At this moment in US political history, Americans have a chance to rid the United States of its contradictory, confusing, and ideologically driven approach to reproductive health around the world.
The United States is the largest donor to global health and humanitarian assistance. But for decades it has been a case study in contradictions when it comes to aid and foreign policy, and in no area is this more evident than reproductive health and rights, particularly abortion.
Reproductive healthcare, including abortion, is a critical need, and is essential. It is time-sensitive and cannot be delayed without profound consequences for pregnant people and their families.
US policies restrict access to safe abortion not just by attaching anti-abortion conditions to foreign aid. The United States also imposes its rules on how medical providers and non-profits spend their own funds, and on how they care for and advise their clients.
More than 35 million people around the world have unsafe abortions each year, and tens of thousands die. The global pandemic has exacerbated the gender, racial, and economic inequities in healthcare systems – and in emergency settings – making safe access to abortion an urgent matter of life and death for even more people.
Recent research suggests a 10 percent decline in contraceptive use would affect 49 million women and lead to an additional 15 million unintended pregnancies over just one year. And, the researchers say, if 10 percent of safe abortions become unsafe amid lockdowns and clinic closures, there would be an increase of 1,000 more maternal deaths each year.
A problem exported by law
The United States has recently been rolling back access to abortion care domestically, but US foreign policy has for decades also harmed the health and well-being of pregnant people in the Global South.
The anti-abortion, anti-rights, anti-woman position held by so many American leaders and policymakers – exaggerated by the current administration – puts the United States at odds with much of the rest of the world and diminishes its historical leadership on global health and human rights issues.
Successive US policies have restricted access to comprehensive and often lifesaving, reproductive healthcare.
In 1973, the Helms Amendment to the Foreign Assistance Act was enacted – effectively banning all US international funding for abortion-related activities. The Helms Amendment remains in force and applies to any foreign assistance, including bilateral support for governments and humanitarian relief.
US foreign policy has for decades also harmed the health and well-being of pregnant people in the Global South.
In 1984, President Ronald Reagan introduced the Mexico City Policy, later referred to as the Global Gag Rule. This executive order – rescinded by Democratic presidents and reinstated by Republican ones since Reagan – goes further: It restricts foreign NGOs that receive US global health funds from using their own resources to engage in abortion-related work.
That rule has been expanded under President Donald Trump to cover all types of global health assistance, including for HIV/AIDS, maternal and child health, malaria, global health security, and family planning and reproductive health. In effect, US government agencies are now directed to apply an unprecedented global anti-abortion policy, impacting about $12 billion in aid.
Both the Helms Amendment and the Global Gag Rule export American abortion policies and, as conditions on assistance, reflect a neo-colonialist ideology that has only grown in the last several years.
The United States has also sought to recruit others into its campaign. In July 2020, the Trump administration released a report attempting to redefine the global human rights framework and undermine the UN. And last year, US diplomats – led by Secretary of State Mike Pompeo – urged UN member states to oppose “harmful” policies that promote sexual and reproductive health and rights.
The campaign even includes an attempt to restrict the use of language. Unbelievably, in May – during the continued spread of COVID-19 – the acting director of the US government department that oversees foreign aid, USAID, sent a letter to the UN asking it to remove references to “sexual and reproductive health” from its global response plan for the pandemic, and to drop references to the provision of abortion as an essential service.
Inequality and colonisation
Before the pandemic struck, the UN estimated that 48 million women, girls, and young people, including four million pregnant people, would need reproductive healthcare in emergency settings.
When health systems collapse, women and girls are disproportionately affected. They are more likely to be subject to rape, prostitution, trafficking, forced pregnancy, and forced marriage.
Maternal mortality is an indicator of inequality between and within countries. Women die from pregnancy-related causes because they don’t have access to information, to healthcare, to education. The lives of poor women, who are predominantly Black or brown, and those who are caught in crisis situations, are valued less than others.
The United States can and should adopt policies that support and defend the rights of all people, instead of undermining the human rights framework and continuing racist and colonial policies.
The lives of poor women, who are predominantly Black or brown, and those who are caught in crisis situations, are valued less than others.
As they look ahead, Americans should recall that their history is full of examples of their compatriots truly leading – both in reproductive health and in support of decolonisation.
The Nixon administration opposed the Helms Amendment, saying it stood against decolonisation efforts, and restricted “developing country governments and individuals in the matter of free choice”.
Many African, Asian, and Latin American countries had colonial abortion laws on the books well into the twentieth century, yet activists in the Global South have successfully advocated for reforms, and governments have taken steps to ensure reproductive freedom. Indeed, since 2000*, 28 countries have expanded legal grounds to allow abortion. America can and should support them.
One simple yet incredibly effective way to do so would be to pass the Abortion is Health Care Everywhere Act. Introduced in Congress in July and co-sponsored by 115 members of Congress and 117 partner organisations, it calls for the repeal of the Helms Amendment and a positive role for the United States in sexual and reproductive healthcare, including abortion.
America can – and should – reshape its role in the humanitarian sector, and the world.
What’s at stake if it doesn’t take up this charge? Ultimately, people’s lives, the reputation of the United States in the eyes of the world, as well as the causes of human rights and social justice.
Americans believe that people in developing countries deserve the safety and dignity of basic healthcare. That must include comprehensive reproductive healthcare.
Americans also believe the United States plays an important role in making the world a better place by addressing poverty, disease, and injustice. Their politicians must listen.
(*An earlier version of this story incorrectly stated that 28 countries had expanded legal grounds to allow abortion "since 2008". The story was updated to say "since 2000" on 3 November, 2020.)