The global gag rule: Women’s health at risk in Latin America?

Photo by Jen Rynda Ginger Spruill

Just three days into his presidency, on January 23, 2017, Donald Trump reinstated the so-called Global Gag Rule. The executive order, also known as the Mexico City Policy, prohibits all US federal money from funding international organizations that provide information about or support abortion rights. Although every Republican president since Ronald Reagan has signed the order, Trump’s version significantly broadens the ban to require foreign non-governmental organizations (NGOs) to certify that they will not “perform or actively promote abortion as a method of family planning” using funds from any sources (including non-US funds) as a condition for receiving not only US government family planning assistance, but also any other US global health assistance of any kind.

The latter condition represents a new constraint for US women’s health partners around the world. And the repercussions for women’s health and family planning are dire.

In Latin America, abortion rights are prohibited or severely restricted in nearly every country. More than 95 percent of the procedures take place illegally and clandestinely, often with catastrophic results. Botched abortions are a major cause of maternal mortality: in Peru alone it is estimated that 13 percent of maternal fatalities are linked to unsafe abortions.

Across the hemisphere, dozens of women are incarcerated for abortion—in some cases after miscarriages that authorities deemed to be voluntary pregnancy terminations. In El Salvador, women suspected of abortion have been charged with homicide and imprisoned for thirty years or more. The legal threat to women is made all the more cruel because of two factors: a pervasive lack of access to contraception and sexual education and high levels of sexual violence (which frequently results in unwanted pregnancy).

The situation for Latin American women can only be expected to deteriorate in the wake of the imposition and expansion of the gag rule.

The Mexico City Policy has gone back and forth along party lines since 1984. In all, it has been in place for 17 of its 34 years, consistently reinstated by every Republican president since Reagan, whose administration introduced the policy at the Second International Conference on Population in Mexico City (hence the name). In all but a few years during the Clinton administration (when there was a temporary Congressional action imposing the ban), the policy has been withdrawn by Democratic presidents.

With Trump’s 2017 expansion of the policy, the gag rule will apply to all US global health assistance. This includes (but is not limited to) aid granted by: the US Agency for International Development (USAID); the State Department—including the Office of the Global AIDS Coordinator; the Centers for Disease Control and Prevention; the National Institutes of Health (NIH); both divisions of the Department of Health and Human Services; and the Department of Defense. The funding affected could add up to $9 billion in lost revenue for agencies providing health services on the ground around the world, including $575 million in reproductive health care globally. Many foreign NGOs that receive US funding for health programs in low-income countries offer a broad range of services, including treatment for HIV/AIDS, malaria, tuberculosis, nutrition, and maternal and child health. As such, the Trump gag rule will have a wide-ranging negative and devastating impact on global health in the coming years.

According to Ann Starrs, president and CEO of the Guttmacher Institute, the last application of the global gag rule “crippled family planning programs.” She wrote recently that “[m]any foreign NGOs… refused to let the US government muzzle their abortion advocacy efforts or dictate what services or counseling they provided using their non-US funds. These health providers were forced to reduce staff and services, or even shut clinics.” This time their decision will come at an even greater cost. As she noted, the US is the largest funder of global health programs worldwide, and the “disruption this aid effort will suffer is massive.”

To make matters worse, Latin America today faces a public health crisis linked to abortion rights that did not exist during previous anti-abortion gag orders: the Zika virus. Affecting primarily the region’s low-income and marginalized women, Zika’s thousands of victims—most of whom are already deprived of safe, legal abortion services—are giving birth to severely disabled babies, with few or no support services to provide for their costly medical care.

Responses to the Global Gag Rule have been swift and decisive. A coalition of approximately 140 US-based civil society organizations immediately issued a letter condemning the order. In the US Congress, Senator Jeanne Shaheen (D-NH) and Representative Nita Lowey (D-NY), introduced the “Global Health, Empowerment, and Rights (HER) Act” that would put an end to the Global Gag Rule. Introduced the same day as the Trump order, the bipartisan bill has 42 cosponsors in the Senate, and the House bill has 121 cosponsors. Moreover, other countries have joined in the effort to ensure women’s access to health care services.

On January 25, just two days after the gag rule announcement, the Netherlands launched a global fund to help women exercise abortion rights to compensate for funding losses due to the US policy. On March 8, International Women’s Day, Canadian Prime Minister Justin Trudeau announced that his government would spend US$650 million in the next three years to support sexual and reproductive health initiatives globally. Discussions are underway with European Union governments in addition to the Netherlands to support efforts to counteract the damaging effects of the Mexico City policy.

The exact financial cost to reproductive rights organizations in Latin America is difficult to measure at this writing. But the most damaging aspect of the Global Gag Rule for the region is that it bolsters and emboldens anti-choice activists and places women’s and child health at risk beyond a woman’s right to choose. The president’s reinstatement and expansion of the policy—coupled with his administration’s aggressive anti-abortion stance—is a crippling blow to Latin American women’s access to health care. The US government’s gutting of crucial funding to health-care NGOs will have devastating and even fatal repercussions on those millions of women who seek to terminate unwanted pregnancies each year and on family planning and on health region wide.


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