“This group just made it more difficult for women to get access to healthcare worldwide. You tell me what’s wrong with this picture,” laments the US Senator for California, Kamala Harris, in her caption of a recent photo of President Donald Trump and his team. The photograph in question shows the new world leader signing an executive order re-imposing the so-called “global gag rule,” surrounded by seven senior staffers, all male, initiating a policy that stands to affect millions of women worldwide.
The Mexico City Policy restricts government funds to any non-governmental organisations who “perform or actively promote abortion as a method of family planning.” In effect, groups wishing to receive family planning funds from the United States Agency for International Aid (USAID) must certify that they will not engage in voluntary abortion-related activities, even with funds from non-US sources. Whilst it is clear what constitutes “performing” abortion, the parameters of “active promotion” includes the provision of information on the availability or benefits of abortion, governmental lobbying, and public campaigning, which has lead to its opponents naming it “the global gag rule.”
After an unabashedly authentic campaign trail, this move will come as a sad, but not surprising revelation, as Trump emulates several of his Republican predecessors. First instituted in 1984 by Ronald Reagan, the then President, at the UN International Conference for Population in Mexico City, it built upon existing policy that blocked US funds from being directly used to fund abortion. The highly partisan policy was revoked by Clinton in 1993, reinstated by Bush in 2001, before being rescinded once more by Obama in 2009. The Trump administration however has not just seen the policy revived, but revised too, expanding its scope from family planning funding, to all US global health assistance, including HIV and maternal and child health programmes, giving the aggressive policy more teeth than ever. According to Suzanne Ehlers, CEO of global reproductive health advocacy group PAI, this amendment expands the current limit to funds from a potential $600m to a staggering $9.5 billion, with effects stretching as far as groups working against child marriage, gender based violence, HIV and even malaria.
32 years on from its inception—with 17 years of active implementation—what are the consequences of the policy on the ground? Ironically, a 2011 Stanford University study found an increase in abortion rates associated with the policy in countries of high exposure, specifically sub-Saharan Africa, one of the hotspots for poor family planning, unsafe abortion and home to those most detrimentally affected by the policy’s reach. Given that many of the services that had to forego US funding in the wake of the policy also provided broad family planning care—most notably access to contraception—unintended pregnancy rates actually rose and thus did abortion, both safe and unsafe. Unsafe abortion, one of five leading causes of maternal mortality worldwide, alongside bleeding, infection, high blood pressure and complicated delivery, is the only one that is completely preventable, accounting for an alarming 13% of all maternal deaths according to the World Health Organisation.
Marie Stopes International, an NGO providing contraception and safe abortion to women in urban and rural communities all over the world, predicts that Trump’s first term alone will herald 2.2 million abortions, of which 2.1 million will be unsafe, 21,700 maternal deaths, and $400m in direct healthcare costs as a result of their service cuts alone. The overall global impact will indubitably be much greater.
Whilst better birth control, education, and greater women’s rights mean that abortion rates decline globally, this archaic hangover will see the already overburdened governments of developing countries pressed for more funds and rob many women of their right not only to maternal care, but primary care altogether.
Just days after millions of women marched in opposition to his inauguration, this contentious move will appease many worried Republicans, witnessing an unpredictable Mr Trump pick up the party mantle. Women’s groups and health advocates worldwide, however, will mourn this, the first in a likely string of imminent domestic and international changes to the healthcare landscape.
Kushal Patel, foundation doctor working at University College Hospital. F1 Representative for the North Central Thames Foundation School. He has studied the implications of the Mexico City Policy at university.
Competing interests: None declared.