Abortion: US “global gag rule” is killing women and girls, says report

A US government policy that blocks federal funding for non-governmental organisations that provide or support abortion is killing women, a new report says, because they are being excluded from a range of essential sexual and reproductive health services and information and turning to unsafe abortions.

The “global gag rule” rule prohibits foreign non-governmental organisations that receive US global health funding from providing legal abortion services or referrals and also bars advocacy for abortion law reform. The rule, first implemented by the Reagan administration and rescinded by subsequent Democratic presidents, was reinstated and expanded by Donald Trump when he took office in 2017. It now affects an estimated $9bn (£7bn; €8bn) of US global health assistance.

Two years on, an assessment of services in Kenya, Nepal, Nigeria, and South Africa has found “irrefutable evidence” that the gag rule was “depriving women and girls and other marginalised populations of essential information and services,” with devastating consequences.1

Vanesa Rios, who wrote the report for the US based International Women’s Health Coalition, told a press briefing at the Women Deliver conference in Vancouver on 5 June that “girls are dying because of this rule.”

Evidence from 170 interviews conducted with reproductive health organisations in the four countries showed that the gag rule was often being overinterpreted.

In Kenya, many services were not providing abortions or post-abortion care to women whose health was in danger even though these services were not prohibited there.

And in South Africa, where abortion is legal, people were not being told about their own laws, said Rios. One interviewee in South Africa declared that the gag rule “promotes unsafe abortion” because it had cut off access to sexual health and reproductive health information and services.

And in Nepal, which has a progressive abortion law, cuts to funding had led to the closure of contraceptive and other services in 11 remote areas.

Carole Sekimpi, country director of the charity Marie Stopes in Uganda, said that her organisation had lost 17% of its funding after it stopped taking US aid because of the gag rule and was $15m short in its global funding requirements for 2019-20. She estimated that by 2020 this shortfall would lead to an estimated 1.8 million unintended pregnancies worldwide, 600 000 unsafe abortions, and 4600 unintended deaths.

“With GGR we are seeing less funding, less contraception, more unplanned pregnancy, more stigma, more fear, more unsafe abortions. Women are dying because of the GGR,” Sekimpi said.

In Kenya, one organisation that was forced to stop providing abortion information and referrals told the coalition that two of its clients had died after having unsafe abortions.

Meanwhile figures just released by the Kenya Sex Workers Alliance showed that at least 35 women were dying each month because of unsafe abortions, said Rios.

In Nigeria, even a representative from a faith based youth organisation acknowledged that the gag rule was robbing women of the information needed to make safe and informed decisions, ultimately increasing maternal deaths, the report said.

Furthermore, the gag rule was fragmenting services, said the report, with HIV and AIDS testing having to be separated from reproduction health clinics, making access more difficult. The same was true of screening for cervical, breast, and prostate cancer and support for people who had experienced gender based violence.

The gag rule was also blamed for a cultural shift in attitudes to abortion.

“The chilling effect of the on and off funding because of GGR is one thing, but to rebuild the bridges that are broken as a result of GGR is more difficult and will take a longer time,” Sekimpi told the briefing. “We see emboldening of the opposition. It is being legitimised—it is connected in high places. They have a very targeted approach, and they are causing significant disruption to service delivery.”