Recently, the Center for Health and Gender Equality (CHANGE) issued a report that highlights just how detrimental the Mexico City Policy (former global gag rule) is proving to be for global health.
Since 1973 US law has prohibited US foreign-aid from using their funds to provide abortion services abroad. The Mexico City Policy which was adopted in 1984 takes this is bit further by requiring nongovernmental organizations (NGOs) to prove that they are are not using US funds to provide abortions, counsel people about abortion or refer them to get one, or advocate for abortion rights. These policies make it more difficult for providers to care for patients and for nations to advocate for social change that would have positive effects on population health.
When Trump re-instated this policy it was not a huge surprise. Pretty much every republican president since the policy’s development has re-instated it when they take office. The difference now though is that Trump has expanded the policy which is causing devastating consequences to global health that are not limited to abortion care services. Trump’s version which is called “Protecting Life in Global Health Assistance,” was not expected. This extended restrictions to not only apply to US funds providing family planning services, but also in global health initiatives that according to the Human Rights Watch fund “family planning and reproductive health, maternal and child health, nutrition, HIV/AIDS—including The President’s Plan for Emergency Relief for AIDS (PEPFAR), prevention and treatment of tuberculosis, malaria (including the President’s Malaria Initiative), infectious diseases, neglected tropical diseases, and even to water, sanitation, and hygiene programs.”
His policy has not only globally affected abortion care, but has also negatively impacted the provision of healthcare services that are not related to abortion. Important public health measures such as preventing the spread of HIV and Zika have lost funding. In the report an NGO that provides not only abortion care, but also contraception explains that this policy will lead to 6.7 million unplanned pregnancies, and approximately 21,700 maternal deaths by 2020, likely due in large part to the 2.1 million unsafe abortions that will occur, because as we know, making abortion illegal does not stop it from happening, it just makes it more dangerous.
This puts NGOs in an impossible predicament. It forces them to stop talking about and providing abortion care to global citizens or face losing a significant portion of their funding. Since the US provides the most funding worldwide to global health, the negative impact of this policy is most likely going to increase as time goes on and funding is lost. As usual the real kicker is that while supporters will claim that this bill is just meant to impact the provision of abortion, the reality is that access to contraception will decrease in about 60 countries which will contribute directly to an increase in abortions, and unsafe ones at that. Unsafe abortions and unplanned pregnancies increase maternal deaths, which is a common indicator of nation’s overall health. For the organizations who do choose to cut funding to reproductive health programs just so that they can continue to receive funding from the US, they are still going to have to pay up. This new policy means that organizations will have to use a portion of their resources just to ensure that they are being compliant.