What the 'Profoundly Anti-Democratic' Global Gag Rule Means For International Public Health

Images via IPPF and Getty.
Images via IPPF and Getty.

On his first Monday in office, President Trump reinstated the Global Gag Rule, a policy that blocks international health organizations from receiving any U.S. federal funding if they provide, advocate for or discuss abortion as a reproductive health option.


Federal funding to directly provide abortions overseas has been banned since 1973. But the Global Gag Rule goes one step further: It denies funding to organizations that even mention abortion as a birth control option, or those that provide the service using other non-U.S. government funding.

Every Republican administration since Reagan has imposed this policy, but President Trump has broadened the measure in “unprecedented” ways, according to Giselle Carino, Regional Director of the International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR). The organization works with 50 local partners in 40 countries across Latin America and the Caribbean to provide health and reproductive services, including contraception, breast and cervical cancer screening, and HIV treatment. In a region with some of the world’s most restrictive abortion policies, they also advocate to change legislation at the national level, including in countries that imprison women for having abortions or those that restrict abortion even in cases of rape or risk to the woman’s life.

The IPPF/WHR has refused to sign the “global gag rule” and the organization as a whole stands to lose $100 million as a result. Based on their early analysis, this would mean a potential loss in funding for a wide range of health services, including access to contraception, HIV prevention programs, tuberculosis treatment, and even emergency efforts to fight Zika.

Jezebel spoke with Carino by phone to understand the devastating impact that this policy will have in Latin America and Caribbean, a region where 97 percent of women live in countries where abortion is restricted or banned completely, and where an estimated one million women are hospitalized each year for complications stemming from an unsafe abortion.

This interview has been edited and condensed for length.

What kind of access to reproductive health services do women in Latin America and the Caribbean have?


We have made huge progress on sexual and reproductive health and rights in the last 15-20 years in the region, but there are huge gaps that remain. We still have 23 million women who want to use contraception, but don’t have access. About 50 percent of pregnancies in the region are unplanned. Even though we have made some progress in making abortion safe and legal in certain countries, about 95 percent of abortions that take place are unsafe. And we are home to four countries in which abortion is prohibited under all circumstances, including to save a woman’s life.

We’ve made huge progress in fighting poverty, but we still have huge pockets of inequality—seventy percent of the women we serve are underserved, and tend to be young people, Afro-descendants, and indigenous women. And there is a very strong opposition, that existed previously and that we predict will be stronger given the result of the U.S. election and some of the measures that President Trump is putting forward.


The Global Gag Rule is a policy that has been in place under past Republican administrations, but your organization described the recent order as an expansion that is “wholly unprecedented.” How so?

One important thing to highlight is that funding from the U.S. can never be used for abortions, so we are not talking about funding abortions here, we are talking about funding for family planning programs, research, and emergencies such as Zika.


We are still trying to understand the full extent and scope of the measure, but in the first analysis we did, it’s really unprecedented because it covers a huge number of areas. Roughly, $9.5 billion in global health funding, as opposed to $575 million in family planning and reproductive health funding [that was threatened under previous administration].

We think that this measure is profoundly anti-democratic and unfair—anti-democratic because U.S. funding does not pay for abortions, and you are telling organizations that with their own money, even in countries in which abortion is legal, they can’t work on the issue, advocate for the issue or counsel women. We have seen this before and now we have evidence that it doesn’t work. It puts the poorest and most vulnerable women at risk, and the number of unsafe abortions increases. So it’s not a measure that is based on evidence. The evidence shows that if you actually want to reduce the number of abortions, you need to make it safe and legal.


So if this broadly encompasses global health funding, other programs that have nothing to do with abortion could also be affected by this broad language?

Yes, based on our first interpretation of the measure, that’s absolutely correct. HIV, for instance, or tuberculosis.


Normally, the rule would not apply to a current program—any contract you have signed before, any program that you are already implementing. But this administration is unprecedented, so we are trying to see what the implications are, not just for programs that we will be signing, but programs that we are currently running.

IPPF as a whole stands to lose $100 million by not agreeing to the policy — you work on so many other crucial areas, why not sign the Global Gag Rule considering abortion is widely illegal in the region where you work?


We are not willing to negotiate our principles. We very much believe that women have the right to choose if and when to have children, and we support the right to safe and legal abortion, both on public health grounds and as a human right for women. This isn’t just about the money; we have already decided both globally and regionally that we are not going to support this decision that we consider both anti-democratic and unfair.

When abortion is not legal, those who suffer are the poorest of the poor, those who don’t have social or economic resources to seek a safe abortion. For us, [not signing] is standing with the women who need us the most and that’s what we have always been about.


What does your advocacy and service provision look like on the ground?

First, there are some exceptions on the books for 100 years in some of the legislation—in 11 countries or so in the region—that make abortion legal for certain circumstances. So we are working to make sure those laws are implemented.


We have worked very extensively to refine the right to health. And we have done a lot of work on that, making sure that there is an option for therapeutic abortions. But we are also working to change the laws that are restrictive.

We are working in Chile, a country in which there are no exceptions for legal abortion, where the President Michelle Bachelet put forward a bill that would allow abortions under three conditions and we are supporting that process and will do so in every country where there are no exceptions to the ban.


There are some very extreme cases in the region—El Salvador, for instance, where there are women serving time [in prison] because they allegedly had an abortion. We are working to bring visibility to this human rights violation and also to see how that law can be changed. And we have cases like Honduras where emergency contraception is banned. So there is a long way to go to give women options.

We’ve had Zika for the past few years, and now the link between Zika and sexual transmission, and when you think things could not be worse, there is a political party in El Salvador trying to increase the penalties for women who seek an abortion from 30 to 50 years of jail time.


So clearly some advances—Uruguay changed the law in 2012 to make it more liberal—but also huge backlash and opposition and a long way to go to make abortion safe and legal in the region.

And politically the region seems to be shifting in a more conservative direction.


We have seen this under Bush, and as a consequence of this U.S. policy we expect to see a much more empowered opposition—some of it religious, some of it not, but clearly dogmatic and fundamentalist—to fight every area of our work, from comprehensive sexual education, to access to contraception and emergency contraception, and finally to access to safe and legal abortion.

Abortion rights in Latin America became a headline issue during the Zika outbreak. But in November, the World Health Organization announced that Zika is no longer a “global health emergency.” What does the fight against Zika look like these days?


Nothing has changed for us. If anything, we are redoubling our efforts, because Zika didn’t disappear. The World Health Organization decision to make it not an emergency—we are struggling with this, because it does nothing to help women who are experiencing Zika today, and we are working very closely with partner organizations in the Northeast of Brazil, in Colombia, and in other countries affected in Central America. We are redoubling our efforts to make sure that women know that Zika is a sexually transmitted infection and a mosquito-borne disease and also giving women options not to get pregnant.

Your partnered with the Brazilian research and advocacy organization, ANIS, in the middle of the outbreak.


Yes, and we are very proud of the work that ANIS is doing, both to help women who are in vulnerable conditions— because we know Zika happens in places where women are already suffering the consequences of climate change— and also bringing visibility by putting women at the center of this discussion.

We were appalled to see some of the government responses— “women, don’t get pregnant” type of advice—without giving them any support to actually carry forward those decisions.


The work we have been doing with ANIS has been about bringing women, not mosquitos, to the center of the conversation and working with governments to make sure that women have options—not only access to contraception and safe and legal abortion, but also social protections for those women and families who have children with disabilities.

One thing is to talk in an abstract way, another is to bring visibility to women and their experiences and how they suffered through their decision-making in the context of Zika.


I understand you’ve faced funding challenges even before the gag rule?

The region suffers a lot from international cooperation assistance moving out, because as a whole, we became middle-income countries. It’s called the “tyranny of averages”— we look great in principle, but the women we serve do experience life in very different ways than the average tells us— we are one of the most unequal regions in the world. When you look at several countries, women have very high out-of-pocket expenditures [for health] which is one of the most regressive measures because in seeking health services women have to give up food and other things. It’s a region that doesn’t receive much international support in general.


You said in an interview that your organization has made significant progress in recent years but that the work has been “isolating.” What do you mean by that?

I think we are oftentimes alone fighting the hardest fights out there. Access to safe and legal abortion, for instance. And I think that has been isolating. But I think that the huge mobilization that we are beginning to see around different issues— immigration, the environment— we are beginning to see connections within the progressive agenda. That seems to be critical to building strong alliances that can push us forward— both our issues and other progressive issues.


We are redoubling our efforts. We will fight hard. We do direct service provision in many of the countries where we work, we also fight the big fights in the advocacy sphere, both at the local and regional level. We are very fired up right now.

Kate Steiker-Ginzberg is a freelance journalist and producer who divides her time between Rio de Janeiro and Philadelphia.


as ripley said to the android bishop

Thank God for countries like the Netherlands who are actively working to overcome these kinds of travesties. I genuinely can’t believe that the global gag rule can even be a thing. Fucking hell.