The US Government Anti-abortion Agenda

On April 3rd the US State Department announced it will discontinue funding for the U.N. Population Fund (UNFPA), in a move described by women’s rights activists as President Trump’s “crusade against the health and rights of women globally.” According to the State Department, the decision was motivated by UNFPA’s support…

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The US Government Anti-abortion Agenda

04/05/2017 - Por: Simon Meretab

On April 3rd the US State Department announced it will discontinue funding for the U.N. Population Fund (UNFPA), in a move described by women’s rights activists as President Trump’s “crusade against the health and rights of women globally.” According to the State Department, the decision was motivated by UNFPA’s support for, or participation in, “the management of a program of coercive abortion or involuntary sterilization” in China State Department. UNFPA issued a statement categorically refuting the claim, stating that: “all of its work promotes the human rights of individuals and couples to make their own decisions, free of coercion or discrimination.” UNFPA is a UN agency dedicated to family planning and reducing childbirth related deaths in more than 150 countries. The United States was one of its founding members and in 2016 contributed $75m towards the agency’s core costs and projects.

International health care experts have denounced the devastating impact that the cuts will have on women’s sexual and reproductive health globally. The UNFPA is one of the largest providers of contraceptives worldwide and a cut of this magnitude can jeopardize the health and rights of the 12.5 million women and girls it provides health services to. The cruel paradox is that UNFPA does not advocate for abortion. Rather it provides support, information and counseling to women, as well as a range of contraceptive methods. As Marge Berer, international coordinator of the International Campaign for Women’s Right to Safe Abortion said, the accusation from the Trump administration that UNFPA funds forced abortions is “ridiculous and reveals Trump’s ignorance of the issues, and copycat behavior, above all”.

The cut provoked a storm of outrage, but many see it as a coherent progression of another controversial executive order signed in January, the so called “global gag rule” which froze any funding to NGOs that offer abortion counseling or even advocate for the right to seek abortion. When it comes to global health programs, the US is the single largest donor, providing nearly $3bn toward health efforts through the United Agency for International Development (USAID) alone. This sharp reversal in foreign aid policies from the Obama era will have deeply felt consequences. The Global gag rule will put thousands of international health care workers in a very difficult position: choosing whether to continue offering family planning care that includes abortion, or abandon critical funding streams.

History of the Global Gag Rule

It is necessary to review the historical context, in order to understand the US government decision to defund these programs. The global gag rule, also known as Mexico City Policy, was devised during the Regan administration in 1984 to impose antiabortion rules on international family programs. Around that time, right wing activists began denouncing these programs for being complicit in coercive abortion practices, citing the US contribution to UNFPA, which provided family planning assistance in China among others. Since then, Republican presidents have regularly imposed the rule and defunded UNFPA, whereas Democratic presidents (including Obama) have rescinded the rule and issued support for UNFPA. Interestingly, US federal law already prohibits international aid for abortion (Helms amendment, 1973), but anti-abortion activists believed the law did not go far enough. The global gag rule does take the prohibition one step further, preventing NGOs from using even private funds to offer abortion or even refer women to other groups that might help them safely end their pregnancy. It even prevents health care workers in foreign countries from advocating for abortion rights, even forms of advocacy which consist of testifying against the danger of illegal abortion.

Impact of the Global Gag Rule

The gag rule has been enforced and rescinded following the whim of conservative US presidencies (Reagan, Bush father, Bush son and now Trump); a political back and forth with grave real-life consequences. But Trump did more than just reinstate the Reagan-era policy. His executive order, signed suggestively one day after the largest demonstration of women’s rights in American history, is much more aggressive. It will apply to 15 times more funding than usual because it will include all global health subsidies, not just those dedicated to family planning, through USAID or the State Department. Trump’s executive order will apply to roughly $9.5 billion dollars in global health funding as opposed to the $575 million of gag rules under previous conservative administrations.

What has been the impact of the gag rule when applied in the past? The first-ever study that attempted to quantify the impact of the gag rule was published in 2011 by researchers from Stanford University. The research was conducted in 20 African countries to identify the effect of the global gag rule issued under President George H.W. Bush. The results are disturbing: in Sub-Saharan Africa, in countries most affected by the global gag rule, abortion rates rose sharply. Under the ban women were almost three times more likely to have an induced abortion. Furthermore reduced financial support for family planning brought on a decrease in the use of modern contraceptives and led more women to substitute abortion for contraception. The conclusion was that policies curtailing the activities of organizations that provide modern contraceptives may inadvertently lead to an increase in the abortion rate.

Other studies focused on the consequences on women’s overall health. Population Action International assessed that between 2002 and 2006 critical family planning programs that provided health care to poor and rural communities were dismissed in Kenya as a result of the ban. In Lesotho, which received 426,000 condoms over two years by USAID under the Clinton administration, the reinstatement of the global gag meant a complete end to condom shipments. At that time one in four women in Lesotho was infected with HIV. A study conducted in Ghana’s rural areas showed that budget cuts determined by the gag rule caused 200,000 additional abortions and between 500,000 and 750,000 additional unintended births. The children who were the product of unintended births were significantly more likely to suffer from malnutrition and reduced height and weight. Also disturbing is the case of Nepal, a country with a very high maternal mortality rate: when G.H.W. Bush won the elections in 2001 and the global gag was reinstated, organizations involved in awareness-raising campaigns aiming to reduce the public health crisis of unsafe abortions saw their funding drastically cut, and their mobile health clinics and capacity to provide contraceptives substantially impaired. Furthermore, doctors who worked in Nepalese clinics supported by American funding had to sign documents affirming they would not provide abortion services anywhere – this in a country with only 7 doctors or nurses for every 10,000 people. Meanwhile Nepal had legalized abortion after a decade-long campaign. Many health organizations denounced the U.S. policy to be an infringement upon Nepal’s sovereignty.

The truth of the matter is that any effort to eradicate abortion through restrictive laws or by preventing family planning aid is doomed to fail. Such policies do not tackle the reasons why women would need an abortion. In fact, in countries where abortion is mostly illegal, abortion rates are between 29 (in Africa) and 32 (in Latin America) per 1,000 women of reproductive age, whereas in countries where abortion is generally permitted (as in Western Europe) rates stand at about 12 per 1,000. Research worldwide has shown that there is no correlation between access to legal and safe abortion and its prevalence. Women will have abortions regardless of whether they are legal or not. However, there is a correlation between lack of access to legal safe abortion procedures and women’s maternal mortality: unsafe abortions are a major cause of maternal mortality and kill tens of thousands of women every year. An exemplary case is that of Ethiopia: after the decriminalization of abortion in 2006, the government issued implementation protocols and today 98% of its public hospitals provide abortion or post-abortion care. As a result, unsafe abortions went from counting for nearly one-third of deaths among pregnant women, (at the time the N. 1 driver of maternal mortality), to now being responsible for less than 6% of such deaths.

Africa has more abortion-related deaths than any other continent: every year, despite increasing access to safe abortion procedures, 6 million African women end their pregnancies with unsafe procedures and 1.6 million are treated for complications. Christian missionaries imported their views on abortion to Africa since the 19th century, introducing a deep stigma to the practice, but since the 1980’s the most influential factor in manipulating and politicizing the issue has been the role of the United States. The US has exported its own very conflicting political debate on the matter, hindering the efforts of health workers and African governments, and infringing on African nations’ sovereign ability to have a sensible debate on abortion rights.

Trump’s global gag rule is an attempt to interrupt a slow but evolving process of change. In order to reduce unsafe abortion rates sensibly, governments have to decriminalize it, increase access to safe procedures and modern contraceptive methods, fight stigmatization of women who have abortions and promote awareness. In countries where abortion is legally restricted, the global gag rule stifles the discussion on liberalization. In countries like Ghana, where the procedure is legal, the rule makes it harder for health care providers to inform women about their options and their rights, compromising their trust in the system.

If policies of this kind seem unnecessarily punishing, it is because they are. President Trump in 2016 said that women who seek abortion should be subject to “some form of punishment”, in a display of callousness that prompted even the most strenuous anti-abortionists to criticize his position. He later recanted his words, but his actions speak clearly enough on where he stands on the issue. It makes little difference whether his actions are motivated by political calculus or by heartfelt conviction. From Sub-Saharan Africa to Asia, Trump’s global gag rule will not only roll back the modest, slow, but critical gains that were taking place in the developing world on the issue of safe abortion and maternal health, but also decades’ worth of progress in decreasing maternal mortality, and increasing family planning, child development policies, and women’s rights more broadly. The foreign aid policies of a superpower like the United States should be dictated by data and evidence, not by ideology and the desire to punish on the basis of religious beliefs.

But there is some reason for optimism: when Bush’s gag rule was implemented in 2001, it had another unintended effect. Small activist groups woke up to the realization that they could easily lose any small progress made thus far. As Aba Oppong from the Center for the Development of People recounted, in Ghana the result was the formation of the Alliance for Reproductive Health Rights, whose goal was to combat unsafe abortions. Advocates pushed the government to draft a protocol implementing the largely ignored abortion law. Since 1994 more than a dozen African countries have liberalized their abortion laws. In 2003, 36 African counties ratified the Maputo Protocol which states the right for women to control their fertility, have access to family planning education, and utilize medical abortion in case of rape, incest, or when the pregnancy endangers the mental and physical health of the mother or the fetus. Perhaps this can be a guiding example of how an ideological, anti-woman policy can produce a new era of resistance, engaged activism, and women’s empowerment in the areas of the world where it is most needed.