Gagging on the gagging of international women’s health programs
Three politically-driven policies have not only gagged women’s health care providers, but have caused an increase in what they sought to prevent. The most recent, and most egregious, is Trump’s gag rule (I’m sure he thinks it is the biggest and the best). And all for naught.
The Helms Amendment (1973)
Passed in wake of Roe v. Wade decision; this Amendment to the Foreign Assistance Act of 1961 prohibits US global family planning assistance funds from being used by organizations that 1) provide abortion-related services or 2) refer patients to other clinics that provide abortion-related services or 3) allow staff to advocate for legalization of abortion in their country.
The Mexico City Policy (1984)
Also called the Global Gag Rule, the policy built on the Helms Amendment and prohibits US family planning assistance funds from being used by organizations that provide abortion-related services, or counseling about abortion, or referrals to other providers who offer those services.
The Reagan/Bush/Bush/Trump Gag Rule (1984-2020)
Prohibits US global health assistance funds from being used by organizations that provide abortion-related services, counseling, or referrals to other providers who offer those services.
The distinction here is what used to just apply to family planning service organizations now also applies to general health care providers. The public health community has learned that providing integrated health services is much more economical and effective than having separate facilities for services targeted to family planning, infectious disease, immunizations, etc. Most international health organizations now provide a wide range of services in one place including malaria, tuberculosis, nutrition, maternal and child health, HIV/AIDS, STDs, and chronic disease management. So that now, instead of having to just shut down free-standing family planning programs, that by the way, provide much more health promoting and protecting reproductive health services than just abortion, recipients of US aid may have to shut down full health services organizations – or practice under the gag rule.
The US, along with most high-income countries, provides billions of dollars to over 60 low- and middle-income countries to support health improvement goals. It will be an ethical challenge for a health care provider to refrain from mentioning certain, and perfectly legal, local services that could be of assistance to a female patient while caring for the rest of her health. Censoring, withholding or intentionally misrepresenting health-related information goes against basic medical ethics, not to mention freedom of speech. Yet, health care providers must somehow choose between withholding information from a patient in need and continuing to provide other services or providing complete care and risking clinic closure due to lack of funding. Rather arrogant of us to put them in that position, isn’t it?
Additionally, in a really perverse twist, if you want to continue receiving US dollars, your organization cannot use money you’ve raised yourself or received from any other donor to provide abortion services or counseling or referrals, or public service announcements, or advocacy efforts to encourage your own government to maintain or liberalize your country’s abortion laws. Nope, you can’t decide how to use your own money if you want to have any of our money. We’ve become an international bully dangling much-needed funds in front of desperate communities who have to do what we say because we are rich and powerful.
To make it worse, the gag rules change depending on the US political party in power. These health care organizations must suppress information and withhold services for four to eight years, then provide them again for four to eight years, then withhold them again at the whim of the US government patriarchy – and the American people who elected it.
Gag Rule Political Football
- In place 1984 to 1993 (Reagan and Bush)
- Rescinded 1993 to 2001 (Clinton)
- In place 2001 to 2009 (Bush)
- Rescinded 2009 to 2017 (Obama)
- In place 2017 to present (Trump)
Ironically, there is no evidence to indicate that these “gag rules” have resulted in fewer abortions. Rather, studies have shown that during the years the gag rules were in effect the numbers of unintended pregnancies rose due to decreased access to family planning services. This was logically followed by an increase in the rate of abortions, particularly unsafe abortions. Ideologically driven, politically motivated policies cause upheavals in basic health care services for the most vulnerable and needy men, women, and children around the world – and reflect very poorly on the US — for no good purpose. Just because we can.
You’d think if you went to all the trouble of formulating new legislation, getting lawmakers to sign on, getting it attached to other legislation in order to get it through congress – that’s a lot of work over a long time period – you’d want to have some evidence that, once implemented, it had the effect you’d anticipated. In this case that would be a decrease in abortion rates in the recipient countries. If it didn’t have the result you wanted, you’d think the effort would be withdrawn or at least revised. But no. One could logically conclude that perhaps the stated result was not really the intended result. Perhaps the intended result was something else. Perhaps, and I’m speculating, the intended result was to control women, to deny them reproductive health care, to punish them for being sexual human beings. As one famous republican once said, “mission accomplished.
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