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End of US ‘global gag rule’ raises hopes for women’s healthcare at crucial time

‘The gag rule has had a trickle down impact by affecting access to other lifesaving services.’

A demonstrator at a pro-abortion rally stands in front of a green banner cheering with one arm up.
Demonstrators attend a rally hours before the Argentinian senate's historic legalisation of abortion on 30 December, 2020. Argentina became only the third South American country to permit elective abortions. (Flor Guzzetti/REUTERS)

When the Trump administration reinstated the “global gag rule” in 2017, the International Planned Parenthood Federation (IPPF) lost some $100 million in funding in the following years, impacting a spectrum of healthcare projects in 32 countries and going well beyond the intended goal of preventing abortions.

A health clinic in Haiti’s southern coastal town of Jacmel was one of the first casualties.

Faced with a $300,000 funding cut, Profamil – a nonprofit that provides birth control, HIV testing, and cancer screenings – closed the Jacmel clinic and sent its workers home. Although abortion is illegal in Haiti, the group had been receiving most of its funding from IPPF.

US President Joe Biden will rescind the policy by executive order today in a move that could help restore funding to clinics and NGOs across the globe at a time when women’s access to healthcare has been particularly hampered during the pandemic.

Also known as the Mexico City Policy, the measure was first instituted by the Reagan administration in 1984 and has prohibited US funding to NGOs – like IPPF – that provide abortion-related services abroad, including counselling and education. This has been the case even if they weren’t using the US funds for those specific services.

In 2019, then-president Donald Trump and his secretary of state, Mike Pompeo, went further, expanding the rule to cut off funding to any organisations found to be supporting other NGOs that provide abortion services or counselling. According to the Kaiser Family Foundation, this expansion potentially impacted as much as $7.3 billion in US aid in the 2020 financial year.

But the impacts reach further than just abortion services: The rule has forced health and humanitarian organisations to choose between forgoing US funding or eliminating their abortion and abortion counselling services.

“The gag rule has had a trickle down impact by affecting access to other lifesaving services like contraception, HIV tests, and prenatal care,” Dr. Roopan Gill, a Canadian obstetrician, gynaecologist, and founder of a reproductive health startup, told The New Humanitarian.

Although Médecins Sans Frontières does not accept US government funding, the medical aid charity said it had seen the harm the gag rule has had on limiting women’s access to healthcare. In 2019, MSF treated more than 25,800 women and girls with abortion-related complications.

“We’ve seen women who have used pens, broken glass, or sticks to try to induce an abortion. We’ve seen women who drank chlorine or poisons,” Dr. Manisha Kumar, head of MSF’s task force on safe abortion care, said in a written statement.

“We can only guess how many women lost their lives over the last several years because access to this essential healthcare was cut off,” Kumar said. “And we know that policies such as the global gag rule disproportionately affect Black women and women of colour.”

The COVID-19 effect

Mina Barling, director of external relations at IPPF, told TNH that rescinding the rule was a hopeful development in what she described as a “constant yoyo” of US policy on reproductive and sexual health funding.

Prior to the pandemic, it was already estimated that 35 million women receive an unsafe abortion every year. A 2019 study published in The Lancet journal found evidence that abortions actually increase when a country is affected by the Mexico City Policy.

According to estimates from The Guttmacher Institute, a sexual and reproductive health policy organisation in New York City, COVID-19-related disruptions could result in 3.3 million unsafe abortions – and 1,000 maternal deaths from unsafe abortions – in the 12 months following the start of the pandemic.

“I got an abortion so that I could save what I already had,” a 26-year-old Haitian woman told TNH late last year, describing how she paid $30 for a back-alley abortion in the capital of Port-au-Prince. Unemployed, she said she was already struggling to take care of her first child with a partner who she said was abusive.

Although some of Profamil’s centres managed to stay open in Haiti, the closure of its Jacmel clinic deprived women of critical healthcare services. Haiti has the highest rate of maternal mortality in the western hemisphere, and unsafe abortions are common.

Although abortion remains illegal in Haiti, a decree last year by President Jovenel Moïse would legalise it in June 2022.

In Namibia, where abortion is also illegal, midwife and reproductive health advocate Sylvia Hamata, told TNH that the country’s border closure with South Africa, where abortion is legal, has caused many women to seek unsafe abortions during the pandemic.

Even prior to COVID-19, travelling for an abortion was expensive, and not an option for most Namibian women. Hamata, who works with the International Confederation of Midwives, said that her colleagues have treated many women presenting to clinics who have attempted their own abortions. “It’s just not fair, in a [higher middle income] country like Namibia, to have women dying of unsafe abortions,” she added.

In countries where abortion is legal in some instances, like Mali, the re-implementation of the rule in 2017 had immediate and dire impacts.

The Association Malienne pour la Protection et la Promotion de la Famille (AMPPF), one of largest reproductive health service providers in the country that provides counselling and post-abortion care, lost $1.5 million of IPPF funding over three years due to the gag rule.

AMPPF was forced to close some clinics, disrupting access to contraceptives for many rural Malian women. The organisation estimates that in the first year of funding cuts, they served only 242,500 patients – nearly half the number they estimate they would have cared for.

In response, IPPF granted AMPPF $329,599 from a pool of money contributed by the Canadian government to NGOs that lost funding due to the re-implementation of the gag rule, allowing the healthcare provider to restore some clinics and rehire some staff.

Other countries did step in to fill the gap in UNFPA funding left by the Trump administration’s decision to stop financing the agency in 2017: UNFPA’s income actually grew from 2017 to 2019. In addition to Thursday’s executive order rescinding the gag rule, President Biden has also pledged to restore US funding to the UNFPA.

Barling says advocacy groups like IPPF are watching to see if the now-Democrat-held US Senate and Congress will take legislative action to ensure the global gag rule can never be reinstated and to follow through on campaign promises to repeal the Helms Amendment.

This legislation, which remains in place despite the rescinding of the gag rule, has effectively meant that US foreign assistance cannot be used for services related to abortion, including information or counselling, even in circumstances of rape, incest, and life endangerment.

But a full repeal of the Helms Amendment has proven unsuccessful for reproductive health advocates before. Despite extensive lobbying, president Barack Obama did not pass an executive order to do so during his eight years in office.

Jessica Obert contributed to this report from Port-au-Prince, Haiti.

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