A little more than one year ago, President Donald Trump imposed and expanded the Global Gag Rule. The Global Gag Rule is a policy that has historically blocked foreign nongovernmental organizations that engage in abortion advocacy or offer abortion-related information, referrals, and services, from receiving U.S. international family planning funding. Notably, under the policy, exceptions are only allowed in the cases of rape, incest, and endangerment to the life of the woman. Yet Trump’s expansion has gone well beyond the confines of its already-harmful previous scope to encompass all U.S. global health assistance. Now, the policy affects almost $9 billion in funding for vital programs that serve the world’s most vulnerable populations.
This policy does not exist in a vacuum. Shortly after imposing the Global Gag Rule, President Trump defunded the U.N. Population Fund (UNFPA), the primary U.N. agency working to advance family planning and reproductive health around the world—including in places enduring humanitarian crises. Since taking office, the Trump administration has also consistently proposed cuts to the U.S international affairs budget with disproportionate cuts to family planning and reproductive health. Last year, President Trump proposed zeroing out the family planning budget. Then, in his fiscal year 2019 budget, the president proposed a 30 percent cut to the international affairs budget and a 50 percent cut in international family planning assistance. U.S. global health assistance supports communities in more than 60 low- and middle-income countries, such as Kenya, Lesotho, Liberia, Indonesia, and Cambodia. The combination of the expanded Global Gag Rule, the defunding of the UNFPA, and the potential for further funding cuts threatens to unravel more than a decade of progress on women’s rights, health, and poverty reduction globally. Each of these actions portends a loss of U.S. leadership on global and reproductive health—which has severe and disproportionate effects on women and girls in the global south, meaning developing and less-developed countries.
Studies have shown that the Global Gag Rule does nothing to reduce the number of abortions in the developing world. In fact, the policy contributes to the millions of unsafe abortions that occur annually—which can lead to needless deaths and injuries among women and girls. According to the World Health Organization (WHO), laws and policies on abortion should protect women’s health and human rights—not undermine them. Indeed, there is consensus among international human rights treaties and global consensus declarations that affirm the respect, protection, and fulfilment of human rights, including the right of all persons to attain the highest standard of health. Sexual and reproductive health is a key aspect of this. Furthermore, in order to ensure the highest standard of health, all people must have access to safe abortion. U.S. funding supports the treatment of injuries and complications associated with unsafe or incomplete abortion, also known as postabortion care. Yet, good U.S. foreign policy and global health programs would prioritize preventing these deaths and injuries in the first place. Laws and policies that restrict or prohibit abortion instigate barriers and are disproportionately harmful to women and girls of color, as well as those living in poverty.
Globally, an estimated 214 million women have an unmet need for modern contraception. Furthermore, about 830 women, all of whom live in areas where resources are constrained, die from preventable, pregnancy-related causes each day. Under the Trump administration, investments in both maternal and child health, as well as in international family planning, are dwindling. Women make up more than one-half of the people living with HIV and AIDS, with young women and adolescent girls disproportionately comprising the number of new HIV infections. Due to Trump’s Global Gag Rule, funding for all of these critical U.S. global health programs are subject to restrictions on whether or not they can provide women with comprehensive sexual and reproductive health care, including information such as where to get a safe abortion. In its technical and policy guidance for health systems, the WHO is clear that policies should be geared toward not only protecting the human rights of women—but also helping them to achieve good health outcomes. Country policies should be developed in a way that helps meet the particular needs of women in poverty; young women and adolescents; women living with HIV; survivors of rape; and women in need of contraception and other health-related information. These policies should support the full spectrum of sexual and reproductive health care services.
While it is too early to understand the full effect of the expanded policy, especially across all health sectors, a picture of the most severe effects on sexual and reproductive health has begun to emerge in countries around the world. PAI, an organization working to advance reproductive health and rights for women across the globe, has documented impact in Uganda and Nigeria.* Such effects include increasing commodity insecurity; chilling effects on advocacy for safe abortion and postabortion care services; the dismantling of referral networks between compliant and noncompliant organizations; heavy administrative burdens for organizations; the disruption of donor coordination; and a bolstering of domestic opponents of reproductive health and rights. All of these are compounded by the uncertainty of future U.S. funding for global health.
Despite the grim outlook and what is known about the dreadful impact of the Global Gag Rule on women and girls in the global south, there is hope for a future without the policy. Sen. Jeanne Shaheen (D-NH) and Rep. Nita Lowey (D-NY) are the lead congressional sponsors on a bill that would legislatively repeal the Global Gag Rule. The Global Health, Empowerment, and Rights Act, also known as the HER Act, would help ensure that foreign nongovernmental organizations receiving U.S. global health funding can do good work without being forced to modify programming in a way that denies women access to comprehensive sexual and reproductive health care. This legislative effort must also be accompanied by continued work in the field to help partners educate themselves about the policy to both blunt its effects and to inspire in-country advocacy efforts globally to mobilize domestic resources for health, including family planning. Ultimately, the greatest antidote to the Global Gag Rule will be a strong, sustainable health system that is not held hostage by the inconsistencies and fluctuations of donor policies.
The resistance of more than 420 organizations and supportive donor governments, as well as partners overseas speaking out against Trump’s Global Gag Rule, should bolster our hope. These entities are not only working to hold the Trump administration accountable; they are also fearless and deliberate about doing the work to make the world a better place for women and girls.
Jamila Taylor is a senior fellow at the Center for American Progress. Jonathan Rucks is the senior director of advocacy for PAI.
*Authors’ note: Publication of these PAI studies, entitled “Access Denied: Uganda—Preliminary Impacts of Trump’s Expanded Global Gag Rule” and “Access Denied: Nigeria—Preliminary Impacts of Trump’s Expanded Global Gag Rule,” is forthcoming at the time of the publication of this column. As of March 8, 2018, these studies are available here and here.