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People Are Dying in the Global South Because of Anti-Abortion Limits on US Aid

U.S. aid still can’t be used to fund abortion care. The ban causes tens of thousands of preventable deaths each year.

A teenage mother breastfeeds her infant as she heads to the dormitory during a tea-break from her classes at the Serene Haven Girl's Secondary School, an informal school that boards young mothers with their infants, some of whom are victims of sexual violence, in Kyeni, Kenya, on September 24, 2021.

Even as the overturn of Roe v. Wade continues to send shock waves throughout the U.S., it’s also having ripple effects overseas.

Nelly Munyasia, the executive director of the Reproductive Health Network in Kenya, told Truthout that after the Supreme Court ruling on Roe, Kenya and other countries with regressive abortion laws have seen renewed opposition against abortion being legalized or abortion services being expanded.

“We have seen overnight that there is stronger opposition to abortion,” Munyasia says. “People are citing the recent events around Roe v. Wade and saying that the U.S. as has made a decision when it comes to abortion, so Kenya as a country should not even be discussing it.”

The court ruling and visible power of anti-abortion forces in the U.S. have also increased fears internationally that a future presidential administration in the U.S. may eventually reinstate the “global gag rule” — a policy that prohibits foreign nonprofits that depend on U.S. global health aid from providing abortion services of any kind, including engaging in advocacy for abortion law reform, even if they use non-U.S. funds for it.

As the Guttmacher Institute explains, the global gag rule policy “has historically been put in place by Republican presidents and rescinded by Democratic ones,” since it was first created in 1984.

In keeping with that trend, the Trump administration reinstated and expanded the global gag rule in 2017, dictating that any nonprofit receiving U.S. health aid cannot offer abortion services even using other funding sources.

While the Biden administration repealed this policy in 2021, the damage was done, and the consequences have been devastating. It is time to permanently end the policy once and for all.

Congress and the Biden administration have the opportunity to end the global gag rule permanently via the Global Health, Empowerment and Rights (Global HER) Act, which was reintroduced in the House and Senate in January 2021, when Biden repealed the global gag rule. If this bill were to pass, future presidents would be unable to unilaterally reinstate this harmful policy, and would allow nonprofits in the Global South to use U.S. foreign aid for various health care services, even if they also offer abortion services supported through a separate funding stream.

Within just two weeks of being reintroduced, the bill saw significant support from 177 co-sponsors in the House and 46 in the Senate. However, making this bill into law would be just the first half of the battle.

The Global Health, Empowerment and Rights Act would bring an end to the U.S. interfering in what organizations do with funding from other sources, but it does not address the issue of whether U.S. aid can be used to fund abortion services. In order to end the ban on the use of U.S. funds to support abortion services abroad, Congress would also need to permanently repeal the source of this ban: the Helms Amendment. The Abortion Is Health Care Everywhere Act, which was reintroduced in the House in March 2021, and currently has the support of 165 cosponsors, would repeal the Helms Amendment if passed. According to the Guttmacher Institute, repealing the Helms Amendment would mean 19 million fewer unsafe abortions each year globally, 17,000 fewer maternal deaths each year and a 98 percent decline in the overall number of maternal deaths due to abortion in the countries affected by the ban.

The global gag rule does not only influence abortion. Organizations in the Global South that provide or advocate for abortion rights, and have depended on USAID in the past, lost significant funding during the Trump era. This led to staff layoffs, and disruption of other sexual and reproductive health and rights.

Munyasia’s organization in Kenya provides integrated reproductive health and rights services like HIV screening and access to contraceptives. “In Kenya, we are currently facing a triple threat: high number of teen pregnancies, HIV infections and gender-based violence. The lack of funding only makes the situation worse,” Munyasia told Truthout.

The global gag rule, also known as the Mexico City Policy, was first enacted under the Reagan administration in 1984, and has since been enacted or repealed based on the presidency, leaving health care access in the Global South vulnerable to political shifts in the U.S. Over the years, researchers have found an increase in HIV infections, and child and maternal mortality during periods where the gag rule has been in effect.

A 2022 study that evaluated the impact of the policy on the 38 countries (as of 2015) which rely on U.S. health aid found that reinstating the global gag rule in the future is likely to result in approximately 24,000 additional child deaths and 2,700 additional maternal deaths every year. Almost 50 percent of global HIV and AIDS funding comes from the U.S. government and HIV services have suffered incredibly in the Trump era global gag rule. The 2022 study also found that 90,000 additional new HIV infections every year are also likely to occur when the policy is in effect. Over a four-year presidential term, this amounts to 108,000 maternal and child deaths and 360,000 more HIV infections, compared to when the policy is not in effect.

The Family Planning Association of Nepal, a member association of the International Planned Parenthood Federation, was the first to offer family planning, abortion services, and other sexual and reproductive health and rights services in Nepal. With uncertain funding, their services have been hit. Abortion is just one of the many services that a client availing services receives. The Family Planning Association of Nepal also offers proper gynecological care, cervical cancer screenings, help in situations of gender-based violence, and more. It is an integrated service which also includes counseling and STI checkups. “With Nepal’s hilly terrain and scattered population in the mountainous region, the cost of these services is quite high. We want to reach everyone at the last mile too,” the association’s program director, Bina Shrestha, told Truthout.

Bergen Cooper, director of policy research at Fòs Feminista, a U.S.-based organization that has been studying the impact of the global gag rule, explained the policy’s impacts beyond family planning and abortion: “We found impacts in water, sanitation and hygiene, and HIV-specific impacts on key populations on LGBTQI populations and sex worker populations,” she told Truthout.

“It’s rare that you will find the standalone clinic that only provides abortion services. These are services that are integrated into other health services. So, for example, an organization lost funding because they could not comply with the global gag rule. As a result, it limited their ability to provide services around hand-washing promotion interventions, anti-microbial resistance activities, neglected tropical disease activities, and prevention and treatment of wash-related illnesses.”

Moreover, it has also been seen that the gag rule policy being in effect does not reduce abortion, but rather increases unsafe abortions. Research has found that in countries like Madagascar where abortion is illegal, the global gag rule made accessing reproductive care even harder. Reportedly, a nongovernmental organization in Madagascar was forced to close clinics, and shut down a program that offered free contraceptives and other family planning services to 17,000 women and girls living in poverty. As a result, health providers are now reporting an increase in women seeking treatment for complications occurring from unsafe abortions.

Kenneth Juma, one of the researchers of “Beyond abortion: impacts of the expanded global gag rule in Kenya, Madagascar and Nepal,” adds that whether abortion is legal or not, abortions cannot be stopped. “What criminalization does is that it makes the abortions much more unsafe, because women who have decided to terminate their pregnancies, you cannot stop them. They will use every means possible to terminate.”

He adds, “So the actual, ultimate results of restrictive policies and reduced funding for abortion is that there’ll be a lot of unsafe abortions, which ultimately will be a burden to the health system.”

The reversal of Roe v. Wade has given providers and advocates across the world the sense that they need to seek out stronger funding sources which are more dependable. Juma says there need to be efforts made to improve self-management of medical abortions in absence of adequate funding: “In countries where mifepristone and misoprostol are already available, there’s an opportunity for greater access to self-manage safe abortions, through the support of community structures and nonprofits servicing the region.” However, this is not in lieu of better and more stable policies. There is a need for countries to develop policies that are not necessarily driven by politics, but rather policies that reflect where the evidence lies.

“One of the recommendations we’ve had is that there is a need for a permanent repeal, but that permanent repeal should not happen at the expense of what each and every country must do,” Juma told Truthout. “Every country must also strengthen the resilience of health systems towards shocks, external or international shocks, such as the enactment of the global gag rule or the reversal of Roe v. Wade. If we have an agreement that depends on you for a particular service, how does it happen that every few years, there is a drastic change that affects our planning?”

While the Supreme Court ruling on Roe v. Wade does not have a legal impact on how global health assistance is allocated or enabled or restricted, it does have an ideological and political impact.

“The Biden administration has stated that it is their policy to support sexual and reproductive health and rights domestically and globally,” said Cooper. “But stating it and doing everything within their power to support it are not the same thing. And they really do need to step up to permanently end the global gag rule.”