President Donald Trump has issued a memorandum with far-reaching consequences for reproductive rights in other countries.
On Friday, he reinstated the Mexico City Policy, which cuts off U.S. aid to any group operating in another country that provides abortion services, counsels people about abortion or advocates for abortion rights.
The name is drawn from a U.N. conference in Mexico City in 1984, when President Ronald Reagan instituted the rule.
Because the policy prohibits even discussion of abortion with patients, groups that favor abortion rights call it "the global gag rule." It "silences what organizations can even say about abortion in their own countries," says Elizabeth Sully, principal research scientist at the Guttmacher Institute, a research organization that supports abortion rights.
Supporters of the rule say that it encourages healthcare providers in lower resource countries to focus on alternatives to abortion — for example, education on family planning and maternal care during pregnancy.
"It prioritizes what developing countries actually need, which is real development assistance not the promotion of coercive or controversial agendas," says Elyssa Koren, the legal communications director for ADF International, an advocacy group that opposes abortion rights.
The policy's history
In the 41 years since the policy was first instituted, every newly elected Democratic president has negated it and every newly elected Republican president has reinstated it. In his first term, Trump brought the policy back on Day 3 of his administration.
The original policy targeted U.S. foreign aid grants to groups that offer family planning services. In 2017, Trump expanded it, adding a directive to extend the policy "to global health assistance furnished by all departments or agencies." That meant that a wider range of groups would lose their share of the $12 billion of U.S. health assistance if they did not comply – including groups whose main goal was not to provide family planning support, like President's Emergency Plan for AIDS Relief (PEPFAR) and groups that focus on diseases like malaria.
Before Trump's change, the policy had affected around $600 million of U.S. aid to family planning and reproductive health groups, says Nabeeha Kazi Hutchins president of PAI, Population Action International, a group that supports abortion rights.
Groups that want to continue offering abortion counseling or services have in the past lost their U.S. funding. In 2017, NPR interviewed representatives of MSI, Marie Stopes International, a global charity that offers contraception and abortion services in 36 countries. Their Madagascar director told NPR that the loss of U.S. aid meant the group could no longer offer free contraceptives and had to shut down 21 of its 22 mobile contraceptive clinics in the island nation, which is part of sub-Saharan Africa.
Researchers have looked at the impact of the policy as well.
A 2019 analysis, published in the medical journal The Lancet, examined access to contraception and abortion rates in sub-Saharan Africa across three presidencies: Bill Clinton, George W. Bush and Barack Obama. The policy was in effect during Bush's years in office but was revoked by Clinton and Obama.
The researchers looked at abortion rates in 26 sub-Saharan African countries during the eight years of the Bush administration, when the funding ban was in place, and the Clinton and Obama administrations, which each lifted the funding ban.
The analysis suggests that the Mexico City policy has actually increased the rate of abortions by about 40% in the countries studied.
As NPR wrote at the time: "Of course, abortion rates could have changed during those two decades for reasons wholly unrelated to U.S. funding policy. But in an effort to factor out that possibility, the researchers divided the 26 countries into two groups: In the first were countries that received the highest amount per person of U.S. family planning aid. In the second group were the countries that received the lowest amount.
The idea is that countries receiving a large amount of aid per person would likely be more vulnerable to changes in the policies governing U.S. aid. So by comparing what happened to the abortion rates in those more aid-dependent countries with the abortion rates of countries that were otherwise similar but less dependent on U.S. money for family planning, the researchers believed they could better isolate the impact of the funding ban on abortion rates.
In addition to finding that the ban produced a 40% increase in a country's typical abortion rate during the period when the Mexico City policy was in place, the authors found a 14% decrease in the use of contraception and a 12% increase in pregnancies".
Co-author Nina Brooks of Boston University told NPR that it seems likely that aid groups unable or unwilling to comply with the abortion restrictions on U.S. funding ended up losing U.S. aid dollars and therefore cut back on their activities, which included distributing contraception.
Speaking to NPR for coverage of the 2019 study, Connor Semelsberger, then with the Family Research Council which has long supported the Mexico City policy, says he finds the study unconvincing because it did not delve into what he argues are key data points — such as which aid groups were operating in the affected countries and how much the amount of U.S. aid changed during the years studied. "I was really wanting more information," he says.
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