How Trump’s latest efforts to stop abortion increasingly undermine global health

The dilemma for a health organization is hard to fathom.

In 2018, two young women died at the hands of knitting needles and other everyday objects in Kenya, where seven women die each day in an attempt to induce an abortion on their own, bereft of safer options.

Even two years earlier, their deaths might have been prevented. But a local organization that would have previously referred them to abortion provision services was forced to choose between giving sexual and reproductive healthcare advice or signing a “global gag rule” and stopping that program, in order to continue to provide HIV services to its 10,000 clients.

In 2017, United States President Donald Trump and his administration reinstated and expanded the Reagan-era Mexico City Policy, also known as the “global gag rule,” forcing organizations around the world, like the one in Kenya, to choose between disengaging from abortion-related activities or losing US funding crucial to their existence.

For Vanessa Rios, a program officer for the International Women’s Health Coalition (IWHC) and the author of a report on the impacts of Trump’s policy released in June at the Women Deliver conference in Vancouver, the women’s deaths signal a deeply worrying trend.

“[It’s] really heartbreaking, because…[the Kenyan organization] knew where they could send the young women,” she told OpenCanada. “Yet they were gagged and prevented from doing so.”

In the wake of this massive funding gap, a number of international initiatives have cropped up, including Canada’s commitment, made at Women Deliver, to alotting half of its international women’s health fund, $1.4 billion, to supporting safe abortion and other reproductive health access.

However, the US is the world’s largest global health donor, and advocates fear that no initiative can bridge the gap better than repealing the global gag rule could. Further yet, experts say a number of other policies enacted by the Trump administration are similarly threatening the sexual and reproductive health and rights of women globally. US foreign policy is once again reversing progress on abortion rights worldwide, with organizations and the women they serve bearing the brunt of these deadly policies.

Trump’s unprecedented expansion

While the global gag rule has been implemented by every Republican president since Ronald Reagan, once Trump took office, he expanded it to unprecedented levels: the policy previously applied to just family planning funding, amounting to around US$600 million a year. Now, officially under the new name Protecting Life in Global Health Assistance, it applies to all US foreign aid — which totals about US$9 billion a year.

“That’s something that we can’t overstate enough,” Keifer Buckingham, senior policy advisor at Open Society Foundations (OSF), told OpenCanada. “Things are so much bigger now, because we’re looking at…$8.8 billion that is gagged versus when it was just the family planning and reproductive health money.”

Buckingham explained that in March of this year, the Trump administration released another clarification of the policy, where “primary recipients of US global health money are responsible for ensuring that even their sub-recipients don’t violate any global gag rule conditionality.”

According to the international reproductive rights organization Population Action International, this has vastly expanded the harm caused by the global gag rule.

The impact of the global gag rule

Despite the aim of the policy being the eradication of abortion worldwide, the effect appears to be the opposite. A report released June 27 by The Lancet found that the global gag rule increased abortion by 40 percent from 1995 to 2014 in the 26 sub-Saharan African countries it studied. A previous study also found that the policy propelled the rise of abortions in Latin America.

“The gag rule doesn’t suddenly get rid of abortion, it gets rid of the ability for women and non-binary folks and other people…to actually undergo safe abortion,” Preston Mitchum, policy analyst at Advocates for Youth, told OpenCanada.

Another immediate impact of the policy is its effect on other healthcare services, given that, according to the IWHC report, “U.S. global health funding implicates…funding for HIV/AIDS, malaria, tuberculosis, nutrition, maternal health, health systems, and a range of other health programs designed to benefit millions of people.”

“That was particularly shocking,” said Rios, citing examples of projects that have ceased to exist because of the policy in both South Africa and Nepal. “The policy is really undermining governments’ ability to…deliver healthcare to its people.”

The limits of international efforts

Prior to Canada’s funding announcement at Women Deliver, another significant international funding commitment was made in 2017 — the SheDecides initiative. It was launched by then Dutch Minister for Foreign Trade and Development Cooperation Lilianne Ploumen and her counterparts from Belgium, Denmark and Sweden, shortly after Trump’s expansion of the gag rule policy that year. The initiative has raised about EUR 450 million so far and also serves to foster a wider movement around the issues of sexual health and rights.

Rios lauded these international efforts but explained that, ultimately, they fall short, given that “the US is still the single largest funder of global health programs internationally.”

Buckingham shared similar sentiments.

“The Trudeau administration has been a huge force in terms of increasing funding for sexual and reproductive health and rights organizations globally,” she said. “But at the end of the day, the US government is still the largest funder.”

Both cautioned that international efforts to combat the global gag rule should not be conditional. Rios shared the example of the Swedish International Development Cooperation Agency, whose funding has only been doled out to foreign organizations that refuse to sign the global gag rule. This has put a number of organizations in a “difficult and confusing position of having to choose between continuing to receive US or Swedish funding,” the IWHC report states.

“[These] efforts by other funders to close the gap [have] really been counterproductive,” Rios said.

Trump’s anti-abortion agenda

Beyond the global gag rule, the Trump administration has been pushing its anti-abortion agenda on the international front in a myriad of other ways.

“This administration has gone to pretty extreme lengths at the United Nations, both in Geneva and in New York, to…ensure that documents that are being negotiated there don’t include any references to sexual and reproductive health,” said Buckingham.

Internal US State Department cables, as reported by Foreign Policy, revealed that Trump’s government forced Germany to remove the term “sexual and reproductive health” from a United Nations resolution on preventing rape in war and conflict. US officials, the memos showed, consider the term to refer to abortion, despite the view held by numerous other governments and advocacy groups around the world that it does not.

Trump’s nominee for US ambassador to the UN in Geneva, Andrew Bremberg, stated last month that he doesn’t believe in abortion even in instances of rape, Buckingham pointed out.

The Trump administration has continued to block funding for the United Nations Population Fund, the world’s largest contraceptives purchaser and distributor. It also slashed funding to the Organization of American States earlier this year, using a provision called the Siljander Amendment, that prohibits US funding from being used for lobbying efforts for or against abortion worldwide. Finally, the IWHC report found that several interviewees in Kenya and South Africa had observed that “right-wing and anti-reproductive rights groups” were now receiving USAID funding.

For Mitchum, this last occurence is especially a worrying sign.

“The fear that many of us have…[is that funding] will be shifted to organizations who want to do harm,” he said.

Buckingham added that OSF has already been observing a “surge of far right…[and] anti-abortion groups in places like Kenya, where…they’re completely inundated with anti-abortion rhetoric, unlike what they’ve ever seen.” She believes these groups have been emboldened by the policies of the Trump administration.

Rios’s organization has observed the same. “We’re really starting to see this emboldening of more regressive actors, like ideologically-based, often religious organizations,” she said.

Alongside global pushback against the gag rule, a number of internal efforts have been spearheaded by lawmakers in Washington. On June 19, the House of Representatives passed legislation that seeks to fully repeal the policy, though it will still require the support of the Senate and Trump himself. Earlier this year, the Global Health Empowerment and Rights Act, which would also seek to reverse the policy, was met with bipartisan support.

Amid this volatile terrain, Rios suggests that international organizations fighting the policy build evidence around the impact of it through documentation, and raise awareness of that impact through advocacy.

“I think beyond the global gag rule, all of these strategies that anti-reproductive rights actors are using here in the US are really inspiring similar groups abroad,” she said. “And that is really concerning.”