The Global Gag Rule: Playing Politics with Women's Lives
Summary
The United States has historically used its development assistance to the world’s poorest countries to promote global health and democracy. Contradicting this history, immediately upon taking office in 2001 the Bush administration reinstated a policy known as the “global gag rule,” an egregious restriction on U.S. funding for voluntary programs that provide access to family planning and other reproductive health services in developing countries (The White House, 2001).
The global gag rule uses the power of the purse to control what foreign nongovernmental family planning organizations (NGOs) do and say with their own funds. In order to be eligible for family planning funding from the U.S. Agency for International Development (USAID), NGOs may not use their own funds to provide any services related to abortion, including counseling or referrals, even if abortion is legal in their country. They also may not lobby to make or keep abortion legal in their own country (Cohen, 2004; USAID, 2001; The White House, 2001).
Under the global gag rule, health care providers cannot discuss the full range of options, including abortion, with pregnant clients. These restrictions defy medical ethics, preventing doctors from fulfilling their responsibility to provide complete information to their clients.
Beyond the clinic doors, providers who see and understand firsthand the devastation caused by unsafe and illegal abortion can do nothing to work for lifesaving changes in abortion laws. In contrast, in the U.S., it was the ability of providers and advocates to speak freely and openly about the harmful effects of our own country's abortion laws that led to the legalization of abortion and, in turn, a dramatic decrease in illness and mortality resulting from illegal abortion.
While the policy is celebrated by social conservatives in the U.S. (National Right to Life Committee, 2001), the impact of the global gag rule on the world’s poorest and most marginalized women is acute: clinics have closed, supplies have dwindled, and women are left without services (Guttmacher Institute, 2003). The result is more unwanted pregnancies and more unsafe abortions (Center for Reproductive Rights, 2003).
How Does the Global Gag Rule Work?
Through USAID, the U.S. government provides family planning assistance including funds, training, contraceptive supplies (including condoms), and technical assistance, to NGOs in more than 60 countries around the world (USAID, 2006a). USAID often works with some of the largest and most effective family planning organizations in the developing world.
The global gag rule is aimed at NGOs in other countries. It prohibits U.S. overseas development assistance for family planning from being provided to NGOs that use funding from any other source to perform abortion (in cases other than a threat to the life of a woman, rape, or incest); to provide counseling and referral for abortion; or to lobby to make abortion legal or more available in their own country. “Assistance” includes funds, commodities such as contraceptives, technical assistance, and training (USAID, 2001). The global gag rule applies regardless of the legal status of abortion in the NGO’s country.
The global gag rule forces organizations to make a choice: they may accept USAID funds, but with restrictions that will prevent them from providing a full range of services and information to their patients, or they may reject the restrictions and lose vital funding (Global Gag Rule Impact Project, 2003b).
The Global Gag Rule Returns: Politics with a Price
On January 22, 2001, newly inaugurated President George W. Bush issued an executive memorandum reinstating the global gag rule (The White House, 2001). This was a highly divisive attack on reproductive rights, coming on Bush’s first full day in office and on the 28th anniversary of the U.S. Supreme Court’s Roe v. Wade decision, which had legalized abortion nationwide. The move was the first of a campaign to mollify the president’s socially conservative base and export the administration’s anti-choice agenda to other countries (Cohen, 2003).
The global gag rule is a throwback to 1984, when President Reagan first imposed the restrictions. (He announced the policy at a global population and development conference in Mexico City. Hence, the policy has been known as the “Mexico City policy.”) The policy was carried on through the George H.W. Bush administration and was then reversed by President Clinton in 1993 on his first working day in office (Blackman, 2001; Cohen, 2004). In 1999, the Republican majority in Congress held up nearly $1 billion in back dues to the United Nations until Clinton acquiesced and reinstated the global gag rule (Cohen, 2000). The following year, the policy was again rescinded. Throughout this period, Congress has repeatedly attempted to remove or add the restrictions, depending on the balance of power.
At the heart of the global gag rule is the goal of anti-choice U.S. policymakers to stifle not only abortion-related activities in other countries, even if the activities are legal, but also international family planning in general.
The Helms Amendment
When he reinstated the policy, President Bush claimed that the global gag rule is needed to ensure that taxpayer funds are not used to pay for abortions in other countries. But taxpayer funds aren't used that way now. Since 1973, the Helms Amendment has banned the use of U.S. taxpayer funds for abortions overseas (CRS, 2006; USAID, 2001).
The White House defense of the global gag rule has become a tired canard. Insistence that “taxpayer funds should not be used to pay for abortions” (The White House, 2001) implies that U.S. funds are being used to pay for abortion. Family planning supporters, such as Senator Patrick Leahy (D-VT), rebut
“Mr. President, if current law did, in fact, permit taxpayer funds to be used to pay for or promote abortions overseas, the President might have a point. But it does not. Our law explicitly prohibits any U.S. funds from being used for abortion or to promote abortion. That has been the law for as long as I can remember. It is already against the law to use taxpayer funds for those purposes, and someone should have told the President that” (Leahy, 2001).
Global Gag Rule Targets
Despite the overwhelming evidence that the policy has had no impact on decreasing the incidence of abortion and the harm that illegal abortion inflicts, the Bush administration insists on the policy as a hallmark accomplishment of its pro-life strategy (Global Gag Rule Impact Project, 2003b; The White House, 2003).
The policy arguably has succeeded in a political sense: it has defunded organizations, such as the International Planned Parenthood Federation (IPPF), long targeted by anti-choice advocates in the United States (Cohen, 2004). Their opposition to IPPF — not to mention its U.S. member, Planned Parenthood® Federation of America, or members in other countries — is nothing new. A declassified government document from 1976 discusses a request by a member of Congress — made at the behest of the anti-choice U.S. Coalition for Life — for an investigation into whether IPPF was in compliance with the Helms amendment (Comptroller General of the United States, 1976). It was.
When challenged with evidence documenting the damage the global gag rule causes — particularly its effect of increasing abortions — the policy’s proponents seem impervious. According to the American Life League’s vice president, “The important thing is that we have hindered the efforts of organizations like Planned Parenthood to lobby for abortion, in countries where it’s illegal, using U.S. taxpayer money” (Plumer, 2006). Clearly, what the policy does is score political points at the expense of women’s freedom and health in other countries, far from view of the U.S. public.
The Global Gag Rule: Compromising the Health and Well-Being of Millions
“In one breath the U.S. is telling my government to promote human rights, good governance. In the other breath it says take away the rights of women to know about all the issues that surround their reproductive health and one of [these issues] will be abortion.”
— Nkandu Luo, Former Minister of Health of Zambia, Society for Women and AIDS in Zambia (Global Gag Rule Impact Project, 2003a)
On its face, the global gag rule is an affront to a fundamental principle of democracy: freedom of speech. A similar restriction on speech would be unconstitutional if applied to organizations in the United States. Because the organizations receiving our taxpayer-funded support operate outside the U.S. they are not granted the same protection of free speech (International Relations Committee Democratic Office, 2001). Furthermore, requiring medical service providers to withhold information from patients contravenes ethical medical practice.
In practice, the global gag rule incurs a high human cost. Medical providers who agree to work under its restrictions are required to withhold potentially lifesaving information from patients. Organizations that refuse the restrictions have been forced to cut services. The result is that the global gag rule “ties the hands of service providers and, by doing so, compromises the health and well-being of millions of women, men and children” (Global Gag Rule Impact Project, 2003b).
The Decision
When the global gag rule was reinstated, family planning providers receiving U.S. funding were faced with an ultimatum: receive USAID funds conditioned on the global gag rule or reject the restrictions and lose access to critical funding as well as contraceptives and other support (Global Gag Rule Impact Project, 2003b). The decision for NGOs is wrenching. Many of those that agreed to the terms did so with grave reservations. At a press conference in New York on February 14, 2001, Susana Galdos Silva, co-founder of Movimiento Manuela Ramos and executive director of ReproSalud, spoke of the harm the global gag rule is doing in Peru:
“My country has the third highest maternal mortality rate in the region. I cannot even discuss this with legislators in my country due to the global gag rule. And of course I am unable even to stand here in your country — where you so value free speech — and discuss openly the reasons that high maternal mortality and unsafe abortion rates continue to impact so many Peruvian women. I do not want to endanger funding for the thousands of women our project is serving” (Center for Reproductive Rights, 2001).
For those organizations that rejected the global gag rule, the impact has also been significant. The following sections provide an overview and examples of the harm caused by the global gag rule.
The Impact
The Global Gag Rule Impact Project, a collaborative research project organized by Population Action International in partnership with Ipas and Planned Parenthood Federation of America, has documented the impact of the global gag rule (Global Gag Rule Impact Project, 2003b). The research undertaken by the project has concluded that “the Global Gag Rule is taking a toll on the lives and health of women, children and families around the world” (Global Gag Rule Impact Project, 2003b). (For more information, see http://www.globalgagrule.org). This toll is exacted directly through cuts to USAID family planning funding and contraceptives that once flowed to some of the largest and most effective NGOs in the world’s poorest countries. Loss of funding has meant clinic closures and reduction in capacity of the clinics that do remain open. It has also meant cuts in projects to reach isolated and otherwise marginalized communities. Loss of commodities is threatening already precarious supplies of contraceptives. Splits between organizations that have accepted the global gag rule and those that have refused also undermine cooperation between groups that would extend the reach of services.
Access to Safe Abortion
“A straightforward public health problem with a known solution has been allowed to become the killing fields of women in developing countries, particularly Africa.”
— Fred Sai, Special Advisor to the President of Ghana, speaking on unsafe abortion, Countdown 2015, the Global Roundtable, London, 2004 (IPPF, 2006b)
A study of global abortion rates between 1995 and 2003 found that almost half of abortions performed worldwide are unsafe. More than 97 percent of these are in the developing world (Cohen, 2007). Every day, approximately 186 women die around the world due to complications from unsafe abortion (WHO, 2004). Beyond maternal deaths, unsafe abortion can cause serious and long-term damage to women’s health. The global gag rule prevents providers from taking steps that would mitigate this toll.
The global gag rule undermines efforts to reduce the number of unsafe abortions. It hampers the ability of organizations to provide family planning services, which leads to more unintended pregnancies that often end in unsafe abortions. The global gag rule also prevents NGOs from participating in democratic processes related to the reform of restrictive abortion laws and speaking out about the problem of unsafe abortion. For example, in countries like India, Cambodia, South Africa, and Romania, abortion is legal but there is a need to improve services and make them more affordable (Global Gag Rule Impact Project, 2003c).
A particularly poignant example is Nepal. Until recently, abortion was illegal and women found to have had an abortion were imprisoned. In 2002, the law was changed to allow unrestricted abortion during the first trimester (Center for Reproductive Law and Policy, 2004). The government requested international assistance to implement the new law and introduce safe, legal abortion services (Global Gag Rule Impact Project, 2003c). The need for this work was urgent, as unsafe abortion is a major contributor to Nepal’s high maternal mortality rate (Global Gag Rule Impact Project, 2003c). However, the global gag rule prohibited U.S.-funded NGOs from participating in this process. In 2004 the Safe Motherhood Network Nepal rejected critically needed U.S. funding rather than halt its activities to increase awareness about the new availability of safe, legal abortion in Nepal. In this case, PPFA stepped in to provide support to the network so it could continue its work.
Planned Parenthood Federation of America (PPFA) and the Global Gag Rule
Since the 1970s, PPFA has worked internationally to support NGOs providing family planning and related services to underserved people around the world. This work was originally supported by USAID, but when the original global gag rule was instated by President Reagan this funding ceased. In 1987 PPFA and other plaintiffs sued USAID in an attempt to reverse the policy. The U.S. Supreme Court dismissed the case in September 1990 (U.S. Department of Justice, 2000).
Today, PPFA works with developing country partners who do not accept “gagged” U.S. government funding for the family planning services they provide.
PPFA is also a member association of the International Planned Parenthood Federation (IPPF), which has member associations in 180 countries (IPPF, 2006a).
In the United States, PPFA’s 108 affiliates work to educate their policymakers and communities about the responsibility of the U.S. to support sound reproductive health policies in the U.S. and overseas, and to advocate for overturning the global gag rule.
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The Family Planning Association of Nepal (FPAN) also rejected funds. As the former director general, Dr. Nirmal Bista, testified before the Senate Foreign Relations Committee in July 2001
“Were we to accept the restricted U.S. funds, I would be prevented from speaking in my own country to my own government about a health care crisis I know first-hand. But by rejecting U.S funds, I put our clinics — clinics addressing that same health care crisis — in very real jeopardy.
"It is an untenable situation. But, we simply could not stand by and watch countless women suffer and die without doing everything we could to prevent this misery."
When FPAN refused to agree to the global gag rule and lost its U.S. funding, PPFA provided the organization with one year of bridge funding so that it could continue to provide services while seeking new support to replace lost U.S. funds.
Thanks to private funding, groups like the Safe Motherhood Network and FPAN continue working to change laws, free women incarcerated for having an abortion, and help prevent the 540 deaths of women from pregnancy-related causes per 100,000 live births each year in Nepal (Spotlight, 2000).
Family Planning Services
Currently, about 200 million women want, but do not have access to, quality, affordable contraceptive services (UNFPA, 2006). Limitations in the points of access to these services — such as too few clinics and trained community suppliers — as well as the lack of contraceptive commodities contribute to the limited access. The global gag rule is creating even more barriers to access through funding cuts to the most effective nongovernmental family planning organizations, which in turn are being forced to close clinics and constrict services. Furthermore, it is compounding the global crisis in funding for contraceptive supplies, described later in this issue brief (Global Gag Rule Impact Project, 2003b; Obaid, 2006).
To illustrate, in Kenya, two of the country’s leading family planning providers, the Family Planning Association of Kenya (FPAK) and Marie Stopes International Kenya (MSI Kenya), refused to accept U.S. funds conditioned on the global gag rule. FPAK’s parent organization, the International Planned Parenthood Federation, also rejected the global gag rule and had to cut the funds it channels to its member organizations. FPAK provided a significant share of the country’s reproductive health and contraceptive services and its clinics were used by Kenya’s Ministry of Health as reproductive health care training sites for doctors and nurses (Global Gag Rule Impact Project, 2003d; IPPF, 2006b). MSI Kenya also provided reproductive health services through clinics and trained health care providers in contraceptive services (Global Gag Rule Impact Project, 2003d). Though both organizations were long-term partners with USAID, they objected to the global gag rule as a matter of principle (Global Gag Rule Impact Project, 2003d).
Subsequent to the implementation of the global gag rule, FPAK lost funding equaling 58 percent of its annual budget, and efforts since then to raise funds from other sources have failed (Global Gag Rule Impact Project, 2003d; Global Gag Rule Impact Project, 2006a). MSI Kenya lost US $600,000 in USAID funds (Global Gag Rule Impact Project, 2003d). The organization’s loss of funds and related support translated directly into loss of services for thousands of women: the closure of eight clinics that provided primary health (including reproductive health care services) to densely populated communities (Global Gag Rule Impact Project, 2006a). In several cases, these clinics were the only provider of affordable primary health care services in the community (Global Gag Rule Impact Project, 2006a).
MSI Kenya’s Mathare Valley clinic was located in a major slum area of Nairobi and closed due to funding lost because of the global gag rule. This clinic was the only provider of basic services such as Pap tests, family planning, and HIV testing and counseling for the community’s 300,000 residents (Global Gag Rule Impact Project, 2003d). Women in the community said they would forego family planning and related preventive care due to lack of transportation and lack of time to travel to seek services elsewhere (Global Gag Rule Impact Project, 2003d).
The remaining clinics and organizational infrastructure to support them also lost capacity to provide services as a result of the global gag rule. Both organizations laid off staff, cut salaries, increased client fees, and reduced access to free services (Global Gag Rule Impact Project, 2003d).
The effects on services extend beyond access to family planning and reproductive health care. In most FPAK and MSI clinics, clients can also obtain immunizations, malaria tablets, and vitamin supplements for infants and children, as well as pre- and post-natal care (Global Gag Rule Impact Project, 2003d). These services were cut back as budgets are strained and clinics lack sufficient staff (Global Gag Rule Impact Project, 2003d; Global Gag Rule Impact Project, 2006a).
Organizations in other countries have experienced similar challenges. The Planned Parenthood Association of Zambia (PPAZ), the country’s leading nongovernmental provider of reproductive health care and related services, refused to accept funding because of the global gag rule. PPAZ’s parent organization, the International Planned Parenthood Federation, had to cut 24 percent of its grant to PPAZ due to its own global gag rule-related losses. PPAZ lost an additional two percent of its budget from cuts in direct funding from USAID (Global Gag Rule Impact Project, 2003e). As a result, PPAZ lost 40 percent of its staff, closed reproductive health centers, and discontinued partnerships with smaller organizations that relied on its assistance (Global Gag Rule Impact Project, 2006b). As a direct result of U.S. policy, the largest family planning organization and one of the country’s leaders in the fight against HIV/AIDS is now struggling to meet the growing demand for services in a country where young people under age 24 compose nearly 70 percent of the population (Global Gag Rule Impact Project, 2006b).
Undermining Community-Based Distribution Networks
The effect of the global gag rule has been a cut in services that go beyond the clinic walls and into the most marginalized and hard-to-reach communities. Community-based distribution (CBD) networks are an innovative and cost-effective way to bring services to people whose communities lack health centers or when barriers of culture, economics, or home responsibilities limit access to family planning information and services.
CBD workers are akin to traveling educators, counselors, and family planning distributors, providing information and contraceptives to remote rural and urban slum communities where services are often limited or nonexistent. Young people form an important component of CBD work and are trained to educate their peers about family planning and sexual and reproductive health issues.
Once again, while these programs focus on training, education, and preventive health care, they are in decline due to the global gag rule. The Global Gag Rule Impact Project documented many examples:
- In Ethiopia and Zambia, rural CBD programs have lost USAID contraceptive supplies and also have a reduced capacity to train and support community workers (Global Gag Rule Impact Project, 2003b).
- In Kenya, MSI and FPAK had to drastically cut their volunteer-run CBD program after the U.S. cut contraceptive supplies and reimbursement of the volunteers’ transportation costs and other out-of-pocket expenses (Global Gag Rule Impact Project, 2006a).
- In Ethiopia, where early marriage is common and the majority of pregnant teenagers have abortions, the International Planned Parenthood member association has had to reduce its training of youth peer educators (Global Gag Rule Impact Project, 2003b).
By curtailing CBD projects, the global gag rule disconnects those in rural and hard-to-reach areas from lifesaving services.
Contraceptive Supplies
Effective use of modern contraceptives is predicated on a reliable, consistent supply. As noted above, demand for contraceptives outstrips donor funding. The loss of USAID-supplied contraceptives to some of the most effective family planning service providers in the developing world is further exacerbating this shortfall. In many cases, family planning providers were either the only recipient of USAID contraceptives or were the main providers of family planning services in their respective countries (Global Gag Rule Impact Project, 2003b). Since 2002 the Global Gag Rule Impact Project documented 16 developing countries around the world where, as a result of the global gag rule, USAID-donated contraceptives were no longer supplied anywhere in the country (Global Gag Rule Impact Project, 2003b). Leading family planning providers in an additional 13 developing countries also no longer receive contraceptives from USAID (Global Gag Rule Impact Project, 2003b).
For example, the Lesotho Planned Parenthood Association (LPPA) — the International Planned Parenthood Federation’s member association in that country — was the sole recipient of USAID contraceptive supplies. In Lesotho, as many as 40 percent of women aged 20–39 are infected with HIV (British Red Cross, 2006). Through LPPA, USAID provided 426,000 condoms as well as long-acting contraceptives such as Depo-Provera to assist in Lesotho’s fight against HIV/AIDS and help prevent unintended pregnancies. When the LPPA rejected the global gag rule, USAID stopped sending supplies (Global Gag Rule Impact Project, 2003b).
A rural clinic in Ethiopia, where 70 percent of family planning clients relied on Depo-Provera to prevent pregnancies, reported being nearly out of the contraceptive after USAID cut off supplies (Global Gag Rule Impact Project, 2003b).
Additionally, many women in the developing world have come to rely on long-acting and permanent contraception to protect from unwanted pregnancies. These methods, such as IUDs and tubal ligation, depend on trained professionals as well as related supplies. The loss of staff and training, as well as the actual supplies, means fewer women are able to protect themselves from unwanted pregnancies.
HIV/AIDS
“Globally, and in every region, more adult women (15 years or older) than ever before are now living with HIV.”
— UNAIDS 2006 Report (UNAIDS, 2006)
Family planning providers are increasingly at the frontline of efforts to prevent the spread of HIV/AIDS. This is particularly critical, as women and girls are among the fastest growing HIV-infected populations (UNAIDS, 2006). Reproductive health services are “a clear entry point for the delivery of HIV/AIDS interventions” (WHO, 2007). However, the global gag rule is undermining HIV/AIDS prevention by weakening these organizations and reducing the availability of condoms for distribution through family planning organizations.
Outside of sub-Saharan Africa, the Caribbean has the highest rates of HIV/AIDS infections in the world (UNAIDS, 2006; USAID, 2004), and women in the region have the highest prevalence of HIV in the Americas (USAID, 2004). Yet, as a result of the global gag rule, the International Planned Parenthood Federation member association in St. Lucia has been forced to reduce its community outreach and education efforts to young people, including cutting a project to train 218 young people to educate their peers about HIV/AIDS and reproductive health. The “peer helpers” would have reached 12,000 school-aged children with lifesaving information (Global Gag Rule Impact Project, 2003g).
According to UNAIDS, “the future course of the world’s HIV/AIDS epidemics hinges in many respects on the behaviours young people adopt or maintain, and the contextual factors that affect those choices" (UNAIDS, 2006). Eliminating programs, such as the St. Lucia Planned Parenthood Association’s, means denying opportunities for young people to make informed, lifesaving decisions.
The global gag rule also short-circuits global HIV/AIDS efforts in the world’s most affected countries. Zambia, for example, is one of the 15 focus countries targeted for rapid scale-up of HIV/AIDS efforts as part of the President’s Emergency Plan for AIDS Relief (PEPFAR). At the current rate of infection, and without intervention, about half of all young people in Zambia who are now age 15 will likely die of AIDS (USAID, 2006b). According to USAID, “sexual contact is the number one mode of transmission of HIV in Zambia” (USAID, 2006b). As such, it is critical to discuss HIV/AIDS in the context of reproductive health. Ironically, the global gag rule has caused the defunding of the Planned Parenthood Association of Zambia (PPAZ), whose work emphasizes reaching young people with information and services aimed at preventing transmission of HIV/AIDS.
Undermining Collaboration
Compounding the negative effects outlined above, the global gag rule has had several secondary effects that further erode access to services. Effective organizations have been dropped from joint projects aimed at extending the reach of services (Global Gag Rule Impact Project, 2003e). And because some organizations agree to the terms and others have refused it, the policy has caused splits between NGOs, further weakening systems and collaboration.
In Latin America, the global gag rule has split and polarized women’s groups that used to work in concert on general reproductive health issues. “The Global Gag Rule has created ‘secondary effects’ among the NGOs we work with,” according to Dee Redwine, PPFA’s regional director for Latin America and the Caribbean. “[These] organizations are now clearly divided into two groups: those that receive [USAID family planning funding] and/or collaborate with those that are USAID funded and those that don’t. The former group is so fearful of losing funding and political support that they won’t even collaborate with the other organizations that are not willing to be silenced on the issue of unsafe abortion” (Redwine, 2006).
In Romania, a public health priority is encouraging women to shift to contraceptive use to prevent unintended pregnancies, rather than relying on abortion. The unavailability of contraception forced women to resort to abortion, leading to a cultural norm of relying on abortion for family planning. USAID has been at the forefront of a coordinated effort, involving government, private sector providers and other donors to change this norm (Global Gag Rule Impact Project, 2003f). A key element of this effort has been to build referral relationships between abortion providers and family planning providers. The global gag rule has undermined this effort by exacerbating splits between organizations that should be working together to achieve this objective. “If family planning providers are prohibited from having any association with abortion, they will not be able to reach a key group of women who could benefit greatly from access to contraception. In this way, the Global Gag Rule is self-defeating” (Global Gag Rule Impact Project, 2003f).
Governments and the Global Gag Rule
The global gag rule does not apply to developing country governments. However, along with other U.S. policies such as the emphasis on abstinence-only approaches and marginalization of condoms in HIV/AIDS prevention, the global gag rule has sent a strong message to governments that reproductive health care, family planning, and, therefore, women’s lives, are not a priority. According to the executive director of UNFPA, the United Nations Population Fund, “Most governments in poor countries have appropriate population and family planning policies, but are receiving little encouragement and insufficient funds from international and bilateral donors to implement them with conviction” (Obaid, 2006).
U.S. Isolation
Other donor countries and international organizations have greeted the actions of the United States, once one of the world’s leading proponents of family planning and reproductive health care, with dismay. The current U.S. position is a dramatic turn-about from its previous leadership in setting a global agenda to promote comprehensive access to reproductive health care. At the 1994 International Conference on Population and Development (ICPD) in Cairo, the U.S. led development of a progressive global agenda to provide universal access to reproductive health care and a host of related policies that 179 countries identified as critical to saving lives, addressing poverty, and providing a sustainable future for people and the planet. However, today “the president’s accumulated actions have distanced the United States from its own position” and that of governments around the world (Cohen, 2004).
Filling the Gap
Other donor countries and organizations have stepped in to fill the “decency gap” created by the U.S. when it withdrew support for sexual and reproductive health programs in the developing world. The European Development Fund began channeling support to IPPF and UNFPA, the United Nations Population Fund, in direct response to the U.S. decisions to defund global reproductive health efforts (Cohen, 2004).
The Safe Abortion Action Fund was launched by the United Kingdom government in February 2006. It aims to offset global gag rule-related funding losses and promote safe abortion around the world (Boseley, 2006; DFID, 2006). The UK has been joined by the governments of Denmark, Norway, Sweden, and Switzerland and other donors in contributing to the fund, which will be distributed to nongovernmental organizations who apply to work in the areas of advocacy, operations research, and service delivery (IPPF, 2007). The UK’s counterpart to USAID, the Department for International Development (DFID), elected the International Planned Parenthood Federation to administer the fund (DFID, 2006).
At the same time, advances are being made in the prioritization of reproductive health and rights. For example, in September 2006, the African Union explicitly and emphatically issued groundbreaking support for universal access to sexual and reproductive health and rights in order to combat maternal deaths (AU, 2006; IPPF, 2006c).
Conclusion
It has never been easy to fully quantify the impact of the global gag rule. Its ramifications are insidious and have occurred over many years. It is impossible to track how many deaths could have been averted with services that were cut due to the global gag rule, how many advocates were silenced from speaking out about preventable public health problems, or how many organizations were prohibited from working with their governments and other NGOs to meet the urgent health care needs of their own communities.
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Lead Author — Rhonda Schlangen, Planned Parenthood Federation of America, International Division
Published: 07.02.07 | Updated: 12.21.07
Published by International Division, Planned Parenthood® Federation of America
©2007 Planned Parenthood® Federation of America, Inc.
All rights reserved.
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Washington, DC: 202-973-4882
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