Two days after large numbers of people across the globe joined Woman’s Marches, US President Donald Trump reinstated the “global gag rule”, which cuts off all US funding to international NGOs whose work includes abortion services or advocacy.
Fortunately, the Dutch government has announced a plan to compensate NGOs for the funding shortfall of US$600 million over four years. Several countries within and outside the EU have indicated their support, as have private companies and foundations.
But it remains to be seen whether this ambitious target will be reached and what other needs will be left unmet as a result of any redirected funds.
Dutch Minister for International Development Co-operation, Lilianne Ploumen, who announced the initiative, said, “I’m pro-choice and pro-women’s rights. It’s important to stand your ground.”
But as welcome as efforts towards replacing the funding lost to the global gag rule is, it’s important to realise that this is not a pro-life debate. It’s a global health issue that has serious implications for the most vulnerable populations – millions of men, woman and children in developing countries.
Threat to services
Also known as the Mexico City policy, the global gag rule requires all NGOs operating abroad to refrain from advising, endorsing or performing abortions as a method of family planning. However, some NGOs operate in contexts where abortion – safe or unsafe – is the only accessible form of contraception.
Many international NGOs are working hard to increase access to both short-term and long-term contraception. But such a transition takes time and money.
NGOs that may be forced to reduce or close health services as a result of the policy are often a woman’s only source of reproductive health care. They may, in fact, be her family’s only point of medical contact for other primary health-care services, such as cervical screening, HIV prevention, testing and counselling, STI prevention and treatment, pre and post-natal care and even newborn health care.
Services threatened by the policy also train health professionals, including midwives and traditional birth attendants, in countries that are desperately short of qualified health personnel.
Most developed countries have 33 health professionals per 10,000 people; most developing countries have two health professionals for the same number of people. Research also shows that unattended births have much higher rates of maternal and newborn death.
The rule was first put into place by former US president Ronald Reagan in August 1984. Since then, it has been lifted by Democratic presidents and reinstated by Republican presidents.
Unlike when Reagan implemented the policy, we now have ample evidence of its unintended health consequences. A 2011 study showed, that women were 2.73 times more likely to have an abortion under the rule. So while its intention may be to reduce the rate of abortion, the policy actually increases it.
Reducing access to family planning services leads to more unplanned pregnancies, more unsafe abortions and more maternal death.
The sexual and reproductive health research organisation, the Guttmacher Institute, quantified this in 2016. It showed that when US$607.5 million is cut from family planning and reproductive health services, 27 million woman and couples are prevented from receiving family planning services and supplies. This leads to six million more unplanned pregnancies and 2.3 million more abortions, two million of which will be unsafe.
This may not mean much in a developed country, where deaths resulting from pregnancy and childbirth are 12 women per 100,000 live births. But it will have a huge impact on women in developing countries, where the maternal mortality rate is 239 women per 100,000 live births, and where 99% of total global maternal deaths occur.
In 2000, 189 countries including the United States, committed to the Millennium Development Goals. These included a commitment to improving maternal health by reducing maternal mortality and providing access to reproductive health services by 2015. This was one of the least successful Millennium Development Goals, falling short by half.
While the US ranks 19th worldwide as an international aid donor in terms of percentage of gross national income, USAID is the largest humanitarian donor in dollar terms. It allocated in excess of $USD6.42 billion to humanitarian aid in 2015.
This means the global gag rule seriously threatens the UN Sustainable Development Goal of reducing maternal mortality to less than 70 per 100,000 live births by 2030. It also threatens the goal of ensuring access to sexual and reproductive health-care services, including family planning, information and education.
The rule targets family planning, which is essentially about spacing out childbirth. The health and economic benefits of child spacing are well documented and include reduced pregnancy-related deaths and better child survival. Then, there’s reduced rates of HIV/AIDS, and sexually transmitted infections, empowerment of women, enhanced education and a reduction in adolescent pregnancy.
These benefits lead to more advantages, including slowed population growth, natural resource conservation, climate change mitigation and economic growth, which reduces conflict and migration.
The wrong debate
Forcing impoverished women – in places where they have no access to health care or contraception – to have more babies has a detrimental impact on the entire family. It places demands on scarce resources, reduces access to education, limits employment options, reduces family income and ultimately reinforces the poverty cycle.
The regions predicted to experience the largest population growth in the coming decades (South Asia and Africa) are also the most impoverished. They have the weakest health-care systems and rely on foreign aid to provide essential services.
Their only hope for economic development and poverty eradication is to undergo the demographic transition, which high-income countries have already experienced. And this starts with a reduction in family size. Anyone who has worked in reproductive health in developing countries will tell you that this is what impoverished women with large families want.
So let’s get it right: this is not a high-income country, religiously charged pro-life debate. The global gag rule actually increases abortion demand and has consequences for a range of other health issues such as HIV/AIDS, cervical cancer and child health and well-being.
This misinformed, short-sighted policy is as far removed from scientific evidence as denying climate change. As a global community, we have a duty to expand access to family planning for people worldwide, particularly to the most vulnerable.