Contraception in the Crosshairs:Impact of the Global Gag Rule

There is a saying in South Africa:You strike a woman, you strike a rock.

It’s a phrase that evokes the unshakeable strength and endurance of women. It speaks to their courage in the face of oppression, to their resilience and life force. And especially today, as we mark International Women’s Day, it reminds us that women are the bedrock of the world.

I thought of the phrase often during my recent travels. Two weeks after the White House issued an executive order reinstating the Mexico City Policy, also known as the Global Gag Rule, I flew to Lome, Togo, for a field visit. Lome is home base for Agir pour la Planification Familiale (AgirPF), a regional health project funded by USAID and managed by EngenderHealth. AgirPF was launched in 2013 to strengthen family planning services in five West African countries – Burkina Faso, Cote d’Ivoire, Mauritania, Niger and Togo – where the need for contraception far outstrips availability.

This is a region where the average woman gets married in her teens and gives birth to five or six children – most of them delivered at home, without the help of a skilled birth attendant. It’s a region where maternal and infant mortality rates are sky-high, where the risk of mother-to-child HIV transmission is significant, and where early, frequent pregnancies leave thousands of women suffering through the nightmare of obstetric fistula.

There are no quick fixes here; the goal of AgirPF is to build local healthcare capacity, so that eventually every woman will be able to get the family-planning care she wants and needs. The key is to work with governments and local NGOs to integrate high-quality contraceptive services into the overall continuum of care.

This is critical, lifesaving work with enormous potential to uplift women’s lives. Now, because of the Global Gag Rule, much of it is in jeopardy.

A woman walks on a rubbish dump as calm returns in Lome, Togo on Tuesday, Feb. 15, 2005. Police killed at least one person on Monday as an opposition long used to repression tried to step up protests to the army’s installation of the late dictator’s son as president.(AP Photo/Schalk van Zuydam)

The main thing to understand about the Global Gag Rule is that it isn’t really about abortion. It doesn’t eliminate U.S. funding for abortion, because there is no U.S. funding for abortion. (The Helms Amendment barred that door in 1973.) And it doesn’t reduce the abortion rate overseas – the last time the policy was in effect, during the prior Republican administration, the abortion rate in Sub-Saharan Africa more than doubled.

What the Global Gag Rule actually does – and this we also know from what happened before – is drastically reduce women’s access to contraception.

AgirPF is a case in point. The project is managed by EngenderHealth, but it’s implemented through foreign NGOs who will now be subject to the Gag Rule. In Togo, for example, our partner is the Association Togolaise pour le Bien-être Familial (ATBEF), the local affiliate of the International Planned Parenthood Federation (IPPF). ATBEF is an important provider of healthcare in Togo and offers family planning, full maternity care (antenatal, delivery and postpartum), primary care, HIV testing, premarital counseling and infertility treatment. Without the participation of ATBEF and other IPPF affiliates, the AgirPF project cannot succeed.

But with the Global Gag Rule in effect, NGOs like ATBEF will be forced out. The rule puts these providers in an impossible position: To continue receiving U.S. funds, they must agree not to use their own funds (or any other donor’s funds) to so much as discuss abortion. In West Africa, where abortion is heavily restricted, this means they can’t provide accurate medical information about the procedure or advise their governments on decriminalization. It’s an extraordinary overreach into the internal affairs of foreign NGOs, requiring health professionals to violate medical ethics, betray their patients, and, in some cases, flout their own government’s regulations. By interfering with critical capacity-building work in the health sector, the Gag Rule has the potential to destabilize an entire nation.

When the Global Gag Rule was in effect during the last Republican administration, family planning clinics throughout Africa, Asia and the Middle East were forced to reduce services or shut down entirely. With access to contraception severely curtailed, the number of unplanned pregnancies rose precipitously – as did the incidence of maternal complications and unsafe abortions. Thousands of women died.

But the new version of the Gag Rule promises to be even more deadly. The policy announced by the White House in January 2017 is far crueler than any previous version of the policy and is vastly greater in scope. This isn’t just a return to the 2001-2008 status quo. It’s worse.

What’s even more startling is the breadth of the new Gag Rule’s reach. In the past, the rule only applied to U.S. aid for family planning; other health programs were exempted. The new version covers the entire U.S. global health budget: as much as $9 billion in aid. Every single program for the whole gamut of global health issues – including HIV and AIDS, malaria, Zika, polio, Ebola and infant and maternal health – will now be held hostage to the Gag Rule. In a world of integrated healthcare, where a single clinic might handle everything from contraception to childhood immunizations to HIV treatment, this is a recipe for unprecedented disaster.

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