The consequences of Trump’s ‘global gag rule’

President Trump has caught the headlines again today after his failed attempts to repeal the Affordable Care Act, or ‘Obamacare’. This was not the first controversial Trump policy to dominate the headlines. Previously, his travel ban on citizens from seven Muslim majority countries had faced numerous legal challenges. However, Trump’s reintroduction and extension of the so-called ‘Mexico City policy’, which bars international non-governmental organisations (NGOs) from receiving US government funding if they perform or promote abortions, has demanded fewer column inches. This is despite the likelihood that it will have far reaching and potentially damaging consequences. Millions of women around the world rely on NGOs for family planning and abortion advice, the loss of US government funding for these NGOs will severely curtail their ability to offer these services. 

The Mexico City policy

Restrictions on foreign aid to NGO’s involved in abortion were first introduced by President Reagan in 1984, and were announced at a United Nations International Conference in Mexico City. The policy was then named for the city where it was announced. It stipulates that in order to receive US government global family planning aid, NGOs must certify that they will not “perform or actively promote abortion as a method of family planning”.

The policy is also known as the ‘global gag rule’ since it prevents NGOs that receive US funding from discussing abortion. If these NGOs use funds from any source for this purpose (including funds from outside the US), they become ineligible for US global family planning aid.

The policy prohibits NGO’s that receive this aid from providing abortions, from providing advice or information about abortions, or from conducting public information campaigns about abortion as a method of family planning. However, the policy does allow NGOs to give information about abortions in cases where a woman has already decided to have an abortion, and in cases where a pregnancy was the result of rape or puts a woman’s life at risk.

Since its introduction, the policy has proved to be extremely partisan. It was rescinded by President Clinton in 1993, then reinstated by President Bush in 2001, before being rescinded a second time by President Obama in 2009.

However, Trump has not just reinstated the policy but has also dramatically expanded its scope and application. It had in the past only applied to US global family planning funds, which make up about $607.5 million of the aid budget. Trump has expanded the policy to cover the entire $8.8 billion US aid budget for global health assistance. The policy will now therefore apply to HIV/AIDS programmes, malaria programmes and even to water, sanitation, and hygiene programs.

The impact of this change is likely be dramatic since many organisations that provide services in the above areas also provide advice on abortion as a method of family planning. For the first time, the policy will affect not just family planning organisations but global NGOs such as Save the Children, WaterAid and the International HIV/Aids Alliance

Consequences of the policy

Many NGOs have stated that they will continue to talk about abortion, and therefore lose US government funding. Examples include Marie Stopes International (MSI) and the International Planned Parenthood Federation (IPPF), who have both already announced that they will not comply with the ‘global gag rule’, and will therefore lose their US government funding. MSI estimates that the resulting loss in its services will cause more than six million unintended pregnancies globally during Trump’s first term.

Many of the organisations that will lose this funding also have important roles in the provision advice on all areas of sexual health and family planning. For example, this April the Trump administration announced that it would strip US funding for the United Nations Populations Fund (UNFPA) due to unsubstantiated reports of UNFPA involvement with coercive abortion in China. The UNFPA is the world’s largest provider of contraceptives. It provides reproductive health services to 12.5 million women in more than 46 countries, and is at the forefront of the battle against HIV/AIDS in Africa. The US was previously the third largest donor to the organisation, and the loss of this funding will necessitate a reduction in its programmes.

Other NGO’s will cut abortion counselling to continue receiving US aid. Such NGOs will no longer be able to provide a service that has proved extremely effective in helping women throughout the world. A large and growing body of evidence shows that one of the most effective ways to reduce poverty and improve education is by giving women control over their reproductive cycle through the provision of contraceptives and the availability abortion. In parts of Africa, girls who become pregnant are often required to leave school which makes them significantly more likely to be in poverty in later life.

The Mexico City policy is unlikely to succeed in its stated aim of reducing the number of abortions, instead it will force women into unsafe abortions outside of the official medical system. A Stanford University study examining the policy during the Bush years found that countries most affected by the policy had significantly increased rates of abortions whereas the rates remained relatively stable in countries less affected by the policy. Thirteen percent of maternal deaths in developing countries are caused by unsafe abortions.

Conclusion

Evidence suggests that the cumulative effect of the Mexico City policy will be to reduce access to contraception, safe abortions, and programmes that combat HIV/AIDS. Whilst various countries and organisations have stepped forward to help fill the funding gap left by the policy, such as Sweden and the Gates Foundation, they will be unable to match the levels of funding previously offered by the US. Furthermore, Trump’s May budget included a proposal to completely eliminate funding for all US global family planning aid. Whilst this proposal is expected to be weakened during Congressional budget negotiations, any cuts to family planning will hamstring global efforts to fight poverty and HIV.

Freddie Lloyd is a research assistant at Bright Blue