Thursday, April 3, 2008

The Global Gag Rule- A Matter of Life and Death

The Global Gag Rule (or the Mexico City Policy as it is best known) which restricts the use of funds on abortion and other related aspects of reproductive medicine, is having a detrimental effect on the health of women--specifically poor women of color--around the world. Chances are high that ending the GGR will hinge on who is in the White House. And for many women in developing countries, that choice will be a matter of life and death.

The Global Gag Rule came about as a backlash to Roe v. Wade. First formulated by Sen. Jesse Helms, it restricted access to abortions to women in developing countries where America was providing aid. It's most extreme implementation came in 1984, under President Ronald Reagan, in the form of the so-called Mexico City Policy. As a USAID states on their site, "The Mexico City Policy requires foreign nongovernmental organizations to certify that they will not perform or actively promote abortion as a method of family planning as a condition for receiving USAID assistance for family planning." Thus not only was American health aid not allowed to go towards such endeavors, but poor countries were themselves restricted from using their own public funding for abortion and related aspects of women's health. The GGR remained in effect until 1993, when newly elected President Bill Clinton repealed the policy, citing it as "excessively broad" and stated that it "undermined efforts to promote safe and efficacious family planning programs in foreign nations."

Upon taking office in 2001 however, President George W. Bush immediately re-authorized the GGR as US foreign policy through executive order, stating, "It is my conviction that taxpayer funds should not be used to pay for abortions or advocate or actively promote abortion, either here or abroad."

Since then, numerous domestic and international groups have been tracking the consequences of the reimplementation of the Mexico City Policy. What they've found is that across the board it has been dire, contributing to a lack of access for women in poor countries to comprehensive health services. By denyingNGOs from "actively promoting abortion," the GGR also restricts any attempts to aid local grassroots women's movements in foreign countries fighting to legalize or make abortion available as a method of family planning.

Dr. Ejike Oji of Nigeria testifying before the House Committee on Foreign Affairs states:

"Women in Nigeria are dying and are maimed daily and needlessly from lack of access to reproductive health care and the all-too-often resulting unsafe abortions. U.S. policy – the Global Gag Rule – is directly at odds with efforts to address these threats to maternal health.

In Kenya, where abortion is illegal with the exception of rape and where the life of
the mother is at risk, unsafe abortion accounts for 30% of maternal deaths, and at least half of the hospitalizations in public gynecology wards. Because of this Kenyan doctors often take a very "liberal" approach to the interpretation of Kenya's restrictive abortion policy, with the knowledge that if they do not, women will be forced to conduct unsafe abortions that place their lives at higher risk. While local Kenyan women's groups have been pushing for greater reproductive rights, the GGR undermines their efforts at every turn. A January 2008 article in Ms. Magazine notes that this forces many such groups and physicians to make hard choices:

Women's-rights groups in Kenya have been pushing for a new national law on reproductive rights, as well as supporting a continental protocol on the rights of African women and a patients' bill of rights. But they're not helped in their efforts to improve reproductive health care by the global gag rule, which has forced a number of clinics to turn down U.S. funds rather than stop discussing abortion. Three clinics of the Family Planning Association of Kenya (an affiliate of the International Planned Parenthood Federation) and two clinics of Marie Stopes International (the U.K.-based reproductive-health NGO) have been closed for loss of funds, according to a 2004 report from the Center for Reproductive Health Research and Policy in San Francisco.

As a 2006 article on Uganda from Off Our Backs points out, "Bush foreign policy, as seen in the Global Gag Rule, contributes to the silence that surrounds abortion.... The policy was meant to reduce the number of abortions; instead, women who need these services are dying from complications due to unsafe abortions."

Tied into women's reproductive rights, the GGR has also had a detrimental effect on varied aspects of sex education, so vital in fighting the global AIDS epidemic:

The global gag rule has also led to a pullback in overseas delivery of contraceptives, according to recent testimony by Rep. Nita M.Lowey (D-N.Y.) before the House Foreign Affairs Committee: "U.S. shipments of contraceptives have ceased to 20 developing nations in Africa, Asia and the Middle East. In some areas, the largest distribution centers for contraceptives have experienced decreased access for over 50 percent of the women they serve."

This decrease in funding for essentials such as contraceptives is already threatening to reverse positive results in high HIV-infected areas such as Uganda, where the impressive gains made in encouraging safe-education is now being replaced by "abstinence-only" programs--which is supported by the GGR's broad premise. This has often put conservative US policies in line with the policies of conservatives in Uganda, both tragically out of touch with what global and local physicians see as the pressing medical needs of the people.

University of Wisconsin-Madison faculty member John Ferrick, who organizes an annual Uganda Study Abroad trip, has noticed first hand how GGR has dismantled that country's effective fight against HIV spread and infection. past years there were many condom advertisements and billboards. This was in accordance with Uganda's ABC program to fight HIV/AIDS: Abstinence, Be faithful, use Condoms. Their ABC program helped to make them a model for dealing with HIV/AIDS in Sub-Saharan Africa. During my trip this year, however, I saw only one condom billboard. There was, however, an abundance of abstinence billboards, sponsored by the First Lady of Uganda, JanetMuseveni. The switch from condoms to abstinence is not only because of the beliefs of President Museveni and his wife but also because of Washington, D.C

Local MD Fred Wabwire-Mangen, MD and professor at the Ugandan Institute of Public Health, agrees: "Washington will fund anything for abstinence," he says.

In early March 2008, Population Action International (PAI) and the Sexuality Information and Education Council of the United States (SIECUS) conducted a joint policy research trip to Zambia, to study the effects of the GGR and the conservative US foreign aid policy on women's health. Their findings paint a dire picture:

By all appearances, reproductive health seems to have vanished from Zambia both conceptually and as a health service. At the policy level, there is no official framework forSRHR. At the program level, sexual and reproductive health (SRH) services are thin and fall far short of demand. Rates of maternal death, unplanned pregnancy and unsafe abortion -- especially among young women -- are persistently high. Contraceptivestockouts have become more frequent and community-based SRH outreach throughout rural Zambia is non-existent, thanks to the Global Gag Rule. While the U.S. is one of a handful of donors providing FP/RH assistance and donated contraceptives to Zambia (about $6 million in FY07, compared with $216 million in PEPFAR funding), this small amount of U.S. assistance is hamstrung by Global Gag Rule restrictions....

As recent as 2007, the U.S. House of Representatives voted to modify the GGR so that organizations that were ineligible for U.S. assistance under the restrictive policy could at least receive contraceptives. The Senate supported this provision and, additionally, passed a provision to overturn the entire policy. But faced with a Bush Administration veto of all the funding for foreign assistance programs, and lacking the numbers to override it, this language never made it into the final bill, and the Mexico City Policy remains intact. This month the House Foreign Affairs Committee passed a bill to increase funding for the fight against HIV/AIDS thru PEPFAR (President's Emergency Plan for AIDS Relief). At question is whether the final bill will reflect a substantial challenge to GGR, or maintain the status quo.

So what can be done?

For one, GET INVOLVED. There are numerous groups (listed below) who have been fighting to repeal the Global Gag Rule through lobbying and education.

Second, VOTE. There is a justifiable tendency to become cynical with politics, and especially in this overlong primary season, to become disenchanted. But the GGR was put into effect by people voted into office, on the Congressional and Executive level, and it is the only way to see it repealed. It's your money that's being used. You can decide on whether you want to have it spent further on such things as a 100 year occupation of Iraq, or whether it can possibly be used to save lives at home and abroad.

And third, VOTE SMART. Disillusion with the loss of a preferred primary candidate may lead some to sit out an election or--in what can only be called absurdity--vote for a candidate opposed to their political leanings. Before anyone walks into a booth to push a button or pull a lever out "sour grapes," remember that real lives are at risk. Find out where your candidate, and even your lesser preferred candidate, stands on this issue, before voting for someone who stands for an opposing principle.

It might just be another insignifcant vote for you, one that may not yield *all* that you were hoping for. But for many women across the globe, it's a matter of life and death.

See also:


How the Mexico City Policy Perpetuates the High Rate of Unsafe Abortion in Nigeria- Dr.Ejike Oji

Reproductive Rights Without Borders

Are U.S. Policies Killing Women?

What Zambia Teaches Us About International AIDS Policy

Uganda and the "Global Gag Rule"- Off Our Backs


Free Choice Saves Lives 2008 Presidential Candidate Campaign

Access Denied: US Restrictions on International Family Planning

International Women's Health Coalition

Center for Reproductive Rights


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