One year after its implementation, and with a domestic iteration under consideration, the Trump administration’s Global Gag Rule is causing profound structural shifts that threaten the health of millions, particularly vulnerable women and girls, according to a new report by the International Women’s Health Coalition (IWHC).
Research conducted by IWHC, with local organizations in Kenya, Nigeria, and South Africa, demonstrates that the Global Gag Rule is already limiting services, sowing confusion and threatening to halt progress to integrate health care systems in those countries. The Rule is also having a chilling effect on collaboration and advocacy, the report finds.
“The Trump administration is exporting its extreme ideology, whose sole aim is to stop women from making decisions about their bodies and their lives,” said Françoise Girard, president of IWHC. “Our findings reveal a shocking picture: the Global Gag Rule drives abortion underground, making the procedure dangerous for women—particularly poor women—even in countries where it is legal.”
Kenya, Nigeria and South Africa receive significant amounts of US global health funding. In 2016, US assistance accounted for 26 and 53 percent, respectively, of the Kenyan and Nigerian health budgets. In all three countries, abortion is legal in instances not allowed under the Global Gag Rule. Moreover, in all three countries, nongovernmental facilities provide a significant share of health services, making them integral to comprehensive health care provision.
Worldwide, 25 percent of all pregnancies end in an induced abortion, with 13.2 percent of maternal deaths attributed to unsafe abortion, according to the World Health Organization. In Kenya alone, seven women die each day due to unsafe abortion. In Nigeria, a woman dies every 13 minutes from preventable causes related to pregnancy and childbirth, accounting for 14 percent of global maternal deaths. Unsafe abortion is considered a major contributor to Nigeria’s high rate of maternal morbidity and mortality. In South Africa, where maternal mortality remains high, and stigma around abortion abounds, it is estimated that approximately 50 percent of abortions in the country are still performed illegally, despite its liberal abortion law.
The Trump administration’s version of the Global Gag Rule—the most extreme in history—forbids any foreign nongovernmental organization (NGO) receiving US global health funds from providing abortion services, information, or referrals, even with their own, non-US funding. This expanded Global Gag Rule applies to programs addressing HIV/AIDS, maternal and child health, and malaria, among other health issues. The Global Gag Rule forces organizations to choose between offering comprehensive care and receiving US funds. The US is the largest funder of global health, spending $8.8 billion annually, and organizations that forgo US funding often struggle to fill resulting funding gaps and are forced to scale back services or end them altogether.
In all three countries, IWHC found that the Gag Rule is jeopardizing decades of US investments in HIV prevention, treatment and care by halting efforts to strengthen health systems and to improve their efficiency and effectiveness by integrating the delivery of HIV and sexual and reproductive health services. In some cases, the Global Gag Rule is undermining countries’ ability to set their own, evidence-informed health policies. In South Africa, for example, some of the civil society organizations contracted by the government to help develop the country’s life skills education curriculum are also recipients of US global health funding. As a result of the Global Gag Rule, ongoing discussions on the curriculum are very likely to exclude abortion, which is legal in South Africa.
Misinformation about the Global Gag Rule is also common, leading many organizations to discontinue permitted activities out of fear of losing US funding, further decreasing access to critical health services. Experts interviewed in all three countries asserted that misinterpretations of the policy have weakened civil society coalitions, as organizations believe they can no longer partner with organizations that work on abortion in any capacity. Further confusing matters, interviewees pointed to a lack of clear instruction from US officials in country, who were unwilling or unable to answer questions about the policy’s implementation.
“Under-resourced health systems in countries around the world, where a significant proportion of health services are provided by nongovernmental organizations, are facing an impossible choice,” said Girard. “The Global Gag Rule must be ended before it becomes a pervasive killer.”
The report is clear: by erecting barriers to services, disrupting efforts to strengthen health systems and undermining evidence-based health policies, the Global Gag Rule jeopardizes people’s lives. A previous iteration of the Gag Rule resulted in an increase in unintended pregnancies, abortions, and maternal deaths in sub-Saharan African countries during the George W. Bush administration. The Global Gag Rule also had far-reaching negative effects, such as deterring HIV prevention efforts.
IWHC’s recommendations to stop or mitigate the deadly impact of the Gag Rule include:
- Permanently repeal the Global Gag Rule through legislation. Congress must pass legislation not only to terminate the current incarnation of the Gag Rule, but also to permanently end the president’s ability to reinstate this harmful policy in the future.
- As long as the Global Gag Rule is in effect, develop and share clear guidelines for implementation with all recipients of US global health funding, including sub-award recipients and local organizations. Until the Global Gag Rule is repealed, the State Department, USAID, and other agencies must provide better, clearer, and more consistent guidance for organizations faced with signing the Global Gag Rule, and should create a mechanism for addressing questions and confusion.
- Any US government review process of this policy must be consultative, transparent, comprehensive and action-oriented. To be credible, any future review must create a process of evaluating the impact of the policy and understanding both its short- and long-term implications. Any review must specifically address the impacts of the policy on low-income, marginalized and rural populations, with particular focus on adolescent girls, LGBTQ+ individuals, ethnic and racial minorities, and indigenous women.
- Document instances of misapplication, over-application, and the chilling effects of the policy on women and girls around the world. Any US government review of this policy must look at the ways the policy is being misapplied, and the impacts of this chilling effect on the delivery of legal and permissible services, like contraceptives, post-abortion care, and referrals for abortion services in cases of rape, incest, or a life-endangering pregnancy.
- Donor governments, international and regional organizations should seek to close the funding gap by increasing funding while prioritizing local and community-based organizations. Donors should document the impact of the Gag Rule on their own and their partner’s work and make these findings public.
- Recipient governments should break the silence and provide their own documentation of how the Global Gag Rule undermines local health efforts responsive to the needs of local populations to whom these governments are accountable.
Note to Editors:
Over the past year, IWHC along with grantee partners in Kenya, Nigeria, and South Africa, conducted 59 interviews with civil society organizations, health service providers, anti-abortion groups, and government agencies across the three countries. The partner organizations were: Trust for Indigenous Culture and Health (Kenya), Education as a Vaccine (Nigeria), and the Critical Studies in Sexuality and Reproduction unit at Rhodes University (South Africa). Experts are available for interviews in all three African countries and in the US.
Click here to download “Reality Check: Year One Impact of Trump’s Global Gag Rule.”
Video Asset: View the story of Monica Oguttu, a Kenyan health activist whose organization, the Kisumu Medical and Education Trust, is threatened by the Global Gag Rule.
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