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Contraception in the Crosshairs: The Real Impact of the Global Gag Rule

International Women’s Day should be a celebration of the progress made toward gender equality. Instead, because of the Global Gag Rule, it’s a time to lament the biggest threat to women’s rights in decades, says Ulla Müller, president and CEO of EngenderHealth.

Written by Ulla Müller Published on Read time Approx. 5 minutes
A woman in Togo, where the need for contraception far outstrips availability. AP/Schalk van Zuydam

There is a saying in South Africa: “You strike a woman, you strike a rock.”

It’s a phrase that evokes the unshakeable strength and endurance of women. It speaks to their courage in the face of oppression, to their resilience and life force. And especially today, as we mark International Women’s Day, it reminds us that women are the bedrock of the world.

I thought of the phrase often during my recent travels. Two weeks after the White House issued an executive order reinstating the Mexico City Policy, also known as the Global Gag Rule, I flew to Lome, Togo, for a field visit. Lome is home base for Agir pour la Planification Familiale (AgirPF), a regional health project funded by USAID and managed by EngenderHealth. AgirPF was launched in 2013 to strengthen family planning services in five West African countries – Burkina Faso, Cote d’Ivoire, Mauritania, Niger and Togo – where the need for contraception far outstrips availability.

This is a region where the average woman gets married in her teens and gives birth to five or six children – most of them delivered at home, without the help of a skilled birth attendant. It’s a region where maternal and infant mortality rates are sky-high, where the risk of mother-to-child HIV transmission is significant, and where early, frequent pregnancies leave thousands of women suffering through the nightmare of obstetric fistula.

There are no quick fixes here; the goal of AgirPF is to build local healthcare capacity, so that eventually every woman will be able to get the family-planning care she wants and needs. The key is to work with governments and local NGOs to integrate high-quality contraceptive services into the overall continuum of care.

This is critical, lifesaving work with enormous potential to uplift women’s lives. Now, because of the Global Gag Rule, much of it is in jeopardy.

The main thing to understand about the Global Gag Rule is that it isn’t really about abortion. It doesn’t eliminate U.S. funding for abortion, because there is no U.S. funding for abortion. (The Helms Amendment barred that door in 1973.) And it doesn’t reduce the abortion rate overseas – the last time the policy was in effect, during the prior Republican administration, the abortion rate in Sub-Saharan Africa more than doubled.

What the Global Gag Rule actually does – and this we also know from what happened before – is drastically reduce women’s access to contraception.

AgirPF is a case in point. The project is managed by EngenderHealth, but it’s implemented through foreign NGOs who will now be subject to the Gag Rule. In Togo, for example, our partner is the Association Togolaise pour le Bien-être Familial (ATBEF), the local affiliate of the International Planned Parenthood Federation (IPPF). ATBEF is an important provider of healthcare in Togo and offers family planning, full maternity care (antenatal, delivery and postpartum), primary care, HIV testing, premarital counseling and infertility treatment. Without the participation of ATBEF and other IPPF affiliates, the AgirPF project cannot succeed.

But with the Global Gag Rule in effect, NGOs like ATBEF will be forced out. The rule puts these providers in an impossible position: To continue receiving U.S. funds, they must agree not to use their own funds (or any other donor’s funds) to so much as discuss abortion. In West Africa, where abortion is heavily restricted, this means they can’t provide accurate medical information about the procedure or advise their governments on decriminalization. It’s an extraordinary overreach into the internal affairs of foreign NGOs, requiring health professionals to violate medical ethics, betray their patients, and, in some cases, flout their own government’s regulations. By interfering with critical capacity-building work in the health sector, the Gag Rule has the potential to destabilize an entire nation.

When the Global Gag Rule was in effect during the last Republican administration, family planning clinics throughout Africa, Asia and the Middle East were forced to reduce services or shut down entirely. With access to contraception severely curtailed, the number of unplanned pregnancies rose precipitously – as did the incidence of maternal complications and unsafe abortions. Thousands of women died.

But the new version of the Gag Rule promises to be even more deadly. The policy announced by the White House in January 2017 is far crueler than any previous version of the policy and is vastly greater in scope. This isn’t just a return to the 2001-2008 status quo. It’s worse.

What’s even more startling is the breadth of the new Gag Rule’s reach. In the past, the rule only applied to U.S. aid for family planning; other health programs were exempted. The new version covers the entire U.S. global health budget: as much as $9 billion in aid. Every single program for the whole gamut of global health issues – including HIV and AIDS, malaria, Zika, polio, Ebola and infant and maternal health – will now be held hostage to the Gag Rule. In a world of integrated healthcare, where a single clinic might handle everything from contraception to childhood immunizations to HIV treatment, this is a recipe for unprecedented disaster.

And once again, it is women who will bear the brunt of the suffering. The gendered nature of this assault on global health cannot be glossed over: This is an attack on women. After all, it’s not men who will die in childbirth or bleed out in a botched abortion; it’s not men who will be denied lifesaving contraception or cut off from basic medical care. It’s women.

That’s not an upbeat message for International Women’s Day, but it’s the truth. Traditionally, this is an occasion to take stock of women’s status around the world and celebrate the progress that has been made on the long, slow journey to gender equality. This year, with the new Gag Rule poised to wreak global havoc, I think we must acknowledge that women are facing the biggest threat to their health and rights in decades.

I lived in Africa for 20 years, working in many different sectors: education, transportation, labor markets, mining, food security. The only intervention I’ve seen that really works – that really makes a difference in women’s lives – is family planning. When a woman can decide for herself whether and when to get pregnant, she holds the key to her own life. Everything else follows: better health for herself and her children, the chance to get an education, an opportunity to prosper.

That’s why family planning is more than just a health intervention. It’s a societal intervention. Family planning unlocks women’s potential as economic actors, as agents of change and as custodians of culture. It enables parents to provide better opportunities for their children. It leads to an educated and productive citizenry that can support a vibrant economy and cope with the challenges of the modern world. A society where women are empowered is stronger, more stable and more prosperous for all.

To know all of this, and then to think of what is happening with the Global Gag Rule, is heartbreaking. It’s even more heartbreaking to think of the women – the rocks of endurance – to whom we’ve promised so much and delivered so little.

The views expressed in this article belong to the author and do not necessarily reflect the editorial policy of Women & Girls.

CORRECTION: This story has been updated to remove reference to post-abortion care, which is not specifically targeted by the current version of the Global Gag Rule.

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