On October 29, U.S. Ambassador to the United Nations Kelly Craft criticized a reference to “sexual and reproductive health” in a U.N. Security Council resolution on women, peace, and security, claiming that such language “would promote abortion or suggest a right to abortion.” Aside from the fact that sexual and reproductive health encompass much more than abortion alone, the statement demonstrates pure ignorance of the implications of lack of abortion access for women around the world. There are nearly 68,000 maternal deaths per year globally from unsafe abortions. Ninety-nine percent of these deaths take place in developing countries. Effective family planning and safe abortion access can be life-saving aids for many women, especially in the global south.

We already know the impact of restricting access to abortion services in the global south. On his third day in office, President Trump signed an executive order to prohibit international organizations that receive U.S. family planning aid from providing any abortion-related services, including medical procedures, referrals, or abortion-rights advocacy. This order marked an expansion of a policy previously enacted by all Republican U.S. presidents since Ronald Reagan.

The Global Gag Rule Has Expanded Under Trump

In the midst of international efforts to reduce preventable deaths from unsafe abortions, the Trump administration’s continuation and expansion of the anti-abortion policy called the “Global Gag Rule” has elicited grave concerns from the domestic and global health sectors.

The so-called Global Gag Rule or “1984 Mexico City Policy” not only precludes U.S. aid resources from being used for abortion services, it also prohibits international NGOs from using their own funds for abortion-related activities if they are the recipients of U.S. foreign aid.

The so-called Global Gag Rule not only precludes U.S. aid resources from being used for abortion services, it also prohibits international NGOs from using their own funds for abortion-related activities if they are the recipients of U.S. foreign aid.

This rule also limits what organizations do with funds that are not from the U.S. government.

Since 1984, these restrictions have been part of the Global Gag Rule. But this administration has gone further. In March 26, 2019, it expanded its anti-abortion policies by cutting approximately $210,000 in funding to the Organization of American States, which had campaigned for legal abortion access across the Americas. Trump’s interpretation and implementation of the Global Gag Rule is also the most extensive to date, implicating almost $9 billion in U.S. funding. Previous versions of this policy addressed funding for reproductive health and family planning, but the newest expansion also impacts funding for HIV/AIDS, malaria, tuberculosis, nutrition, maternal health, health systems, and other health programs if those programs are related to abortion.

Previous versions of this policy addressed funding for reproductive health and family planning, but the newest expansion also impacts funding for HIV/AIDS, malaria, tuberculosis, nutrition, maternal health, health systems, and other health programs if those programs are related to abortion.

The effects are devastating and far-reaching, particularly for the most vulnerable communities. Women, young people, LGBTQI people, poor people, religious minorities, and people living in rural areas already face significant barriers to accessing health care; the Global Gag Rule only increases their risk of negative health outcomes.

How the Global Gag Rule Harms Women and Developing Communities

Since the Global Gag Rule was established, the International Women’s Health Coalition (IWHC) has been tracking its effects with partners in four countries: Kenya, Nepal, Nigeria, and South Africa. In the past two years, IWHC has connected with almost 200 interviewees from civil society organizations, health service providers, anti-abortion groups, and governmental agencies from these counties. IWHC’s research demonstrates that although the four countries have significantly different abortion laws, the Global Gag Rule has harmed their communities in similar ways.

Organizations that agree to comply with the policy have to take extreme measures. Many must completely restructure their organizations, from the services they offer, to the way their staff are trained, to their partnerships with other organizations. Organizations that sacrifice U.S. funding and decline to comply are also forced to restructure, reduce their services, or shut down altogether.

The Global Gag Rule has also exacerbated tensions between sexual and reproductive health organizations and organizations that specialize in HIV/AIDS prevention. Progressive organizations tend to refuse to sign the policy as a matter of principle, leaving funding for organizations that are less progressive, or even anti-LGBTQI and anti-choice.

Progressive organizations tend to refuse to sign the policy as a matter of principle, leaving funding for organizations that are less progressive, or even anti-LGBTQI and anti-choice.

A chairperson of a sexual and reproductive health and rights coalition in South Africa said: “We’ve had other groups that have now gotten funding from USAID who are anti-choice . . . They have got funding from the U.S. government to do [comprehensive sexuality education] that is just abstinence . . . they want to cure homosexuals, it’s just shocking.”

The confusion and fear around the Global Gag Rule result in spillover effects. The policy allows for the provision of post-abortion care or referrals for services in cases of rape and incest. However, many organizations that signed the policy interpret it to mean that absolutely no information related to abortion can be shared. Providing even allowable services seems risky, so many organizations avoid them altogether and avoid partnering with other organizations that do address abortion needs. Many interviewees told IWHC: “In my understanding, organizations are not allowed to be affiliated to [or work with others who are involved with] the termination of pregnancy.”

Previous versions of the Global Gag Rule have led to an increase in abortions, particularly under unsafe circumstances.

Previous versions of the Global Gag Rule have led to an increase in abortions, particularly under unsafe circumstances.

A Kenya-based organization that serves sex workers and young women of reproductive age signed the policy so they could continue to provide HIV/AIDS testing and treatment. This decision had fatal consequences. According to the director of the organization: “[After] we signed . . . we cannot advocate for sexual reproductive health services . . . As a result, we have lost two girls. One who tried to put knitting needles and the other one I don’t know what in order to self-procure an abortion. Because they know that we don’t [provide information or referrals for abortion], we have lost two girls as a result of that.”

A director of an organization in Nigeria said: “You’re creating a situation where higher rates of abortion would happen because women would always procure abortion. Nothing has said that this would not happen, that means we are going to have a higher case of maternal deaths, and in all aspects to me, it is counterproductive.”

A Violation of the Human Rights of Women and Girls

The first two years of the expanded Global Gag Rule have already seen destructive effects. The Foundation for AIDS Research reported that one third of the 286 organizations implementing the President’s Emergency Plan for AIDS Relief had changed their practices and service delivery because of the Global Gag Rule. These organizations no longer provide support for sexual and reproductive health, abortion services, outreach to youth, and HIV-related treatment.

The IWHC report reveals that the most marginalized populations – such as LGBTQI people, sex workers, and young women and women in puberty – have suffered the most from the Global Gag Rule.

The Global Gag Rule weaponizes U.S. international health funding against sexual and reproductive health and rights, which has the most devastating impact on the most vulnerable.

As a Lancet editorial suggested, the Global Gag Rule weaponizes U.S. international health funding against sexual and reproductive health and rights, which has the most devastating impact on the most vulnerable.

Global Health, Empowerment, and Rights (HER) Act

We urgently need to reverse the Global Gag Rule and prevent its future reinstatement. Senator Jeanne Shaheen (D-NH), the only woman member of the Senate Foreign Relations Committee, has sponsored legislation called the Global Health, Empowerment, and Rights (HER) Act. This legislation would lift the global gag rule imposed by President Trump.

In January 2017, Congresswoman Nita Lowey (D-NY17) and Senator Shaheen initiated a formal step to permanently repeal the Global Gag Rule. Congresswoman Lowey said, “With the dire consequences of the Administration’s expanded Global Gag Rule already being felt, permanent repeal of this vicious, anti-women policy is more important now than ever before.”

Congress must act to advance the Global HER Act without delay. As of February 2019, 150 members of Congress had cosponsored the act. In late September 2019, the Senate rejected a bipartisan amendment on the repeal of the Global Gag Rule. The Act is under the Senate process and referred to the Committee on Foreign Relations after February 2019.