The global gag

An assault on women's health across the world

By Genevie Fernandes

Surrounded by a group of men on his first day in the Oval office, U.S. President Donald Trump signed an executive order reinstating the ‘Mexico City Policy’ that will restrict the reproductive rights of women all over the world. This policy, also known as the ‘Global Gag Rule’, bans U.S. government funding to all international non-governmental organizations (NGOs) that provide abortion services or promote it any way. The Global Gag Rule was created by Ronald Reagan in 1984, and Republican presidents since then have imposed this policy, while their Democrat counterparts have lifted it. Trump’s version of the Gag Rule is by far the most shocking one.

Previously, the Global Gag Rule only banned funding for foreign NGOs receiving U.S. assistance for family planning, if they were involved in abortion related services. In fact, much before the Global Gag Rule was created, the Helms Amendment of 1973 banned the use of U.S. taxpayer money for overseas funding of abortion services. Trump’s executive order dangerously extends this policy to all foreign NGOs receiving global health funding. This extension can thus block women’s access to abortion as well as other general health services.

This means that even international organisations working on areas other than family planning, such as maternal and child health, HIV/AIDS, tuberculosis (TB), and malaria, could lose all their funding from the U.S government, if they provide abortion services or promote it any way, such as through referrals.  For instance, if an organization that runs TB and HIV/AIDS clinics with U.S. funding decides to use its own funds and counsel pregnant women about all contraceptive options including abortion, they will lose all their U.S funding, thereby reducing or completely shutting down their regular TB and HIV/AIDS related services including access to life saving antiretrovirals and other drugs.

Studies from Sub-Saharan Africa and Ghana  indicate that cutting overseas funding for NGOs as part of the Global Gag Rule has generally increased, rather than stopped, the number of abortions performed. Marie Stopes International, an organisation that provides contraceptive and abortion services in 37 countries, estimates that with no alternative funding, the loss of their health services could lead to 6.5 million unintended pregnancies, 2.2 million abortions, 2.1 million unsafe abortions and 21,700 maternal deaths by 2020. This gap in funding will also severely affect prevention and control activities for Zika in Latin American countries, where many families do not have access to or cannot afford lifelong care for children born with Microcephaly, and early diagnosis and abortion may be their only option.

In this post-truth era, how do we respond to any future assaults on the reproductive rights of women in the world? One possible approach is to fundraise for developmental assistance for health from multiple donors, including sovereign states and private foundations and corporations, rather than relying on a single major donor like the U.S, which is currently the largest donor for global health.

A day after Trump signed the executive order, the Dutch government responded, by setting up an International Safe Abortion Fund to fill the $600 million gap for reproductive health services in developing countries created by loss of U.S funding. This European platform has found support from nearly 20 countries including Sweden, Belgium, Denmark, Norway, and Finland, and is organising a ministerial conference in Brussels on March 2 to galvanise international support and raise funds. This platform also allows individual citizens to contribute to the fund.

The World Bank’s recent Global Financing Facility also leads the way by offering multiple countries, private foundations and corporations a ready-made and systematic platform to invest in reproductive, maternal and child health projects in countries where action is needed the most. This facility promotes universal health coverage and also works closely with developing countries to increase domestic investments, making financing sustainable in the long run. 

With growing support for such innovative multilateral initiatives, hopefully the global health community can work together to secure financing for reproductive health services and provide women with autonomy over their own health.