What is ‘global gag rule’ on abortions? Here’s what Joe Biden’s move to reverse the policy means for women
US President Joe Biden has scrapped the policy that prevents federal funding from being used overseas to support aid organizations that perform, promote or provide counseling on abortion. While signing the presidential memorandum on January 28, he said that it will reverse his “predecessor’s attack on women’s health access".
The memo also instructs the Health and Human Services Department to immediately consider rescinding the Trump administration rule, blocking healthcare providers in the federally funded “Title X” domestic family planning program that offer abortion referrals for low-income Americans.
“The order I’m signing relates to protecting women’s health at home and abroad, and it reinstates the changes that were made to Title 10 and other things, making it harder for women to have access to affordable healthcare as it relates to their reproductive rights. I’m not initiating any new law, any new aspect of the law. This is going back to what the situation was prior to the (former) President’s executive orders,” Biden noted in a statement.
What is this policy?
The Mexico City Policy, also known as the “global gag rule", was first enacted by Republican President Ronald Reagan in 1984 and has been repeatedly renewed by Republicans and canceled by Democrats.
The Trump administration reinstated the restriction in 2017 by a presidential memorandum and then extended it to cover all applicable US global health funding. While the policy usually applies to family planning organizations, the Trump administration expanded it to include all global health programs, including programs that address HIV, nutrition, malaria, and cholera. Widening the restrictions meant it increased the pool of aid funds it affected from roughly $600M to about $12B.
“The Mexico City Policy is a US government policy that – when in effect – has required foreign NGOs to certify that they will not “perform or actively promote abortion as a method of family planning” using funds from any source (including non-US funds) as a condition of receiving US global family planning assistance and, when in place under the Trump administration, most other US global health assistance,” explained the Kaiser Family Foundation (KFF).
According to KFF, since Biden has rescinded the policy, agencies involved in foreign assistance, including the Department of State, USAID, HHS and DoD, are required to “immediately cease” imposing the conditions of the Mexico City Policy in any future assistance awards. “Therefore, it can be expected that the standard provisions for grants and cooperative agreements will soon be revised to remove the policy so that it will not be added to new funding agreements or modifications to existing agreements. Furthermore, these agencies are required to “immediately waive” Mexico City Policy conditions that were imposed during the Trump administration in assistance awards and to notify current recipients “as soon as possible” that such conditions have been waived,” write experts.
The agencies are also required to “suspend, revise, or rescind any regulations, orders, guidance documents, policies, and any other similar agency actions that were issued” under the imposition of the Mexico City Policy during the Trump administration, adds KFF.
What has been its impact?
A report by the US Government Accountability Office released last year found that in 2017, NGOs were unable to receive around $153M (£112M) because they chose not to cut back on abortion programs.
A 2019 study linked the Mexico City Policy to a 40% increase in abortions in sub-Saharan African countries reliant on US foreign aid. It measured the impact of the policy between 1995 and 2014. The restrictions imposed by the policy were also associated with a corresponding reduction in modern contraceptive use and an increase in pregnancies, among women living in countries highly affected by the policy while it was enacted. This pattern of more frequent abortions and lower contraceptive use was reversed after the policy was rescinded, suggesting a causal effect, according to the authors.
“The difference-in-difference in abortion rates between high-exposure and low-exposure countries was on average of 4.8 per 10,000 — a statistically significant 40% increase relative to when the policy was not in effect. The corresponding difference-in-difference was 3.2 percentage points lower for contraceptives and 3.2 percentage points higher for pregnancies — a relative decrease of 13.5% and a relative increase of 12.0%, respectively,” state findings published in The Lancet Global Health.
Study author Dr Eran Bendavid from Stanford University, US, emphasized back then that the full consequences of the policy include additional potential harms to maternal health that “we do not capture". “Because abortions are an important cause of maternal mortality, the increase in abortion uptake that we find might also increase maternal deaths, and possibly disproportionately given that abortions under the policy could be less safe if they were less likely to be performed or guided by experienced organizations and providers. Our estimates of excess abortion under the policy, therefore, provide only a partial estimate of the policy's harm to maternal health,” he wrote.
A recent report published in The Lancet found the rule often led to cuts in health and reproductive services that caused increases in unsafe abortions. It warned that the rule increases unsafe abortion.
Researchers identified three crucial effects of the policy: decreased stakeholder coordination and reduced discussion related to sexual and reproductive health and rights; reduced access to contraception with accompanying increases in unintended pregnancy and induced abortion; and negative outcomes beyond reproductive health, including weakening of healthcare system functioning. These consequences are all associated with adverse maternal health outcomes, they stressed.
“By increasing the incidence of unsafe abortion — while simultaneously decreasing discourse, reducing access to sexual and reproductive health care, and disassembling health systems — the Protecting Life in Global Health Assistance policy makes a dire public health situation worse. The public health community should urge the USA to repeal the Global Gag Rule,” suggested the team.