Trump’s war on reproductive rights has already gone global. On only his third day in office, the new President reinstated a devastating policy that threatens the lives of thousands of women around the world. Known by its critics as the “global gag rule,” the executive order withholds American foreign aid from all international organizations that include abortion counseling in their family planning services. In order to receive federal aid, on which many of the organizations depend, NGOs must prove they do not even mention abortion in the resources they provide. Unsurprisingly, organizations like the International Planned Parenthood Federation have refused to comply. Their statement in response to the order read, “As a rights-based health organization that seeks to protect and enhance the lives of women, men, and young people… IPPF will not sign a policy that denies human rights and puts the lives of women at risk.” But a refusal to comply would result in defunding. With hundreds of other groups all over the globe relying on federal aid, millions of women stand to lose access to their services.
Trump’s reinstatement of this policy isn’t a shock to anyone. Since its inception in 1984 under Ronald Reagan, the policy has been perfectly partisan: supported by every Republican administration and suspended by every Democratic one. Also known as the “Mexico City Policy,” it was introduced at a population conference in Mexico City by Reagan’s representatives. The conference marked the first time the domestic war on abortion was inserted into the discourse of international development. The original announcement read, “The United States does not consider abortion an acceptable element of family planning programs and will no longer contribute to those of which it is a part.” The effect of this funding suspension cannot be understated. When access to reproductive health care is restricted, the world’s most vulnerable women are hurt most – this is certain.
What was unexpected, however, was the aggressive degree to which Trump expanded the global gag rule’s reach – this time far beyond women’s reproductive care.
In its original form, the policy restricted aid from two federal sources: the US Agency for International Development and the US State Department. The order withheld USAID or State Department funding from any NGO found to “perform or actively promote abortion as a method of family planning in other nations.” This restriction – effectively coercing silence for funding – was dubbed “the gag.” The restriction was particularly frustrating for providers because it was based on a massive misconception: The aid in question never even went to abortions. The US has not allowed federal money to fund abortion procedures at home or abroad since the Helms Amendment passed in 1973. For four decades now, money collected from taxpayers has never been used for foreign abortions. If NGOs did provide abortion services, they used alternative sources of funding distinct from US aid. But with the gag rule, it no longer matters where that money comes from. Speak of abortion as an option, and the money is gone.
Since its inception, the policy has been disastrous for women’s health care. Critics have long argued that the policy is not only unjustified but also does not achieve its intended goal: There is no evidence that the policy reduces abortion. Studies published by the World Health Organization showed that in Sub-Saharan Africa, the policy is actually associated with a rise in abortion rates. Though providing no definitive causation, they suggest a reasonable – and arguably commonsense – explanation. When organizations that provide abortion counseling or services lose their funding, their other services take the hit too. More often than not, this hit lands upon the provision of contraception. Current estimates for the number of women who rely on contraceptives from these organizations – the ones who will now be defunded – put the figure at around 225 million women.
But the criticisms extend well beyond the decrease in contraceptive access. Historically, this money has done far more than just prevent billions of unwanted pregnancies, it has saved lives. The abortion counseling targeted by the gag rule is often all that stands between a woman undergoing a safe procedure and a life-threatening one. Every year, seven million women in the developing world attempt unsafe abortions and must undergo medical treatment for complications. Many others never receive treatment and die. This is particularly true in countries where abortion is illegal, because counseling may direct them to an abortion provider in a neighboring country. But it is also common in countries where abortion is legal. Even if abortions are legal in a country, women with little expendable income and no education, particularly those living in rural areas, have difficulty accessing them without advice and funding. Barring organizations from even having these conversations with women – informing them of their options and rights – is putting them at even greater risk.
The traditional Mexico City Policy has long threatened reproductive rights and endangered the lives of women around the world. Trump’s version of the global gag rule, however, is not a mere reiteration; he has expanded its reach to unprecedented levels, and its devastation will no longer be limited to women.
In past versions, NGOs had to accept the no-abortion condition demanded by the policy to receive funding from USAID and the State Department. Trump’s version no longer specifies these sources; the wording seems to cover all aid provided by every US agency. This has massive – and confusing – implications. Like other Trump executive orders, only time will tell how literally the administration will apply this broad phrasing. However, its potential reach is certainly vast and likely catastrophic. In addition to suspending reproductive rights aid, Trump may have just limited all US global health funding.
Departments across the US government use federal money for a wide range of foreign health projects, including improving child nutrition and maternal health, preventing infectious diseases like HIV/AIDs and malaria, and investigating treatment for viruses, such as Zika. Trump’s wording, though unclear, could apply to all of these. While the old policy affected around $600 million in annual aid, this broader application could impact a total of $9.5 billion. And the separation of these programs, even ones not explicitly concerned with women’s health, from the abortion “gag” is not as simple as it would seem. Often, the same health organizations provide the whole spectrum of services: antiretrovirals for HIV, nutrition supplements, oral malaria medication, and birth control. And yes, they might also occasionally provide information to pregnant women on their childbirth options – including abortion. If they do, however, the funding could be cut for their myriad of other lifesaving health services.
The global gag rule has always been most devastating for women in developing nations, particularly those without the resources and access to sophisticated medical care. Trump’s version is no longer limited to women – it will wreak havoc on men and children too. It’s difficult to know how far he will implement its flexible wording. It could extend to the millions of recipients of PEPFAR aid (Emergency Plan for AIDs Relief), which other Republican administrations have included in a list of specific programs to be exempted from the gag rule. Trump made no exemptions.
It’s difficult to fathom how far-reaching the effects of the gag rule could stretch within the next years. Marie Stopes International, one of the largest and most active health care providers for women in the world, will be one of the major organizations now defunded. They estimate that unless they can find replacement sources of funding, the suspension of their services will cause 6.5 million unintended pregnancies, 2.2 million abortions, and 2.1 unsafe abortions, and more than 20,000 deaths from childbirth complications. These numbers are not accounting the millions more men, women, and children who may no longer have access to their malaria medication, HIV prevention education programs, or other basic health care provisions. We can’t know how far Trump will take this, but we do know the US has historically been the world’s largest funder and implementer of global health programs – giving this the potential to affect millions of more lives.
The decades-long siege on reproductive rights is a familiar war for Americans, but this time it is taking place abroad – and Americans will not be the victims.