Though Donald Trump has vacated the White House, the former president left damage to the international women’s health community in his wake.
When Trump became president, one of the first actions he took was to reinstate the Mexico City Policy, also known as the global gag rule. The policy prohibits U.S. global health funds aid from foreign nongovernmental organization that provide abortion services. However, the rule goes a step further, preventing organizations from even talking about abortion care services, such as referrals,
The policy has actually flip-flopped back and forth since 1984, with Republican presidents readily reinstating it and Democrats rescinding the policy. President Joe Biden similarly rescinded the policy within weeks of taking office in 2021. While the move restores funds to critical healthcare services around the world, communities are negatively impacted by the rule whenever it is restored, even for a seemingly brief period of time.
The Real Impact
Cutting off aid creates funding gaps that further fragment women’s health care around the world, according to the International Women’s Health Coalition, an NGO based in New York City that recently published a report on the impact of Trump’s gag rule. It also worsens existing barriers to care, including making abortion care, contraceptive services, and HIV/AIDS testing and treatment less accessible, the report found.
Not only does limiting funding limit access, it also makes social stigmas and cultures of non-acceptance of abortion care and family planning health services worse in some parts of the world. For example, women facing unwanted pregnancies in Kenya--where abortion is legal only in emergency and health-related circumstances--lost the ability to have counseling services.
“Some of our partners in other organizations that have been offering the actual services of abortion are closing down their shops,” a technical Advisor, HIV and sexual and reproductive health organization, Kenya, said in the report. “Those who used to receive the US funding.... FHOK [Family Health Options Kenya] and Marie Stopes have been affected. Those are the two key [organizations] that we worked with and as partners in sexual and reproductive health.”
Other organizations, rather than shut down, were forced to sign on to the policy and completely refocus their work and even alter public-facing health information just to comply. That meant access to both the service of abortion and basic information about it were dimished. At risk of losing critical funding, some health organizations also tend to over implement the policy, in essence self-gagging their work beyond what’s necessary to comply--and out of step with what’s legal
“For example, in South Africa, even in situations where organizations and the government are allowed to provide or refer for abortion services, they are becoming silent or removing language from training materials,” the report noted.
The global gag rule also impacts access to contraceptive care and even post-abortion care, though that’s likely because of miscommuncation of the policy’s overall impact.
Trump’s Anti-Women Rampage
The policy has been a hot subject of debate for years, but what is likely not as well known is just how the Trump administration expanded it and harmed more health care efforts than previous administrations by applying it to more global funds.
“While previous versions of the policy only applied to reproductive health and family planning funding, representing about $600 million a year, the Trump version of the Global Gag Rule was applied to all U.S. global health funding, implicating more than $9 billion,” IWHC reported.
To be sure, the U.S. is far and away the biggest global health donor, providing roughly half of all official development assistance for health provided by Organization for Economic Cooperation and Development (OECD) donor countries. And Congress has earmarked funds for different health objectives, such as $608 million for reproductive health and family planning within the overall $9.1 billion global health programs budget.
Even though other donors have upped their funding for reproductive health and family planning, it’s not enough to make up for the losses inflicted by the gag rule.
Beyond blocking funding, the Trump administration went further in its anti-abortion agenda, even going so far as to “to reverse international human rights standards that recognize sexual and reproductive rights as human rights and removed mentions of reproductive rights from the US State Department’s annual Country Reports on Human Rights Practices in 2018,” IWHC noted.
In 2020, as the Trump era was waning, CIA Director Mike Pompeo took aim at international women’s rights by using a US State Department panel, the Commission on Unalienable Rights, to “undermine global human rights laws and norms” to be replaced with a hierarchy of ranking religious rights. Pompeo initiated a non-binding statement, the Geneva Consensus Declaration, that committed to opposing abortion globally along with 33 other countries, including Brazil, Hungary, Egypt, Uganda and Indonesia.
The global gag rule strongarms health care organizations into making a tough choice: comply or don’t. When women’s lives are on the line, it’s not a fair fight, which is why call to get rid of the policy for good are becoming louder. President Biden’s move to rescind the rule is only a temporary solution until another Republican president comes along and puts it back in place. The Global Health, Empowerment and Rights (Global HER) Act, which was reintroduced in early 2021, would end policy and interference into women’s global health--if leadership makes a point to pass it.