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U.S. Policy Targets Global Women’s Lives

President Trump’s expanded Global Gag Rule limits NGOs’ ability to serve vulnerable populations and dramatically reduces access to sexual and reproductive health care.

Soon after settling into the Oval Office in 2017, President Donald Trump reinstated the Global Gag Rule (GGR) and triggered a major shift in the global health ecosystem by limiting women’s access to sexual and reproductive health services and counseling. In accordance with this policy, non-governmental organizations (NGOs) that accept U.S. aid money cannot perform abortions and related counseling, distribute educational resources that reference abortion, or connect individuals to abortion services.

Access to safe abortion care is a critical part of reproductive health according to the World Health Organization (WHO) and the American College of Obstetricians and Gynecologists (ACOG). Both organizations believe that women should be responsible for their own decisions regarding reproductive choices and health. Unfortunately, one of the GGR’s tragic consequences is an increasing number of barriers that women now face when accessing critical health care services and information, rendering them powerless to make decisions and reducing their autonomy. As NGOs adjust to the new financial reality imposed by the GGR, they are forced to restrict services, shutter sites, and reduce the number of patients they serve.

The GGR, originally conceived as the Mexico City Policy, has been a mainstay of Republican administrations since President Ronald Reagan signed an executive order in 1984. While Democratic presidents Bill Clinton and Barack Obama revoked the GGR during their time in office, President Trump has embraced it. With a new name, “Protecting Life in Global Health Assistance,” the GGR also has an expanded scope under Trump’s administration. It not only applies to family planning funding, which amounts to approximately $600 million, but also affects money allocated for all global health efforts. Global health funding reaches approximately 8.8 billion dollars, all of which now falls under the GGR and covers services that go beyond family planning, including mother and child wellness, nutrition, access to clean water and hygiene, and treatment of infectious diseases.

While the GGR is meant to limit abortions and unintended pregnancy, research shows that it has the opposite effect. A Stanford University study compared the abortion rate in sub-Saharan African countries who were highly affected by the previous administration’s GGR to those countries that were less affected. Their findings confirm that individuals residing in countries with greater exposure to the policy were two times more likely to have an abortion. The authors hypothesize that these women used abortion as a birth control method given their limited access to contraceptives. Left without comprehensive information and care choices, women must rely on limited and suboptimal options. 

Under the current GGR, millions of women lost access to sexual and reproductive health care as organizations reduced outreach and closed clinics. NGOs like the International Women’s Health Coalition (IWHC), who study the effects of the GGR on the ground and have initiated over 100 interviews with stakeholders, conclude that not only do vulnerable populations experience difficulties accessing health care but this policy also has profound effects on a societal level. Organizations and individuals are less likely to be transparent with others; communication about important issues like family planning is stifled; and politicians and leaders who support oppressive policies become more popular.

In Nepal, where the Family Planning Association of Nepal (FPAN) and Marie Slopes International (MSI) together had to shutter 22 outreach services, women are more likely to have children at a younger age, give birth to more children than they are able to raise comfortably, and pursue unsafe abortions. They are also more likely to experience poverty, be burdened with medical complications, and have less control over their own lives. Women find themselves in similar situations in Kenya, Nigeria, and South Africa where IWHC conducts its research.

As activists, organizations, and universities continue to document this global situation, the need for change can only intensify. Denmark stepped up efforts to find funding for affected organizations by starting the change-driven movement She Decides. In the United States, Congress has the option to pass the Global Health, Empowerment and Rights (HER) Act, which would make U.S. funding independent of global health organizations’ services and counseling work. In other words, NGOs could accept American aid while using their own funding from a separate source for abortion and abortion-related services.

There are opportunities to support women’s sexual and reproductive health at Penn and in Philadelphia. On February 15th, the Center for Global Women’s Health (CGWH) hosted its 2nd Annual West Philadelphia Women’s Day at West Philadelphia High School. In small group sessions, participants discussed sexual and reproductive health as well as issues that impact women, adolescent girls, and gender minorities. Attendees also had access to presentations, basic health screenings, and menstrual hygiene products that support health and wellness right here in the Philadelphia community.