Exporting Ideology, Risking Lives
The global gag rule bars overseas health organizations that receive US funding from performing abortions or promoting their legalization, even when these activities are paid for with the organization's own funds. This policy doesn't stop abortion, it merely drives it underground — pushing women to dangerous decisions and often to early graves.
by Susan A. Cohen
On February 6, declaring its strong opposition to the US government’s global gag rule policy, the United Kingdom put its money where its mouth is. Britain’s International Development Minister Gareth Thomas announced in Parliament that the UK is contributing more than $5 million to a new fund called the Global Safe Abortion Programme. Established by the London-based International Planned Parenthood Federation (IPPF), the fund is designed to increase access to safe abortion services in the developing world and to help replace family planning funding for nongovernmental organizations (NGOs) disqualified from US aid because of their refusal to submit to the gag rule policy. Other European donors are also considering making contributions.
"Punitive legal measures and restricting access to safe abortion do not reduce the incidence of abortion; they just make it more dangerous," Thomas wrote in the foreword to the IPPF report "Death and Denial: Unsafe Abortion and Poverty." Indeed, abortion is completely illegal in Uganda, for example, yet the abortion rate there is more than twice the rate in the United States, and unsafe abortion is the leading cause of maternal death. At current rates, half of all Ugandan women will seek treatment for complications from unsafe abortions in their lifetimes.
Despite such evidence, mounting harms, and international disapproval, the current administration and its allies in Congress remain unmoved. President George W. Bush imposed the global gag rule on the US international family-planning and reproductive- health program on January 22, 2001 — his first official day in office and, not coincidentally, the anniversary of Roe v. Wade. The policy states that foreign NGOs may only receive US familyplanning assistance if they do not provide abortion services or information, even where abortion is legal. Further, NGOs are ineligible for such assistance if they promote laws or policies to liberalize access to abortion in their own country (although anti-abortion advocacy remains permissible). The policy was first introduced by President Ronald Reagan in 1984; President Bill Clinton rescinded it in 1993.
Commenting on the law's reinstatement in 2001, White House spokesman Ari Fleischer spoke of President Bush’s belief that this policy "will help make abortion more rare." Since the policy has been in effect, however, there has been no evidence that the gag rule results in any fewer abortions in the developing world. What is clear is that many clinics have closed or vastly reduced their capacities because they lost US support. As a result, women in some areas of the world's poorest countries no longer have access to quality contraceptive services.
In Nepal, for example, maternal mortality rates have been among the highest in the world, with unsafe abortions estimated to account for half of those deaths. Just three years ago, Nepal legalized abortion, mainly because of the public health crisis associated with clandestine procedures. The Family Planning Association of Nepal (FPAN) felt morally compelled to participate in governmental discussions about reforming the nation’s abortion law. As a result, FPAN lost all of its US support for family planning services and the bulk of its supply of contraceptives. Today, FPAN has only a limited ability to provide reproductive health care to the thousands of Nepali women living in remote areas.
Similarly, in Kenya, Marie Stopes International had to close its Mathare Valley clinic, located in one of the poorest areas of Nairobi. This clinic had provided services ranging from contraception to malaria treatment and childhood immunizations for 300,000 people.
Where NGOs have reluctantly agreed to the US conditions — in exchange for desperately needed family-planning funding — they have lost their voice as advocates. The US policy precludes indigenous NGOs from participating in their own national debates over legal abortion. They risk losing their US family planning aid if they dare to speak out, for example, about the toll that clandestine abortion takes on women’s lives.
This has been the case in Ethiopia, where key NGOs have reluctantly acquiesced to the gag rule. Ethiopia’s National Office of Population has called for a debate on broadening Ethiopia’s abortion policy. Yet the NGOs most knowledgeable about the problem are unable to participate fully.
Five years ago, on the same day that President Bush announced his global gag rule policy, the White House issued a statement asserting that the president "knows that one of the best ways to prevent abortion is by providing quality voluntary family planning services." But since the policy's implementation, the administration has done little to demonstrate its commitment to what really makes the greatest difference in making abortion less necessary: preventing unintended pregnancy in the first place, particularly by improving access to effective contraception.
This year, on the same day that the UK recommitted itself to the critical importance of promoting and protecting reproductive health, President Bush proposed his FY 2007 budget to Congress. It calls for the US family-planning and reproductivehealth program overseas to be slashed by almost 20 percent. This cut is indefensible as a matter of policy, as well as politics. And history has already shown that women around the world will be the ones to pay its price.
HIV ON THE HOME FRONT
HIV has an increasingly feminine face. Although we understand how to prevent transmission and medical breakthroughs have made longer, more fulfilling lives possible, the number of infected women and teenage girls is skyrocketing.
In 1985, seven percent of all US diagnoses occurred in women, according to the Centers for Disease Control and Prevention. By 2004 that number had climbed to 27 percent. And those statistics didn’t include women unaware that they were infected. For young women and African-American women, more recent news is particularly grim: According to a 2005 Kaiser Family Foundation report, girls made up 57 percent of people aged 13 to 19 with new HIV infections, while AIDS has become the third most common cause of death for African-American 25- to 44-year-olds.
Trying to raise awareness, the National Institutes of Health helped launch the first National Women and Girls HIV/AIDS Awareness Day this March. "Frequently, women infected with HIV have difficulty accessing health care, and they may carry the additional burden of caring for children and other family members who also are HIV-infected," according to a statement issued by Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases.
With all that we now know about HIV, why are women at such high risk? Part of it is biological. By design, the female body — the vagina — is more susceptible to the HIV virus than the male body. But social and cultural factors play a significant role. The vast majority of HIV-positive women become infected as a result of unprotected heterosexual sex. Many women are unable to refuse. Others lack accurate information. Some are financially dependent on their partners and worry that a sexual denial will upset their economic arrangements and the stability of their families. Others fear physical violence.
When the HIV/AIDS epidemic first reared its deadly head a quarter-century ago, grief and outrage helped pave the path to action. As new options for women’s protection are being developed (like microbicides, topical creams that kill HIV), women must continue on this path — educating and empowering one another until HIV/AIDS Awareness Day is only a memory of more dangerous days gone by. — Erica Brody