First Do No Harm: What the Global Gag Rule Means for Women’s Health Worldwide

By Megan Keeling

Among the many horrifying executive orders signed by President Donald Trump within his first two weeks was the reinstatement of the “Global Gag Rule.” This rule bars any organization that receives US funding from performing or even “actively promoting” abortions, even if they use non-US funding to do so. Basically, this means that organizations that receive any US funding are prohibited from counseling women on abortions or making referrals to (non-US funded) providers who offer abortions, regardless of the laws of the country they’re in or what’s in the best interests of individual women, their health, and their families. The Global Gag Rule prevents both health care providers and US development workers from carrying out the foremost part of both of their jobs: First, do no harm. This rule replaces evidence-based practices in reproductive health care counseling with a political script – forcing health care providers to withhold care or mislead patients, and putting women at risk for unsafe abortions that can result in serious injury or death.
Rich white men always know what’s best for every woman. Right?

While the Global Gag Rule, also known as the Mexico City Policy, has been re-instated by every Republican administration since Reagan, Trump’s version goes beyond previous iterations to include all “global health assistance” work carried out by US government agencies. This could cut off funding or compromise care in organizations that work in HIV/AIDs, infectious diseases, maternal and child health, and malaria and tuberculosis. In the age of the Zika virus, this rule is likely to have particularly devastating consequences for women and their families in affected regions who depend on access to contraceptives and family planning counseling to reduce their risks of having a child affected by the virus.

It’s too soon to know the extent of the effect this will have on US foreign assistance, as it will be up to the State Department to determine the parameters of which programs are affected by the ban. However, here are a few facts about US public health programs, the impact of family planning funding, and the importance of high quality health care:

  • By expanding the Global Gag Rule to include all health care services, this new mandate impacts $9.5 billion of health care programming, including those that provide AIDS/HIV care and prevention, and maternal and child health.
  • Organizations that refuse to accept the Gag Rule restrictions don’t just lose US funding, but also access to US donated condoms and contraceptives, and USAID family planning expertise
  • Access to quality family planning saves lives: Guttmacher predicts that out of the 27 million women and men receiving planning services, 2 million unsafe abortions and 11,000 maternal deaths were prevented

The Gag Rule prevents health care providers from doing their jobs, and denies women access to essential health care services. However, gag rules don’t just impact women in other countries: in 21 states in the United States, health care providers at organizations that receive state funding are prohibited from counseling or referring women on abortion services. Other states have laws dictating what providers must say to women, some of which require providers to share medically inaccurate or misleading information about the risks of abortion. For instance, 5 states require providers to tell women about a debunked link between abortion and breast cancer, and 9 states require providers to tell women about the negative mental health impacts of abortion (there’s no link between depression and abortion, though there may be a link between depression and anxiety in women who need an abortion but can’t get one. Irony!). Between counseling laws, mandatory waiting periods, and other onerous regulations on abortion providers, at-home (or “DIY”) abortions have been on the rise in the US.

But while US gag rules only impact how organizations spend money given by the state and federal government, the Global Gag Rule dictates how to spend other people’s money as well. A law as sweeping as the Global Gag Rule would likely be found unconstitutional in the United States, but with a stroke of the pen the president has imposed it upon millions of women worldwide who rely on organizations that receive US funding for their healthcare needs. This decree allows extremely conservative US lawmakers to score political points back home by imposing restrictions on women abroad that would be unacceptable to their own constituents.

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