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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 President Joe Biden similarly rescinded the policy within weeks of taking office in 2021.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.

Updated: 5 days ago

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Women are heading to an unexpected place to receive treatment for uterine fibroids—the emergency room. Some symptoms of uterine fibroids, including heavy menstrual bleeding that won’t stop, pelvic pressure and difficulty emptying the bladder, would send any woman into a panic and heading to the nearest emergency room.

In spite of that, the ER is not the best course of treatment, as fibroids are a chronic condition, and care is costly, according to researchers from Michigan Medicine (University of Michigan).

Fibroids are benign muscular tumors that grow on the uterine wall and are known to cause a variety of worrying symptoms. An estimated 26 million women between the ages of 15 and 50 have uterine fibroids, according to the National Institute of Health. A woman of any race can develop fibroids, but Black women are disproportionately impacted.

The researchers evaluated more than 487 million emergency visits by women between the ages of 18 and 55 over an 11-year period for their study. Thousands of women visited the ER for uterine fibroids, and the number of visitations more than doubled from 28,732 to 65,685 during the study period. Hospital admission rates fell 13%, and only 1 in 10 fibroid-related ER visits resulted in hospital admittance, signifying that most cases can be managed in a non-emergency setting.

"Fibroids are often a chronic disease, so we have opportunities to treat this through established care with a trusted health provider,” Erica E. Marsh, MD, chief of the division of reproductive endocrinology and infertility at the Center for Reproductive Medicine at Michigan Medicine Von Voigtlander Women's Hospital, said in a statement. “Yet we’ve seen a big increase in women using the emergency room for fibroid care.”

Emergency room physicians typically require the patient to receive immediate imaging, to get to the root cause of the pelvic pain and continuous menstrual bleeding, leading to skyrocketing costs. The average cost for a fibroid-related ER visit was $6,000, and researchers believe many of these patients, especially those who are uninsured or low-income, would have fared better in an outpatient imaging facility.

More research should be conducted to determine why women look to the emergency department for a chronic condition like fibroids. And more importantly, resolving barriers to fibroid care should be a priority as women who are uninsured are less likely to be admitted to the hospital even if they have a serious condition like uncontrolled bleeding.

"Ultimately, we want to ensure patient centered and equitable care for all individuals with this chronic condition," Marsh said.

The study was published in Obstetrics & Gynecology.

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With a number of health care rights currently under threat, a group of Senators has introduced the Women’s Health Protection Act to guarantee the right to access abortion services in the United States.

The bill would guarantee the right of a patient to access an abortion, as well as the right of health care providers to deliver such services. Importantly, the bill prohibits medically unnecessary restrictions that interfere with a patient’s choice or the provider-patient relationship.

The bill comes amid a wave of attacks on women’s health rights, including a number of new restrictions and bills aimed at limiting access to abortion care services and making it harder on women to receive abortions. Additionally, a new case at the Supreme Court throws the right to abortion up in the air.

“The rights of women to make decisions about their own health care and access the health care resources they need continue to come under attack as more states pass draconian laws to ban abortions,” Senator Feinstein (D-Calif.) said. “As the Supreme Court prepares to hear a case that could further undermine Roe v. Wade, it’s imperative that we pass the Women’s Health Protection Act and put a stop to these attempts to outlaw abortion.”

Leaders of the bill include Senators Dianne Feinstein and Alex Padilla (both D-Calif.), who joined with with Senators Richard Blumenthal (D-Conn.) and Tammy Baldwin (D-Wisc.) and Representatives Judy Chu (D-Calif.), Lois Frankel (D-Fla.), Ayanna Pressley (D-Mass.) and Veronica Escobar (D-Texas).

The bill is an urgent priority for a number of women’s rights activists and is supported across several groups, including the Center for Reproductive Rights. Over the last decade, nearly 500 state laws have been passed restricting access to abortion, according the Center. And even more recently, the Supreme Court, which has a 6-3 conservative swing, decided to take up a case that could threaten to overturn Roe v. Wade.

The Women’s Health Protection Act is not a new piece of legislation. In fact, it was first introduced in 2013 and has been revived ever since. As the bill is brought up again, a new poll from the Center reveals a majority of Americans support access to abortion--61% of Americans support passage of a national law that protects the constitutional right to access abortion.

The bill would act as a safeguard against legislative restrictions again abortion services that have cropped up at the state level over the last decade.

“This poll sends a clear message to Congress: the majority of voters want abortion protected under federal law,” Nancy Northup, president and CEO of the Center for Reproductive Rights, said in a statement. “We cannot wait any longer. If Roe falls, many states will immediately take action to make abortion a crime. Even now, with constitutional protections in place, state legislators have made it impossible to access abortion in the South and Midwest—especially for Black people and other people of color who already face barriers to health care.’"