The Global Gag Rule – the Fightback Has Already Begun

Jan 27, 2017, by Safe Abortion

Donald Trump's first death-dealing directive from the White House challenged by the Dutch government and others

President Trump reinstated a policy on 23 January 2017, called both the Mexico City Policy after the place where it was first signed, and the Global Gag Rule, because it tries to silence people who provide abortion services or even give anyone information about safe abortion – by withholding funding for other reproductive health care that they provide, such as contraception. The policy originated in 1984 under the Reagan presidency and was reinstituted under both Bush governments, all three Republicans. It has been in force for 17 of the last 32 years. The policy in the past required non-US NGOs to certify that they would not “perform or actively promote abortion as a method of family planning”, even with non-US funds, as a condition for receiving USAID global family planning assistance.

The phrase "abortion as a method of family planning" is an anti-abortion invention; it refers to any abortion that is carried out because a pregnancy is unwanted, i.e. the vast majority of abortions. The rest are considered "different" because they are requested for health reasons (risk to the woman's life) or as a result of a crime (rape or incest). The Gag Rule represents the ultimately self-defeating attempt to separate the need for contraception from the need for abortion.

The policy applies to non-US NGOs
A detailed report by the Kaiser Family Foundation, published on 23 January 2017, explains that before the Mexico City policy, USAID recipients of family planning funds could use non-US funds to engage in abortion-related activities, but were required to maintain segregated accounts for US assistance. The Mexico City Policy said foreign NGOs were no longer allowed to carry out voluntary abortion-related activities if they wished to continue to receive or be able to receive US family planning funds.

Under the Trump version of the policy of 23 January 2017, NGOs who are receiving any US global health assistance will have to sign the Gag Rule, including those running HIV programmes, maternal and child health programmes, infectious diseases programmes, or those dealing with Zika virus – as well as family planning programmes. Moreover, it applies whether the funds come from USAID, as in the past, or from any US government agency or department (assuming this is found to be legal).

The policy applies to international and regional NGOs based outside the USA, and local NGOs in countries who receive US funding for family planning or other global health assistance. US NGOs are not directly subject to the Gag Rule, but they must agree to ensure that they do not provide family planning assistance to any foreign NGO sub-recipients unless those sub-recipients have first certified adherence to the policy. If they don't sign, they will lose the funding.

NGOs are required to certify that they do not provide abortion services, even with non-US funds. Other activities that are not permitted include:

> providing advice and information about and offering referral for abortion – where legal – as part of the full range of family planning options;
> promoting changes in a country’s laws or policies related to abortion as a method of family planning (i.e. engaging in lobbying); and
> conducting public information campaigns about abortion as a method of family planning.

The policy has not prohibited providing advice and information about abortion, doing abortions or offering referral for abortion in cases where the pregnancy has either posed a risk to the life of the woman or resulted from incest or rape. It is also OK to respond to a question about where a safe, legal abortion may be obtained when a woman who is already pregnant clearly states that she has already decided to have a legal abortion (this is considered passively providing information).

However, fear of unknowingly crossing a line and being penalised has often meant NGOs do nothing whatsoever related to abortion in order to feel safe about retaining their funding.

Policy as it applies to recipient governments
The Gag Rule does not apply to governments. Some news articles this week have confused this because there are other US foreign policy directives, in place since 1973, that forbid governments receiving family planning assistance from the US government, if they do the following:

>  pay for the performance of abortion as a method of family planning or motivate or coerce any person to practice abortion (the Helms Amendment, 1973, to the Foreign Assistance Act);
> pay for biomedical research related to methods of abortion or the performance of abortion as a method of family planning (the Biden Amendment, 1981, to the Foreign Assistance Act); or
> lobby for or against abortion (the Siljander Amendment, first included in annual appropriations in 1981 and included each year thereafter).

In 1985, shortly after the Mexico City Policy was first announced in 1984, the Kemp-Kasten Amendment was passed, prohibiting the use of US aid to fund any organisation or programme, as determined by the US President, that supports or participates in the management of a programme of coercive abortion or involuntary sterilisation (it is now included in annual appropriations). In Trump's reinstatement of the Mexico City policy, this memo included, for the first time, directions to the Secretary of State to enforce the Kemp-Kasten Amendment. Such directions had been provided separately in the past.

Some examples of the consequences
Here are some examples of the consequences of these prohibitions under past iterations of the Gag Rule from a recently published paper by the Center for Health and Gender Equity:

>A 2011 Stanford University study, published in the Bulletin of the World Health Organization, examined the effects of the Gag Rule in sub-Saharan Africa after President GW Bush reinstated it in 2001. It found that the "policy is associated with increases in abortion rates in sub-Saharan African countries” due to reduced access to contraception leading to increased unintended pregnancies and more reliance on (unsafe) abortion to prevent unwanted births.

> It hampered HIV prevention efforts because of the closing of health clinics and disruption of relationships and supply chains of commodities – leading to reduced access to condoms and sexual health services generally. For example, during the Clinton presidency, the Lesotho Planned Parenthood Association received 426,000 condoms over two years from USAID. When the Gag Rule went back into effect in 2001, USAID had to suspend condom shipments to Lesotho because Planned Parenthood was the only provider of condoms in that country. At the time the condom shipments ceased, one in four women in Lesotho was infected with HIV.

> The Gag Rule also resulted in the closure and consolidation of clinics in countries whose USAID funding was stopped. For example, a 2015 study found that the Planned Parenthood Association of Ghana had to close and/or consolidate many family planning clinics because they could not receive USAID funding after the imposition of the Gag Rule. In the aftermath, there was an increase in unwanted pregnancies across the country.

> Research conducted from 2002 to 2006 found there was a devastating impact on the health of women in Kenya. The Family Planning Association of Kenya and Marie Stopes International Kenya, leading providers of health care in poor and rural communities in the country, refused USAID funding rather than comply with the Gag Rule. A 2005 study from the Joseph R Crowley Program at Fordham University found that this forced them to drastically curtail community-based outreach activities for contraceptive counselling and provision, condom distribution, and HIV testing, and the flow and availability of contraceptive supplies.

> A consortium of NGOs led by Population Action International also found that USAID had to cut off shipments of contraceptives – already in short supply – to 16 countries in sub-Saharan Africa, Asia, and the Middle East.

What cannot be forgotten is how much governments, health service providers and other NGOs work together, so that restrictions on one will affect them all. Reports published by EngenderHealth in 2006 on what happened because of the Gag Rule and other directives in Nepal, Kenya and Zambia, for example, describe devastating setbacks in programmes and service provision.

The situation for abortion in Nepal is nevertheless a success story. The country reformed the abortion law in 2002 to allow abortion on request in the first trimester of pregnancy, managed to rescue and reverse the damage to their family planning programme and slowly rebuild these services and provide abortions in the public health system. This year, 2017, abortion services will be free to women who receive them in the public heath system, thanks to a new government subsidy. Nepal has managed to improve women's health indicators over these years, even though they like so many others paid a high price.

From South Africa, Marion Stevens, Chair of the Sexual and Reproductive Justice Coalition, writes: "Following the re-imposition of the Gag Rule by Bush, in 2000 the HIV treatment movement moved to exclude practically any intersectional analysis that included reproductive rights and abortion. The women’s rights, reproductive rights and abortion rights movement in South Africa was decimated. Folks flocked to jobs in the HIV treatment and social justice world and resigned from boards and groups doing abortion work. The effect was insidious because the Department of Health then moved to exclude committed programming on abortion provision. The focus is now on maternal health only, with a 'family planning and population control' framework. We have not recovered, and deaths from unsafe abortion have increased, accounting for almost 10% of maternal deaths in South Africa."  And this is despite a liberal abortion law, passed in 1996.

What is likely to happen in South Africa this time around? A 25 January report by TimesLive in South Africa quotes US Embassy spokesperson Cynthia Harvey to say that no US agency is currently funding abortion abroad, including in South Africa. However, Eddie Mhlanga‚ Provincial Specialist in Obstetrics and Gynecology in the Mpumalanga Department of Health‚ said that the Gag Rule would stop any NGO in the country that offers HIV services and prevention options from giving women who come for HIV treatment information about termination of pregnancy, even if they have an unwanted pregnancy. He said the state had been "captured by Americans" and that US funding had allowed Americans a huge say over South African health policy.

In the past, US funding to UNFPA was also dealt an enormous blow. It is not clear whether this will happen this time around, but some say it is highly likely if not definite.

The financial loss globally will depend on how broadly some aspects of the new iteration of the Gag Rule are interpreted, and whether they are deemed legal in the US itself. According to PAI, in monetary terms, the expansion of the reach of Trump's Global Gag Rule means that up to 16 times more funding may be withheld than if the Gag Rule were still applied only to family planning assistance – that is, the loss worldwide would be in the region of US$ 575 million in relation to family planning assistance vs. some US $9.5 billion related to all US global health assistance across government departments.

What can you do when a tyrant makes you dependent on him for money?
When a tyrant makes you dependent on him for funding, and then threatens to cut off your funding if you do something he doesn't like, whether you are a government, a UN agency or an NGO, you have only two choices. Either way, there will be serious consequences. In the past, the Gag Rule created serious problems for everyone who was dependent on USAID. The funding and services of those who refused to sign were badly affected, while the abortion services provided by those who did sign were closed down. Either way, the lives and health of those needing the services were badly hurt. And the reputations of those who stopped providing any abortion information or services were badly tarnished. There was a lot of conflict and bitterness against them too. International and national work for abortion rights has been dealt a terrible blow during 17 of the last 32 years. But abortion work also recovers, because it never stops being needed and so many people committed to providing it remain committed. Today, it is stronger than ever.

Whether we and our movement can, individually and collectively, stand up to Trump and keep on doing our work for safe abortion, whatever he and the anti-abortion movement in our countries throw at us, is an ongoing conversation, and one we keep having with our governments too. But the bottom line is, as in the past, you either tell the man to keep his money – or not.

The fightback began the same day
Both the International Planned Parenthood Federation and Marie Stopes International published statements on 23 January stating that they will not sign the Global Gag Rule. IPPF stands to lose US$100 million for programmes that provide sexual and reproductive health services to millions of women and youth. The IPPF statement concludes:

"We cannot – and will not – deny life-saving services to the world’s poorest women. We will work with governments and donors to bridge the funding and service gaps the Global Gag Rule creates. We will ensure that women can exercise their rights and access safe abortion and family planning."

Statements by long lists of individuals and NGOs condemning the policy are being published daily. For the record, the International Campaign for Women's Right to Safe Abortion is also absolutely opposed to the Global Gag Rule.

The question of how we as advocates can talk to our governments about how to respond to this is complicated by where our governments stand on this issue, whether they are donor governments or recipients of US government funding, and what the situation of abortion law and services is nationally. But this is the place where the real work is.

In Canada, Joyce Arthur, executive director of the Abortion Rights Coalition of Canada, called on the Canadian government on 23 January to step into the breach: “The Canadian government needs to help fill the moral gap created by the Trump administration by investing more to save women’s lives. Canada can’t do it alone – developed nations around the world should be prepared to step up their foreign aid programs to advance women’s rights and health around the world."

In Australia, on 25 January, in what was described as a rare intervention on US policy from a senior Australian politician, deputy Labor leader Tanya Plibersek said her party was "deeply concerned" about a policy "that could cost the lives of women in developing countries". She said: "Labor calls on the Turnbull government to lobby for the repeal of this damaging and dangerous policy and immediately rule out any move to reinstate the Howard-era restrictions on Australian aid for reproductive health services." (This refers to similar government restrictions that Labor repealed after it won government in 2007.) A spokeswoman for the Australian Foreign Minister, Julie Bishop, said the government "remains committed to the protection and promotion of sexual and reproductive health rights on our foreign policy and aid program".

The response from the Netherlands government – and others too
The government of the Netherlands responded with action first, and most strongly. The Minister for Foreign Trade and Development Cooperation, Lilianne Ploumen, announced on 24 January that the Dutch government will launch an international fund to finance access to birth control, abortion and education for women in developing countries, which could be supported by governments, businesses and social organisations to “compensate for this financial setback as much as possible”. She was not alone.

On 25 January, she announced that up to 20 countries had indicated support for the Dutch plan to set up an international fund to plug the funding gap caused by the Gag Rule. ‘We’re in talks with 15 to 20 countries and we’ve also spoken to foundations,” Ploumen told the Guardian. “As well as contacting a number of European countries that we work with on these issues, we’re also in touch with countries in South America and Africa, as well as the foundations. It’s important to have the broadest possible support for the fund."

She said the aim would be to continue support for existing programmes and that she hopes to be able to start arranging funding within the next two to three weeks, given that US funding is being stopped immediately. As to possible tensions with the Trump government, she said: “I’m pro-choice and pro-women’s rights. It’s important to stand your ground. We respect the decisions of a democratically elected president, but we’re democratically elected too and we can make different decisions." Dutch national elections are in seven weeks’ time, but Ploumen is confident that given the long tradition of standing up for sexual and reproductive rights in the Netherlands, the plan will continue.

In the USA itself, Democratic Senator Jeanne Shaheen has introduced the Global Health, Empowerment, and Rights (HER) Act in the US Senate and Representative Nita Lowey has introduced a companion bill in the US House of Representatives, which are aimed at repealing the Gag Rule by law, which would stop presidents being able to introduce it as a directive. Journalist Christine Grimaldi notes in Rewire that this: “marks a cohesive effort among Democrats in the early days of Trump’s presidency to push back against legislative assaults on reproductive health care”. In a Republican-controlled Congress, they won't get far enough, but it's one of many signs of early fightback in the US as well.

What's coming down the road?
The most complicated conversations will be within global south governments who both receive USAID funding for family planning and other health programmes, and who have also been considering positive abortion law reform, as well as within national NGOs in the same position who support abortion law reform, particularly in Africa. Do they think they can survive (and eventually still thrive) without USAID money? Do they see this is an opportunity as well as a threat? Can they develop blueprints for how to fund family planning, safe abortion, sexual health and other affected public health services within their governments? The question of where the money might come from greatly affects the answers. Other governments may offer to step in. Or can the affected countries find the funds in their own coffers, reducing dependence on any major outside power? What will it cost?

The Gag Rule is only one of many egregious blows that Trump will deal. On 24 January, he eliminated all grants in the USA for programmes on violence against women, including all 25 of the programmes managed by the Office on Violence Against Women, housed in the Department of Justice. The grants, established under the 1994 Violence Against Women Act and other federal legislation, go to organisations working to prevent domestic violence, sexual assault, dating violence, stalking, and elder abuse; support survivors of assault and abuse for housing assistance and legal aid; and training to help civil and criminal justice systems better respond to sexual and domestic violence, grants specifically targeted at protecting child victims, residents of tribal lands, women with disabilities, children who’ve witnessed the abuse of a parent, and rural women.

Then Trump gave the go-ahead to two major projects that will cause serious environmental damage and threaten indigenous peoples' lands and water. Then it was on to "security" and immigrants – all as he had promised. Today, the world's media are talking about his wall on the US-Mexican border.

But on 21 January, we marched as a united international front of millions of people who stand for women's rights as human rights, led by women. What did we expect when we upstaged a US presidential inauguration? Of course!! We brought it on ourselves, ladies!!!

So now let's work together and do our best to upstage the Global Gag Rule too.

HISTORY: For a detailed history of the policies and details of how the new iteration of the policy expands the number of affected NGOs, and thus the harmful effects it will have, and details of related US government policies that restrict funding to recipient governments, see Kaiser Family Foundation, The Mexico City Policy: An Explainer, 23 January 2017.

OTHER SOURCES: MSN, by Edith M Lederer, 25 January 2017 ;, by Adam Gartrell, 25 January 2017 ; Salon, 24 January 2017 ; E-mail from Susan Yanow, 24 January 2017 ; New York Times, by Serra Sippel, 24 January 2017 ; New York Times, by Somini Sengupta, 23 January 2017;, by Amanda Connolly,  23 January 2017; Rewire, 19 January 2017. PHOTO 2016.

by Marge Berer

Source, International Campaign for Women's Right to Safe Abortion: