speaking at last week’s Teach-In, Terry McGovern, professor of Population and Family Health, pointed to the global outbreak of Zika, which is particularly dangerous for pregnant women and their future children. “It’s going to have a devastating impact,” she said. “Zika is one of the best reasons to come out against this policy. The economic argument is compelling—there are so many families in Brazil right now whose children were born with microcephaly because of Zika, who have absolutely no way to pay for their children’s care. If you get U.S. funding and you cannot even mention abortion when you counsel pregnant women, you can’t provide comprehensive care.”