President Donald Trump signs the executive order reinstating the Mexico City Policy on January 23, 2017.

New research shows that a US Republican policy is increasing rates of abortion by forty percent in 26 African countries. It is a bitter irony that the policy is designed to starve NGOS which offer advice on abortion or help for policymakers in making evidence-based decisions about abortion services. “Decisions made in Washington DC have considerable consequences for African girls’ and women’s possibilities to take control of their fertility,” one of the study authors told Hyderus.

The Mexico City Policy, also known as the global gag rule, is often overlooked. Democrats running for the Presidency often talk about the Hyde Amendment, which prevents government funds from being used to fund most domestic abortion services. The Mexico City Policy is seldom mentioned, but its effects are disastrous.

The policy, according to Kaiser Foundation, does not allow most NGO recipients of US funding to “perform or actively promote abortion as a method of family planning”. In practice, that means that they cannot advise about or refer to safe abortion services unless the life or health of the mother or foetus is at risk.

Many of the same organisations provide a broad range of healthcare assistance measures such as contraception, treatment for HIV/AIDS, and other sexual and reproductive health services. They feel that they cannot, ethically, provide those services while gagging themselves about safe abortion.

“The objective of the policy, ostensibly, is not to compel taxpayers to fund abortion services in other nations when they are not compelled to do so at home. However…if the broader idea to stop or limit abortions from happening, the global gag rule has failed.”

A placard concerning the benefits of family planning displayed near Lalibela, Ethiopia. Access to family planning services is threatened in nations including Ethiopia by the Mexico City Policy. Image credit: Maurice Chédel [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)]

In 1984, the administration of Ronald Reagan first implemented the policy. Bill Clinton rescinded it in 1993, before George W. Bush reinstated it in 2001, stating “it is my conviction that taxpayer funds should not be used to pay for abortions or advocate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.” (US funding cannot be used to provide abortion services regardless, because of longstanding restrictions in the Foreign Assistance Act). Barack Obama rescinded the policy upon assuming the presidency in 2009. In 2017, Donald Trump reinstated it again and the administration has now made it more restrictive than ever.

The objective of the policy, ostensibly, is not to compel taxpayers to fund abortion services in other nations when they are not compelled to do so at home. However, as new Lancet research suggests, if the broader idea to stop or limit abortions from happening, the global gag rule has failed.

“In 26 countries in sub-Saharan Africa…when the Mexico City Policy was in effect (2001-08), abortion rates rose among women in countries highly exposed to the policy,” the study reports. This was “relative to women in low-exposure countries and relative to periods when the policy was rescinded.” (The analysis covered the period from 1995 to 2014, in which time the policy was twice revoked (1995-2000, 2009-14) and once in place (2001-08).) The study pegs the increase in abortions at approximately forty percent – in tandem with reduced use of contraception and higher pregnancy rates.

“Many organisations affected by this policy are also providers of modern contraception,” the study authors say. Service providers in the sexual and reproductive health field are left facing a dilemma: “comply with the policy and retain US federal assistance, or maintain organisational missions that conflict with the policy and forego US funding.” The study highlights Marie Stopes International and the International Planned Parenthood Federation, noting their “[forfeit of] a substantial amount of support” due to a long-standing refusal to adhere to the global gag rule.”

“Ever since President Trump restored the global gag rule, he has gone further than his Republican predecessors did. In particular, his administration’s iteration of the policy did not just cover family planning aid, but also health assistance funds. This meant that the amount of funding covered under the policy increased from US$600 million to US$8.8 billion. It was noted at the time that US cuts to family planning aid would reduce access to contraception in sixty low- and middle-income countries. This estimation has manifest in reality.”

A mother at a family planning clinic in Malawi. Image credit: Lindsay Mgbor/Department for International Development [CC BY 2.0 (https://creativecommons.org/licenses/by/2.0)]

When President Trump reimposed the global gag rule, Amnesty International’s Americas Director Erika Guevara-Rosas branded it “a devastating blow for women’s rights.” Highlighting past periods when the policy was in effect, Guevara-Rosas wrote “the gag rule during both Reagan and Bush´s administration [sic] was a barrier to comprehensive sexual and reproductive health in many parts of the Global South…[imposing] significant cuts in funding for programs that provide family planning, HIV/AIDS treatment, emergency contraception, and other reproductive health-care services, alongside abortion services and information.”

Under the Trump administration, the Mexico City Policy has been scaled up despite domestic opposition. Secretary of State Mike Pompeo announced earlier this year that the policy would not only cover what US organisations did with their own money but that it would additionally amount to the administration “[refusing] to provide assistance to foreign NGOs that give financial support to other foreign groups in the global abortion industry.”

Ever since President Trump restored the global gag rule, he has gone further than his Republican predecessors did. In particular, his administration’s iteration of the policy did not just cover family planning aid, but also health assistance funds. This meant that the amount of funding covered under the policy increased from US$600 million to US$8.8 billion. It was noted at the time that US cuts to family planning aid would reduce access to contraception in sixty low- and middle-income countries. This estimation has manifest in reality.

Time magazine reported that, within a year of the policy’s launch, it “had disastrous effect”: clinic closures, a rise in unsafe abortions, loss of access to contraception and other reproductive health services, including life-saving procedures. The effects of this on the health of women worldwide are manifold, compromising their dignity, fertility, sexual and reproductive health, and quality of life overall.

“What is clear about the Mexico City Policy is that it takes a heavy toll on global efforts to improve the healthcare and quality of life of women. And, as The Lancet’s study has made clear, it is doing so without any incremental progress being made towards reducing the number of abortions across the globe. The opposite, in fact, is true – and we still may not have a full grasp of the damage the global gag rule inflicts.”

Women wait to avail family planning services. Image credit: Lindsay Mgbor/Department for International Development, [CC BY 2.0 (https://creativecommons.org/licenses/by/2.0)]

Writing in the article’s linked comment, Dr Joseph Zulu of the University of Zambia identifies “a complex web of socially, morally, and politically embedded factors that along with the Mexico City Policy have implications for contraceptive use and abortions…Only by situating the policy in the contexts it is implemented in and considering the wide range of relevant factors can we get a better understanding of what conditions unwanted pregnancies and unsafe abortions.”

US decisions are stopping women in Africa from controlling their own lives, Marte E. S. Haaland, co-author of the linked comment, told Hyderus. She is a PhD fellow at the Centre for International Health and the Department of Global Public and Primary Care at the University of Bergen. “The considerable rise in abortion rates they find in countries most exposed to the Mexico City Policy from 2001 to 2008 suggest that decisions made in Washington DC have considerable consequences for African girls’ and women’s possibilities to take control of their fertility. To properly understand the consequences of the policy, we must remember that the lack of contraceptives caused by the Mexico City Policy comes on top of already existing social, cultural and political barriers women often face when taking care of their reproductive health,” she said.

What is clear about the Mexico City Policy is that it takes a heavy toll on global efforts to improve the healthcare and quality of life of women. And, as The Lancet’s study has made clear, it is doing so without any incremental progress being made towards reducing the number of abortions across the globe. The opposite, in fact, is true – and we still may not have a full grasp of the damage the global gag rule inflicts.

The Lancet Global Health study, “Mexico City Policy linked to 40% increase in abortions in sub-Saharan African countries reliant on US foreign aid”, can be accessed here.