THE GLOBAL GAG RULE the Unintended Consequences of US Abortion Policy Abroad by Emily Ausubel
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THE GLOBAL GAG RULE The Unintended Consequences of US Abortion Policy Abroad By Emily Ausubel Emily Ausubel is a frst-year Master in Public Policy candidate at the Harvard Kennedy School concentrating in International and Global Afairs. Before coming to HKS, Emily worked at global health organizations in the US and Uganda. Emily is passionate about advancing women’s health and preventing sexual and gender- based violence. pproximately 55 million abortions take A HISTORY OF US FOREIGN POLICY A place each year globally.1 In the United TOWARD ABORTION States, abortion is a deeply contentious In 1973, Congress passed the Helms issue, occupying a rift between religious and Amendment to the US Foreign Assistance Act, non-religious—and, often by proxy, conser- which prohibited direct US federal funding of vative and liberal—Americans. In the 1970s, abortion services outside of the United States. the US government started passing legisla- Under this policy, such organizations could tion to remove US funding from abortion-re- use other funds for abortion services through lated services, both domestically and globally. separate accounts.2 However, many pro-life While some policies have likely succeeded in Americans argued that even funding these eliminating direct US funding of abortions organizations to provide other services was abroad, there is mounting evidence that they comparable to funding abortion (sometimes also have widespread negative effects on the referred to as the “fungibility argument”).3 In lives of some of the most vulnerable women response to this pressure, President Reagan in the world. Under these policies, and espe- announced the Mexico City Policy in 1984 cially with recent changes from the Trump at the 2nd International Conference on administration, millions of women around Population in Mexico City.4 Beyond the Helms the world are unable to access other cru- Amendment restrictions, the Mexico City cial family planning and health services that Policy additionally prohibited the provision ensure their wellbeing and, ultimately, pre- of any US federal family planning assistance to vent abortions. Under these policies, not only organizations that provide or promote abor- are women still having abortions, but also tion-related services, even if they use funding many more are now forced to pursue unsafe from non-US government sources for those services. abortions, often at the risk of their own lives. The Mexico City Policy has been a decid- Given these realities, the US government edly partisan issue ever since its inception, must rethink its policies for funding family with each Democratic president rescinding planning and abortions abroad. it and each Republican president reinstating 68 ∙ Women’s Policy Journal it. Opponents of the policy dubbed it the government money from funding the provi- “Global Gag Rule” for the extensive restric- sion of any abortion-related services (save the tions it institutes. (Note: I will refer to this few aforementioned exceptions). While there policy by its original name, “the Mexico City is not comparable international data, studies Policy,” instead of “the Global Gag Rule.”) The show that the domestic counterpart of the restrictions under this policy apply to local, Helms Amendment—the Hyde Amendment— regional, and international NGOs but do not did successfully reduce US federal funding apply to foreign governments, public inter- of abortions in the US to almost zero: only national organizations, multilateral organiza- 331 out of more than 1.1 million abortions in tions, or US-based NGOs that directly receive 2010.10 This trend indicates that as a result of USAID grants.5,6 However, US organizations the Helms Amendment, the vast majority of receiving US government funding are obli- US funding is not going toward direct provi- gated to sign contracts stating they will not sion of abortions abroad. sub-grant funds to foreign non-compliant However, beyond these stated aims, the organizations.7 There are also notable excep- Helms Amendment and Mexico City Policy tions for both the Helms Amendment and the have had far-reaching consequences on the Mexico City Policy: organizations are not pro- provision of family planning services in devel- hibited from providing “advice and informa- oping countries and could actually be increasing tion about, performing, or offering referral abortion rates (including unsafe abortions). for abortion in cases where the pregnancy has either posed a risk to the life of the mother or IMPACTS ON FAMILY PLANNING AND resulted from incest or rape.”8 These policies HEALTH SERVICES PROVISION also do not prohibit provision of post-abor- Globally, the unmet need for family planning tion care.9 is 12 percent; that is, 12 percent of women On 23 January 2017, eight years after age 15-49 around the world want, but do not President Obama rescinded the Mexico City have, access to contraception. In the world’s Policy, President Trump reinstated the pol- least developed regions, that percentage icy once again and renamed it Protecting Life jumps to 21 percent, or more than 200 mil- in Global Health Assistance. This new plan lion women.11 Despite this need, many orga- not only upheld most aspects of the origi- nizations’ experiences under the Mexico City nal Mexico City Policy, but also expanded it: Policy show how the limits on funding severely now, all US government global health assis- inhibit their ability to provide adequate fam- tance—totaling nearly $9 billion annually—is ily planning services. These impacts are seen restricted to organizations that do not provide clearly in the case of Planned Parenthood abortions. This change is further jeopardizing Association of Ghana, which lost $200,000 provision of crucial health services for mil- of USAID funding after choosing to continue lions of people around the world. providing abortion services: they had to lay off many of their staff, which consequently SUCCESSFUL ELIMINATION OF US reduced use of family planning by 40 percent FUNDING OF ABORTIONS among their beneficiaries.12 MSI Kenya sim- Before looking at the unintended impacts of ilarly was forced to close 15 clinics between these policies, we should first ask whether 2001 and 2005, leaving tens of thousands of they achieved their stated aims thus far. The Kenyans with no options for family planning stated goal of both the Helms Amendment and or other health services, including HIV coun- the Mexico City Policy has been to prevent US seling and testing.13,14 The United States also Reproductive Rights ∙ 69 refuses to provide non-compliant organiza- OF THE ESTIMATED 55 tions with contraceptives and condoms or any MILLION ANNUAL ABORTIONS, other funding for family planning services.15 APPROXIMATELY 45 PERCENT, Yet, most women have abortions because their OR 25 MILLION, ARE UNSAFE: 97 pregnancies were unplanned, which is often PERCENT OF WHICH OCCUR IN due to a lack of access to modern contracep- DEVELOPING COUNTRIES. tion. The implications of this policy are clear: women who have a harder time accessing con- family planning services, instead of decreas- traception can consequently face increased ing abortion rates, are more likely to increase risks for unintended pregnancies. unsafe abortion rates, endangering the lives of thousands of women. Studies show that DO US FUNDING RESTRICTIONS IN FACT women who do not have access to safe abor- INCREASE ABORTION RATES? tions usually resort to other unsafe meth- Some recent studies seem to indicate that ods.20 In places that lack contraceptives and these policies might even be associated with other family planning services or have bans increases in abortion rates with fewer women on abortion, women—including adolescents receiving comprehensive family planning and youths—have higher rates of unsafe abor- services. A 2011 WHO study compared abor- tions. Unsafe abortion is one of the leading tion rates in 20 countries in Sub-Saharan causes of maternal morbidity and mortality Africa from 1994 to 2001 (when the policy was in developing countries. Of the estimated 55 rescinded under President Clinton) and from million annual abortions, approximately 45 2001 to 2008 (when the policy was in place percent, or 25 million, are unsafe—97 per- under President Bush). This study found that cent of which occur in developing countries.21 the Mexico City Policy was associated with Every year, it is estimated that between 22,000 reduced contraceptive use and increased abor- and 47,000 women die from complications tion rates.16 Another 2004 study conducted in associated with unsafe abortions, a mortality Romania found that in locations where family rate of between 88 and 188 per 100,000.22,23 planning services declined due to the Mexico In contrast, in the United States, the mortal- City Policy, abortion rates increased.17 A third ity rate from safe abortions is 0.7 per 100,000 study found that pregnancy rates increased procedures.24 by 12 percent and abortion rates increased by 50 percent among rural women in Ghana THE DANGERS OF INCONSISTENT once the Mexico City Policy was in effect.18 The IMPLEMENTATION WHO also explains the inefficacy of abortion Another major concern is that both of these bans on reducing abortion rates, showing how policies are implemented inconsistently. regions with more abortion bans (e.g. Latin Many organizations are often confused about America and Africa) in fact have higher rates of the details of the policies and are afraid of abortion than those regions without such bans losing their US funding. Therefore, they