In a political news cycle that churns faster than a smoothie blender, perhaps you’ve forgotten that not only is the Global Gag Rule back, it has wider ranging implications than ever before. The short version of this article is that lots of people will get sick and die, and not only women, though if that were the case that’s reason enough to oppose the Global Gag Rule.
But in order to understand why that outcome is likely, we need to take a look at the Global Gag Rule’s history, what it does and doesn’t do, and how this time is different.
The Global Gag Rule is the term used by those who oppose the policy, which is actually called the Mexico City Policy, so named because Ronald Reagan announced it during the 1984 International Conference on Population in Mexico City, Mexico.
The Mexico City policy states, “[T]he United States will no longer contribute to separate nongovernmental organizations which perform or actively promote abortion as a method of family planning in other nations.” The language, while straightforward, is vague. What does it actually mean to “actively promote abortion”? In practice, this prevents non-governmental organizations (NGOs) from talking about it at all except in cases where a person’s life is endangered by the pregnancy, if the pregnancy resulted from rape or incest, or if the NGO is responding to a question regarding where a safe, legal abortion can be performed and the question comes from a someone clearly stating that they’ve already made the decision to have an abortion. (That last one probably doesn’t come up often where abortion is illegal in all cases and punished with years of jail time.)
What the policy does not do is restrict the U.S. federal government from funding abortion overseas. That’s a different restriction, the Helms Amendment, which states, “No foreign assistance funds may be used to pay for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortions.” Technically there’s a hair’s breadth of wiggle room for direct funding if your pregnancy will kill you or resulted from rape, but it often isn’t interpreted that way by USAID, the government agency responsible for distributing U.S. funding for international assistance.
The Mexico City Policy also doesn’t restrict funding regarding lobbying for or against legal abortion. That’s what the Siljander Amendment does.
So why bother with the Mexico City Policy? It prevents family planning and reproductive health (FP/RH) NGOs from receiving any U.S. funds if they provide abortions or abortion information regardless of whether or not those funds go towards anything abortion related. Medical professionals can’t even testify about the injuries caused by unsafe abortion. Hence the “Global Gag Rule.”
The U.S. foreign aid budget is less than 1% of the federal budget, but a behemoth of international health funding, with $608 million going towards FP/RH in 2016. In the past the Global Gag Rule has been a terrible blow to FP/RH NGOs, and led to the closing of critical facilities. This time around, the reach of the Global Gag Rule goes beyond funding from USAID, but to “global health assistance to furnished by all departments and agencies.” That represents $9.5 billion in aid, and affects health organizations working to combat diseases like malaria, tuberculosis, HIV/AIDS, Zika, and more.
If NGOs need the money to serve their missions, of which safe abortion is just one of many like STI education, birth control access, or disease treatment, why not just certify that you’ll follow the Gag Rule?
First of all, I question NGOs’ ability to even comply with the gag rule because it’s so vague. Take the exceptions for example. Who makes the determination if a woman’s life is at risk, or, for that matter, what constitutes rape? If a child bride says her husband raped her does that count? If a woman can’t take necessary medication during pregnancy, is her life at risk? Post-abortion care funding is supposed to be okay, but the instruments needed to ensure someone doesn’t go septic could also be used to provide an abortion. There are a lot of judgment calls to be made, and there’s limited guidance as to how to even follow these rules.
But more pertinent than NGOs’ ability to comply with the Global Gag Rule is that they don’t want to, and with good reason. Unsafe abortion accounted for about 68,000 maternal deaths world wide in 2008 (about 13% of total maternal deaths). A tragedy on its own, but death from unsafe abortion leave over 200,000 children a year motherless, as well. Millions more women face long-term health complications from the over 20 million unsafe abortions that take place every year. The incredibly frustrating part about all those numbers is that safe abortion is remarkably safe, especially in the first trimester. But NGOs aren’t supposed to give so much as a referral, much less talk about the weight of this problem.
FP/RH NGOs are now in a difficult position of not addressing a pressing and preventable worldwide health issue that is critical to their stated missions or losing much-needed funding. Currently, there are no exceptions to the Gag Rule. Even though President George W. Bush reinstated the Gag Rule in 2001, he excluded it from applying to programs that combat HIV/AIDS, malaria, and tuberculosis. Part of this has to due with the nature of these diseases, but also because in poorly served areas an organization may need to be responsible for a broad range of care. Family planning and reproductive health are an important part of overall individual and community health, which sometimes includes talking about abortion. While it’s bad enough that FP/RH NGOs may lose funding, a wide swath of other health organizations may as well.
We have an idea of what the repercussions will be from the last time the Global Gag Rule was in place. Despite not wanting to “actively promote abortion,” areas highly reliant on foreign assistance saw an increase in abortion rates, some as high as women being 2.75 times more likely to have an abortion after the Gag Rule was in place. Of course, these places are much more likely to have restrictive abortion laws, which will lead to an increase in unsafe abortions and abortion-related deaths, projected at an increase of 21,700 maternal deaths. There are several reasons why this is likely to happen, such as lowered access to contraception due to organizations needing to close clinics and increased unintended birth rate.
Even beyond more people becoming sick, dying, or losing a parent directly due to lack of FP/RH services, we need to remember that this time around the Global Gag Rule affects pretty much all global health assistance. What will the AIDS epidemic look like if critical organizations lose funding? Or maternal and children’s health? Or tuberculosis and malaria treatment?
Yes, women will be endangered because of the Global Gag Rule, not only from lack of family planning services, but potentially from losing even more critical health resources.
