As the Trump administration plans to institute new limits on family planning providers from making abortion referrals domestically, a new report sheds light on the impact of the international version of the policy.
The administration's "Protecting Life in Global Health Assistance" policy has existed in some form on and off since the Reagan era, but a new report (PDF) from the Center for Health and Gender Equity (CHANGE) suggests that the latest iteration of the so-called gag rule may be the most restrictive to date.
Bergen Cooper, director of policy research for CHANGE and the report's lead author, said the policy's 2017 rollout led to mass confusion, and an immediately recognizable "chilling effect," as different groups worked to understand the policy.
"It's like a horrible game of telephone," Cooper said at an event Tuesday to mark the report's release.
President Donald Trump signed an executive memorandum reinstituting the policy—which had been rolled back under President Barack Obama—almost immediately after taking office. Also known as the "Mexico City policy," it prevents foreign groups from promoting abortion as a method of family planning if they want to receive funding from the U.S. government.
CHANGE's report highlights the impact of the global gag rule on agencies in Mozambique and Zimbabwe as case studies for its larger impact, while also tracking how the policy has evolved and played a role in how these groups operate since it was first implemented in 1984.
Santos Simione tells us that @MAJMOZAMBIQUE, a leading #SRHR group in Mozambique, lost 2/3 of its funding because of Trump’s #GlobalGagRule. This funding gap will impact service provision related to #HIV prevention, #TB, #malaria, and more. #PrescribingChaos— CHANGE (@genderhealth) June 5, 2018
For example, at one clinic operated by the Mozambican Association for Family Development (AMODEFA) in the southern city of Xai-Xai, rates of services far beyond abortion dropped dramatically. The clinic provided 12,258 general family planning counseling visits between July and September 2017, and then just 2,728 between October and December 2017, after the gag rule took effect.
The clinic also saw dramatic declines in the number of gynecological services provided. It provided 2,789 well-woman visits and cancer consults between July and September, and none between October and December. They did not release year-over-year figures.
Santos Simione, executive director of AMODEFA, said at the release event that the rule is "a policy that's going to increase the problems the country is facing." Mozambique is very poor, has high rates of fertility and adolescent marriage and has about 110,000 children living with HIV, making the services groups like his provide incredibly important, he said.
The policy is also not likely to decrease the number of abortions but instead drive women to seek methods to end unwanted pregnancies on their own, he said.
"[Limiting] access to abortion does not stop abortion," Simione said. "If women need one, they find a way."
Today’s #PrescribingChaos report launch featured incredible advocates from Mozambique & Zimbabwe: Edinah Masiyiwa @WagZimbabwe, Helena Chiquele @oxfamnovib, and Santos Simione @MAJMOZAMBIQUE. It’s time to end the #GlobalGagRule. pic.twitter.com/8q5jdC7yII— CHANGE (@genderhealth) June 5, 2018
The CHANGE report comes as the Trump administration gears up to finalize a "gag rule" here at home as well. The Department of Health and Human Services issued the proposed rule change to Title X in late May, which would prevent U.S. health providers from receiving Title X funding if they provide abortion referrals. However, providers would not lose funding if they offer additional information on abortion when asked, a difference from the global policy.
HHS Secretary Alex Azar defended the global gag rule at a congressional hearing Wednesday and said the Title X proposal did not constitute a "gag rule," as its opponents have argued.
"The important principle this administration is taking with this policy is to ensure no federal monies are going to support in any way directly or indirectly the provision of abortion services abroad," Azar said.
In addition to impacting access to services in foreign countries, the advocates at Tuesday's event said that the administration's policy also impacts advocacy efforts and hinders women's empowerment. Edinah Masiyiwa, executive director of the Women's Action Group in Zimbabwe, said the reinstitution of the "global gag rule" set back a growing pro-choice movement in the country. It has also divided organizations that would previously have worked together on sexual health, women's health and other initiatives.
"This rule is prescribing chaos in our countries," Masiyiwa said.
Because of the #GlobalGagRule, org partnerships and coalitions have been fractured. Confusion and mistrust pervades networks that are now divided as #GGR complying and non-complying orgs, says Edinah Masiyiwa of @WagZimbabwe. #PrescribingChaos pic.twitter.com/NizyoWYCdL— CHANGE (@genderhealth) June 5, 2018