Global Gag Rule: What we know, one year later



On January 23, 2017, President Trump issued a Presidential Memorandum stating that any foreign non-governmental organization that takes US global health funds must certify that they do not engage in abortion-related activities, including providing abortion services, counseling or referrals.

The Global Gag Rule applies to what organizations do with their own, non-US government funds, and forces health care providers to choose between providing a comprehensive spectrum of reproductive health care and taking US funding. Trump’s Global Gag Rule expands a bad policy to almost $9 billion in US foreign assistance. The consequences will be devastating for women and girls around the world.

WHAT WE KNOW SO FAR

In the summer of 2017, IWHC launched a documentation project aimed at capturing and analysing the impacts of the Global Gag Rule, in partnership with local organisations in Kenya, Nigeria, and South Africa. Through initial interviews and analysis, we have seen some clear initial trends:

 The policy jeopardizes women’s and girls’ health. Organizations and individuals heavily emphasized the potential impacts the policy will have on women’s and girls' access to health care, particularly for already-marginalized groups of women. Studies of previous versions of the policy have documented negative health implications for women, including increases in unsafe abortion and maternal death. In particular, IWHC’s initial research has raised concerns that the policy will prevent women from accessing information about/referrals for safe abortion services, leading to increased reliance on unsafe services. In some communities, women’s and girls’ access to contraceptives, maternal health care, and other sexual and reproductive health services is already at risk due to closures or reduction of services.

“Unsafe abortion is a very silent killer in Kenya…It’s likely, that we are going to have another rise in maternal mortality, which we have really seen going down.” — Monica Oguttu, Kisumu Medical and Education Trust (KMET), Kenya

“We would be losing over $250,000 if that grant had to be withdrawn because of our stand on safe abortion. What is also most dear to our heart is actually the fact that we are also going to be losing young girls and women who are supposed to contribute to the growth and development of this country for not being allowed to make a choice that would save their lives.” — Organization based in Nigeria, sub-recipient of USAID funding

 Affected communities and groups continue to experience high levels of confusion and misinformation around the policy. IWHC initial research has documented a persistent lack of understanding among affected groups about what the policy is, to whom it applies, and what activities are included under the rule. In many cases, this is leading to over-implementation. The persistent confusion and misinformation surrounding the policy is disruptive and diverts resources from essential work by implementing organizations.

“I don’t know the detail of it. I just know that you’re not supposed to in any way promote abortion or link people to services. And you have to sign a document that tells you when you do your grant… I’m just trying to think who would know. I should know. Actually, I am a person who should know, yes.” — Dr. Sue Goldstein, Soul City Institute for Justice, South Africa

“I have heard of it, but I don’t understand the details.” — Organization based in Nigeria, sub-recipient of USG funding

 The policy could threaten progress toward integrated healthcare systems. IWHC’s research has documented fears that the policy will set back recent progress toward the integration of HIV prevention, treatment, and care with other health care services – something that both national governments and the US have heavily prioritised in recent years to increase its efficiency and effectiveness. IWHC’s research suggests that the Gag Rule could pose a significant challenge to this work, potentially undoing many years of investment, fragmenting funding and the delivery of services, and undermining the efficiency of the health system.

“It’s absolutely appalling. Countries like ours depend on PEPFAR, and CDC, and USG funding for a lot of our essential health services. Women are disproportionately affected by HIV [and] this program will disproportionately affect women who are HIV positive and poorer women who need public health services… Many of these people are people who desperately need birth control, they need access to family planning services, and they do need abortions... Increasing the Global Gag Rule to cover HIV services is going to be extremely damaging." — Sally Shackleton, activist, South Africa

“The effect goes right down to the village. We see the integration in services breaking down. Commodities are not easily available; there is stock out, so then you have to go to a private provider at prices we cannot afford.” — Monica Oguttu, Kisumu Medical and Education Trust (KMET), Kenya

 The policy is already having a chilling effect on civil society engagement, cooperation, and research. Even in this early phase, the policy is already causing divisions among civil society organizations. Misinterpretations of the policy have led some organizations to believe they can no longer partner, even informally, with any organization that does work on abortion. US-based NGOs who continue to work on abortion have, in some cases, found it increasingly challenging to find qualified local partners because of the Gag Rule.

“Partners are fearful. We have just lost a partner in one of our coalitions and therefore lost funding for a five year project which started this year.” —Organization based in Kenya

“I see more and more NGOs are fearing to go there…even the advocacy around women’s rights. Where people receive money that is associated to the US, people tone down. I once heard a term called ‘soft advocacy,’ when we say something but not in a way that would expose where we are for or against [something]… And the implication is that of civil society being disarmed, I would say, over our rights to speak out.” — Organization based in South Africa, recipient of USG global health funding  The uncertainty surrounding the policy has negative effects, even when it is not in place. IWHC’s initial research has found that back-and-forth nature of US policy around abortion funding based on which political party holds the White house has caused serious problems and uncertainty for groups working in the global health space. The cycle of re-instatement and removal of the Global Gag Rule destabilizes organizations and health systems by making funding unreliable. The unpredictability surrounding US funding on this issue has made organizations reluctant to take on work in areas where funding might be jeopardized by political change.

“But of course, it's predictable, you know that Republicans come in, and they extend and make the Global Gag Rule one of the conditions that people have to absolutely adhere to, in terms of lack of abortion information, services, or advocacy work. And so we know it was coming, but I don't think we had an idea of how bad it was going to get… Yes, maybe the Democrats win power for the next 20 years, people may start to forget the threat of the Global Gag Rule. But if it's happening every four or eight years, that you're getting this ping pong effect happening, it doesn't work out well. Fear is more memorable to people.” — Dr. Tlaleng Mofokeng, Sexual and Reproductive Justice Coalition, South Africa

“Under Obama, it was there in a sense. The legacy of the Gag Rule, from Reagan… People were saying, ‘Let’s be careful because we could get another Republican again, so we don’t want to set ourselves up, let’s not change anything too much, let’s not be too supportive. Let’s keep a very narrow lens because that’s what works, that’s what will get us money, that’s what will get… Let’s not focus on something that’s going to make life difficult.’” — Marion Stevens, Sexual and Reproductive Justice Coalition, South Africa

Read the full report and policy recommendations here.


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