Editor’s Note: Terry McGovern, JD, is chair of the Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health. The views expressed here are her own. Read more opinion on CNN.
I am haunted by the memory of a very young, pregnant girl I met at a clinic in Kisumu, Kenya. She had been raped. Her mother had brought her to the clinic saying she had a stomachache. The girl stared at the floor and didn’t speak. No one told the girl that terminating the pregnancy was an option, even though there was an abortion clinic literally across the road. Looking at her tiny frame, I wondered if she would survive a pregnancy.
I was witnessing the Trump administration’s handiwork. Kenya had liberalized its abortion law in an effort to reduce maternal mortality, but the country’s decision and that girl’s choice was effectively overridden by our government. Time and again, President Donald Trump and his administration have taken the political stance that it is they who should control the bodies of women and girls. Now, right before the election, Trump and Senate Republicans have installed on the Supreme Court Judge Amy Coney Barrett, who holds anti-abortion views and – deflections during her confirmation hearings aside – whose vote could help cement a majority to overturn Roe v. Wade, which would destroy a decades-long precedent for abortion rights in the US.
One of the very first acts of his administration in January 2017 was to reinstate and expand the Mexico City Policy, also known as the Global Gag Rule (GGR), which strips funding from any foreign non-governmental organizations that perform, provide counseling on, make referrals for abortion or lobby for the liberalization of abortion law. First implemented by former President Ronald Reagan, the policy had been in place under Republican presidents and rolled back under Democratic presidents since.
Earlier iterations of the GGR were more narrow applying to only those receiving funding for reproductive health. President Trump expanded the policy’s impact by extending it to all types of US global health assistance (such as for HIV and malaria) to ensure the policy is “enforced to the broadest extent possible” and has even extended the ban to any group working with a group receiving US global health assistance even if the partnering groups do not receive US funding.
This administration clearly does not respect science or women. But as we hurl towards November 3, it is important to recognize that when it comes to reproductive rights, their rhetoric does not match the evidence. This policy has not reduced abortion, it has not succeeded. It has only managed to wreak havoc on modest gains in sexual and reproductive health outcomes and rights for women and girls. To stop this, we must end the GGR. Americans are not just voting for ourselves – we are voting for women around the world.
The truth is that abortion has never just been about the medical procedure itself. It is about women and girls having bodily autonomy and economic equality, It’s about the very high rates of sexual and physical violence around the world. It’s about access to contraception and preventing maternal mortality due to unsafe abortion or children giving birth. This policy, the expanded GGR, has not achieved the administration’s stated goal to decrease abortion rates. What it did do was reduce global access to contraception, reproductive health care, HIV treatment and other basic health services for women.
A recent study conducted by my colleagues and I examined the impact of the GGR since 2017 in three countries heavily dependent on US global health assistance: Nepal, Madagascar and Kenya. According to our published findings from Kenya, and forthcoming publications from Madagascar and Nepal, the GGR caused critical funding losses to organizations and health systems in all three countries. Clinics have been forced to close. Doctors and nurses have lost their jobs. Basic supplies have run low, and training has ended.
In the past, the GGR restriction only applied to sexual and reproductive health. Under the expanded GGR, restrictions now apply to all global health assistance funding, which was 7.5 billion in FY2020. The result has been particularly devastating for women in rural areas, where there is often just one clinic providing an array of services.
Make no mistake: women and girls suffer because of this policy. Needed clinics have closed. Family planning methods that were previously free or subsidized now cost more, forcing women to switch methods or stop using contraception altogether. In Madagascar, I have seen women who have to choose between buying food for their families or paying for their contraceptive method. Because so many providers are afraid to lose their funding if they have even a slight connection to an organization which makes abortion referrals, these policies propagate fear and disrupt basic sexual and reproductive healthcare.
Each country we studied has vastly different laws and policies on abortion, yet no matter how varied the policies, our data make clear that the GGR still doesn’t significantly impact abortion rates. Nepal and Kenya changed their policy in recent years in an effort to reduce high maternal mortality rates, recognizing that unsafe abortion was killing women and girls. Nepal, Madagascar and Kenya all have high rates of sexual and gender-based violence, according to data from UN Women and the US policy only hinders these countries’ ability to address this crises. In the wake of sexual violence, access to comprehensive sexual and reproductive healthcare is critical
If the US truly wants to reduce abortion rates at home and abroad, Americans should vote in political leaders whose policies will increase access to sexual and reproductive healthcare and services for gender-based violence, not decrease it.