Global Gag Rule Expansion Will Harm Global Health Gains
By Seema Jalan
Access to quality sexual and reproductive health information and services is often treated as a controversial issue. Instead, it should be treated as a human rights issue, and a key tool to allow women and girls, communities and countries, to achieve their full potential.
Girls and women around the world want the option to use contraception so they can plan their families and determine their futures. These are women like Fatuma from Tanzania. Fatuma has four children ranging from ages six to 21. She is the main earner in her family, selling donuts and tea to support her children. Fatuma does not want to have more children and goes to a Marie Stopes International (MSI) clinic every three months for contraceptive injections. She deserves to be in charge of her body, her family, and her life.
Fatuma is one of the nearly 1.5 million women in Tanzania who last year used a contraceptive provided by MSI — services that prevented 409,233 unintended pregnancies and 169,437 unsafe abortions in the country. MSI delivers approximately 33% of contraception in Tanzania, with a focus on reaching under-served women who are predominantly young, living in poverty, or residing in hard-to-reach rural locations and urban slums — or a combination of all three.
Because of the U.S. Administration’s re-imposition and unprecedented expansion of the “Global Gag Rule” — or Mexico City Policy — on January 23, MSI’s work is at risk, and it will be more difficult for millions of girls and women like Fatuma to access the contraception and health care they need. In fact, MSI estimates that continued U.S. support for its programs in Tanzania from 2017–2020 would have prevented nearly 630,000 unintended pregnancies, 200,000 abortions, and 1,300 maternal deaths, and saved around $50 million in direct health care costs.
When the Global Gag Rule was last enacted, it was confined to all U.S. bilateral (government-to-government) assistance for reproductive health and family planning undertaken by foreign NGOs — and this had devastating consequences. Health care clinics in many countries were forced to close and outreach services for the hardest to reach populations were eliminated, leaving many of the world’s poorest people without access to critical services, such as maternal and child health care, HIV testing and counseling, and contraceptives, including condoms.
Now, the administration has not only re-instated the policy, but dramatically expanded its reach to impact all U.S. global health assistance. This week, the administration issued detailed guidance on the implementation of the Global Gag Rule under a new name: “Protecting Life in Global Health Assistance.” But this policy does the opposite of what its new name suggests: it expands to other aspects of global health assistance, impacting U.S. funding not only for reproductive health and family planning, but also for maternal and child health, nutrition, HIV/AIDS, malaria, tuberculosis, infectious diseases, and neglected tropical diseases. Life-saving services will now be out of reach for women and communities who already have limited access to affordable, high-quality health care.
The expanded Global Gag Rule impacts 15 times more funding than its previous iteration, affecting nearly $9 billion of global health assistance provided by the Department of State, USAID, and the Department of Defense. The expansion effectively forces providers to choose between receiving U.S. global health assistance funds and providing comprehensive sexual and reproductive health care — at the risk of women’s health and lives. This will not protect life; rather, it will lead to more unintended pregnancies, more unsafe abortions, and more mothers dying from pregnancy-related complications. Infant and child deaths will also increase.
The United States has long been a leader in global health, helping to turn the tide against diseases like malaria and HIV, to reduce child and maternal deaths by half, and to give millions of people the chance to lead healthier lives. Under any name, the Global Gag Rule undermines longstanding, bipartisan U.S. leadership in global health and development. Its unprecedented scope will create confusion and a drag on how U.S. development assistance is provided to local and community organizations. Because of the sheer number of U.S. global health assistance recipients, we cannot yet know how deeply it will threaten some of the most effective health organizations in 60 low- and middle-income countries. In some cases, affected organizations are the only health care providers serving a given community, and these partners have the infrastructure, expertise, and community trust in areas we must reach in order to achieve our global health goals.
In short, it puts the health gains we’ve made in the world at risk. Especially for women and girls.
It also hurts U.S. interests. Women’s access to contraception is one of the world’s most effective tools to break the cycle of poverty. When women are healthy, empowered, and can plan their families, they can go to school, earn an income, have healthier children, and invest in the next generation. The Global Gag Rule therefore not only threatens women’s lives; it fundamentally restricts their economic and social potential.
Now is the time to speak out for women like Fatuma, for the health of girls and women, and for the fundamental rights of all people. Let’s work together to change course and protect the health and rights of women everywhere.
Learn more about the Universal Access Project and get involved atwww.universalaccessproject.org.
