Abortions on lockdown: How the US ‘global gag rule’ impacts the reproductive health of women around the world

In October, the US signed the Geneva Consensus Declaration, an unprecedented “women’s health” and “family welfare” agreement, alongside a coalition of 31 countries such as Belarus, Saudi Arabia, Bahrain, Libya, Sudan, Indonesia, Poland and Egypt. 

At first glance, the declaration seems well-intentioned, asserting “all are equal before the law,” and “human rights of women are an inalienable, integral, and indivisible part of all human rights and fundamental freedoms.” It also emphasises that “women and girls must enjoy equal access to quality education, economic resources, and political participation as well as equal opportunities with men and boys for employment, leadership and decision-making at all levels”.

And yet the declaration glaringly excludes abortion in the gamut of human rights and healthcare, stating: “in no case should abortion be promoted as a method of family planning”.  

“There is no international right to abortion,” said US Secretary of State Mike Pompeo at the time of the signing.  

This campaign signals efforts by outgoing US President Donald Trump’s administration to reduce access to safe abortions and reproductive healthcare further. “We are making it harder to get an abortion now, want to overturn federal protections and would support a near-total ban,” he said during his latest 2020 election campaign

In the US, the 1973 Roe v Wade Supreme Court ruling legalised abortion at the federal level, protecting access to abortion nationwide. However, President Trump has dramatically restricted access to abortions abroad by controlling how international NGOs can spend US aid. Since 2017, when President Trump reinstated and expanded the global gag rule (GGR), also known as the Mexico City Policy, US aid for abortions or related education, has plummeted. 

First introduced by former President Ronald Reagan in 1984, the US policy prohibits foreign NGO recipients of US funding from providing legal abortion services, as well as information or referrals on the topic. Organisations that do not comply miss out on US funding, which also impacts their ability to provide sexual and reproductive healthcare, family planning services, and AIDs and HIV medications to developing communities around the world. 

The GGR has come and gone over the past three decades based on the administration: republican leaders like former President George W. Bush instituted the policy, while Democrats like former Presidents Bill Clinton and Barack Obama rescinded the constraints during their time in office. 

Since President Joe Biden’s projected win, many NGOs and activists are hopeful the gag rule could soon be revoked, which could reverse cutbacks and limit further damage. According to US media, pro-choice activists also hope Biden will pass the Global Health, Empowerment and Rights (HER) Act, which would permanently end future reinstitution of the gag rule. 

“Gagged Organisation”

President Trump’s recent policy expansion has had the most severe impact of all, says Yana Rodgers. As the faculty director of the Center for Women and Work at Rutgers University in the US, Rodgers specialises in labour studies and feminist economics. 

“When Trump came into power, he reinstated the policy, but expanded it to cover foreign aid towards global reproductive health – not just family planning,” she explains. “So now, drugs that go towards HIV and AIDs care, foreign aid for nutrition, health, tuberculosis – all that funding is subject to the global gag rule.” 

In 2019, Trump further expanded the gag rule, restricting previously “gagged” organisations. Under these additional limitations, gagged NGOs also cannot fund sub-organisations – even if they do not receive any US aid – to provide abortion services. 

NGOs around the world lost access to US$600 million in the past when the policy only covered family planning. But now, they stand to lose access to US$8.8 billion in aid due to President Trump’s sweeping expansions. It is a serious hit, says Rodgers, because the US provides nearly 50 per cent of global HIV and AIDs funding. 

“The [current] global gag rule is the most extreme version we have ever seen, cutting across all realms of global public health from malaria, TB, HIV to family planning and maternal health [for those NGOs that plan to continue to provide abortion services or education],” says Manuelle Hurwitz, director of programmes at the International Planned Parenthood  Federation (IPPF). “This has had devastating effects on public health access for people around the world. Especially on various integrated HIV and family planning interventions for many countries.” 

Many NGOs, she says, integrate these types of healthcare services, meaning that communities cannot access the full range of family planning and sexual and reproductive healthcare if the NGO chooses to reject US funding. They may also lose access to life-saving treatments and medicines [as well as] health testing like cervical cancer. “

“The gag rule denies US government funding to organisations like IPPF even if [our members] use non-US government funds to provide abortion services, counselling, or referrals,” says Hurwitz. “It blocks critical funding for services like contraception, maternal health, and HIV prevention and treatment.

Several IPFF member organisations across 32 countries including Mali, Uganda and Mozambique, chose not to sign the GGR. “Many organisations in Sub-Saharan Africa, where HIV rates are among the highest in the world, could no longer access President [Trump’s] Emergency Plan for Aids Relief funding, which heavily affected their operations and caused service disruptions,” says Hurwitz. 

It comes at a tremendous human cost, she adds. “There has never been such a greater need for integrated sexual and reproductive health services – COVID-19 has escalated this need, leaving millions in crisis and unable to access life-saving healthcare.”

While experts expect the policy to have widespread negative repercussions, it will take time for organisations to measure and analyse the impact, says Rodgers, of Rutgers University. “[The GGR] was only reinstated three years ago, and as far as I know, there’s not enough data to see what the impact on actual disease or abortion outcomes is,” she says. “[However,] this has disrupted services such as the delivery of contraceptives and HIV counselling in a major way.”

More unsafe abortions

Rodgers, who wrote a book on the impact of previous iterations of the GGR, says the policy typically impacts countries in Sub-Saharan Africa, Latin America and the Caribbean the most. In Asia, she says, the GGR could profoundly affect states such as Cambodia, Nepal, the Philippines and Bangladesh

 It can be challenging to prove that this policy and nothing else has caused a fluctuation in abortions; however, the GGR is likely to result in more abortions – not less, Rodgers explains.  

In developing countries, reproductive health clinics may have to close or cut staff due to a loss of funding. They may also stop receiving donations like contraceptives from the US, which means women have less access to contraception and family planning.  

“This means the risk of unwanted pregnancy increases, and many women are likely to end up with unintended births – or more abortions,” says Rodgers. “Conservative political parties may say they want to reduce abortion, but they’re increasing unsafe abortions.”

Essentially, when women want an abortion, they are going to find a way to have an abortion often through illegal or unsafe means, she explains. “Abortion restrictions lead to more unsafe abortions rather than fewer abortions.” 

Hurwitz from IPPF says communities around the world need more investment from governments to make up for the gap in funding created by the GGR. 

“Recent research shows that sexual and reproductive health services do not meet the need in lower- and middle-income countries,” she says. Indeed, up to 218 million women between 15 and 49 worldwide still need access to modern methods of contraception, according to a July 2020 report by the Guttmacher Institute

“Healthcare must be universal. Covid-19 and the global gag rule have demonstrated the critical need for inclusive life-saving integrated sexual and reproductive healthcare,” she adds. 

Governments and health policymakers have an opportunity to improve access to healthcare and education for people, regardless of their situation or location, according to Hurwitz. For instance, governments could increase national health budgets, expand the skills of all health providers, and harness partnerships to meet the needs of women, young people and those living in extreme poverty.  

“With the backdrop of Covid-19 and the roll-back of women’s and youth rights, we need to expand access at scale for those who would not normally be reached by healthcare services and information,” says Hurwitz. “We must keep up the effort to invest and scale up interventions to ensure we are supporting the needs of people to ensure we leave no one behind.”