The Global Gag Rule: American Partisanship Harming Global Health?

By Dana Craig

The United States takes pride in its role as a global leader, and America’s foreign policy initiatives are often framed as vehicles to promote democracy worldwide. While these efforts are largely praised, the U.S. frequently fails to acknowledge any negative consequences of its ideologically-centered policies. Supplanting American values on countries with different cultural and economic circumstances can have unintended outcomes, and in the case of the Global Gag Rule, these consequences are harming healthcare worldwide.

More formally known as the Mexico City Policy, the Global Gag Rule aims to limit abortion around the world. America’s involvement with abortion on the global stage began with backlash against the landmark U.S. Supreme Court decision Roe v. Wade. Though Roe protected abortion rights in the United States, conservative lawmakers were able to use the controversial case to build support for the Helms Amendment, a policy forbidding any international family planning program from using U.S. funding to perform or promote abortion. After the amendment passed, the United States continued to fund global family planning but stipulated that abortion-related costs could not be paid for using American aid. 

When Ronald Reagan came into office, he passed the Mexico City Policy. This new legislation strengthened the Helms Amendment and ultimately resulted in funding pulled from any global family planning organization that promoted or performed abortions at all, regardless of whether or not that organization was using American money to fund the procedures.

Since the initial introduction of the Global Gag Rule under Reagan, the legislation has been repealed by every Democratic president just to be reinstated by every Republican president. This inconsistency creates its own challenges for family planning programs, but even more pressing problems began when President Trump took office.

Under Trump, the Mexico City Policy was again reinstated, but this time the funding restrictions were broadened. With Trump’s memorandum in 2017, the Global Gag Rule was expanded to include all global health aid rather than just family planning aid. This was a massive monetary shift: while the United States spends roughly $600 million in family planning aid each year, its global health budget was $11 billion last year. This is a $10.4 billion difference, all of which is now subject to the restrictions of the Global Gag Rule.

The United States global health budget funds organizations that offer an array of services, from HIV and malaria prevention to birth control distribution. These programs provide care for pressing health issues. Often, these programs include abortion services as a part of their initiative to improve women’s health. They may provide counseling and information on abortion or offer to perform abortions in a safe environment. For many of these organizations, their role in advocating for and administering safe abortions is central to their core mission. 

While American anti-abortion advocates praise the expansion of the Mexico City Policy as a step forward, global health organizations are trying to articulate that the socioeconomic circumstances of developing countries are incredibly different than those in the United States. Women in nations like Madagascar and Uganda are more likely to be unable to afford the children they already have, let alone children from future unwanted pregnancies, without access to infrastructure in their communities that will provide for these children if their mothers are unable to do so. Furthermore, many of the pregnancies that women in these situations experience are not a result of their own choices; many regions of developing nations are still fighting to provide women with the bodily autonomy they deserve. Taking into account these social and economic factors, it becomes clear that safe abortions are sometimes necessary to preserve the wellbeing of women and the children they already have.

Recognizing the need for safe abortion access, there are several global health organizations that have refused to accept the new stipulations attached to American aid and will instead choose to lose funding. The Washington Post spoke to Marie Stopes, a London-based organization that provides health services in thirty-seven countries. They forfeited nearly $30 million for refusing to comply with the new policy, and the places hit hardest by budget cuts were remote regions that have no other access to healthcare. These rural areas in developing nations are the ones most threatened by the new Global Gag Rule. Clinics in these communities are often the sole provider of family planning services, AIDS and malaria prevention, nutrition programs, healthcare for mothers and children, and even some sanitation efforts. Because organizations like Marie Stopes are not solely family planning programs, the funding that they previously qualified for came from the global health budget and was unaffected by the old Mexico City Policy. Now, their funding is subject to the stipulations of the new Gag Rule; when they lose U.S. funding as a result of Trump’s new policy, they also lose the ability to provide other essential healthcare. 

This possibility alone should shock Americans. A politically-charged American debate about abortion has affected foreign policy to the extent that AIDS and malaria prevention is in danger in some communities. This policy has and will continue to deny vulnerable people access to basic healthcare, even when the healthcare they were seeking had no connection to abortion. Making matters even worse, few Americans are aware of this ripple effect, and there has been little to no effort within the United States to correct these consequences.

For a full scope of the policy’s consequences, the Human Rights Watch has compiled a list of anticipated effects from the new Global Gag Rule. Chief among these effects is the prediction that abortion rates will actually rise as women and girls lose access to birth control. With no resources with which to prevent unwanted pregnancies, these women may turn to abortion as a last resort. Furthermore, in the absence of clinics providing safe abortion services, these anticipated abortions are more likely to result in maternal death. Taken together, these observations demonstrate that the new Global Gag rule is ultimately ineffective.

In their investigation into the ripple effects of the funding cuts, the Washington Post spoke to a woman in Madagascar who wanted to prevent any future pregnancies because she could not feed another child. She had a three-year hormonal implant placed into her arm by the Marie Stopes clinic in her village. Now, she faces the very real possibility that at the end of those three years there will be no clinic there to continue providing her birth control or to safely remove the implant. Her reproductive health is dependent on U.S. policy and the hope that a future president will rescind the Global Gag Rule again.

What right does the United States have to allow a political fight within our borders to eliminate a woman’s healthcare options across the globe? Is there any justification for valuing a pro-life position on abortion over AIDS and malaria prevention, nutritional programs, initiatives to stop the spread of infectious diseases, and the reproductive safety of thousands of women?

At the end of the day, the new Global Gag Rule harms healthcare efforts worldwide, and, as an international leader, the United States bears a responsibility to promote global health regardless of partisan debates. As the consequences of the Global Gag Rule become clear, the United States must acknowledge the policy’s flaws and look to repeal it permanently. Doing so will take a step in improving the health and safety of millions of people worldwide, a goal that any global power should proudly promote.

Photo courtesy of Michael Vadon (Flickr).

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