From secret mixtures of herbs and spices to knitting needles, the practice of botched, back-alley abortions is the reality for many women in developing countries around the world. In order to prevent this, it is necessary for women to have access to contraception, reproductive health, family planning services, and in some cases, safe abortions provided by a medical professional. From 2009 to 2017, the United States provided aid to foreign NGOs that gave millions of women the opportunity to get access to contraception, health services, and abortion referrals counselling. However, that quickly changed when Donald Trump came into office, and reinstated the Mexico City Policy on January 23rd, 2017. Despite evidence that the Mexico City Policy has caused abortion rates in certain developing countries to increase, many Americans are in favor of the policy. However, this policy will have a variety of negative consequences for family planning, maternal and child health, and a multitude of other important global health issues. Therefore, The Mexico City Policy should be rescinded, as it would still prevent US funds from going to abortions or abortion-related services abroad, but would still allow women in developing countries to receive the reproductive healthcare and family planning services that they rely on.
The Mexico City Policy is a policy which prohibits United States federal funds from going to international health organizations that promote abortions. Often referred to as the “global gag rule,” this policy has become a highly partisan issue, with US presidents either choosing to reinstate or rescind the policy within their first week of office since it was created during the Reagan era. While other laws in place before the Mexico City policy prevent the organizations that perform abortions from using US taxpayer money, this policy prevents the use of money for any organization that simply promotes abortion as a method of family planning. This not only affects abortion services, but any services performed by that organization. For example, if an international NGO performs abortions or provides abortion support in one country, that same organization would no longer be eligible to receive US funding for any health services, even if it is in another country. The policy has been described as “seek(ing) to restrict activities that are deemed lawful in the USA and many recipient countries, on partisan ideological grounds, even when US funds are not being used for those activities.”
While the Mexico City Policy, or “global gag rule” is one of the most well-known pieces of abortion legislation, there are several other laws that govern the use of US funds in abortion services overseas. The Helms Amendment of 1973 prohibits the use of US funds to perform “abortion as a method of family planning or to motivate or coerce any person to practice abortion.” The Biden Amendment of 1981, which prevents funds from going to biomedical research relate to abortion. The Siljander Amendment prohibits the use of US funds to lobby both for or against abortion. The Mexico City Policy goes even further, and bans any foreign non-governmental organization that provides abortion services, counseling, or referrals from using US family planning funds. It was first introduced by Ronald Reagan in 1984 at the 2nd International Conference on Population in Mexico City, and prevented any foreign NGOs that performed or promoted abortion as a method of family planning from receiving US funds. However, Since its creation, it has either been rescinded by every democratic president in office and reinstated by every republican president in office through presidential memorandum, as has been in effect for eighteen of the past thirty-three years. The Mexico City Policy requires foreign NGOs to make a tough choice: stop promoting and practicing abortion, or lose all US federal funding.
Trump’s most recent iteration has expanded the Mexico City Policy. Previously, the policy only applied to foreign family planning and reproductive health organizations, but it now affects almost all global health organizations, including funding that goes to HIV/AIDS prevention through PEPFAR. The new policy, entitled “Protecting Life in Global Health Assistance,” affects any foreign NGO that uses US funding for HIV/AIDS, maternal and child health, malaria, nutrition, infectious disease, tuberculosis, global health security, and family planning and reproductive health. Protecting Life in Global Assistance went into effect on May 15, 2017. All foreign NGOs are eligible to receive US funding as long as they abide do not actively promote abortion, which includes “abortion counseling, referrals, lobbying, and public information campaigns…except in case of rape, incest, or endangerment of the life of the mother.”
According to the Department of State, the goal of the policy is to “stop US taxpayer money from flowing into entities that promote or provide abortions as a method of family planning. This includes any organization that receives US funds, even if funds from other sources are used for abortions or abortion-related services. The policy is supported by many Americans, most of whom consider themselves “pro-life”, as it ensures “hard-earned tax dollars are used by other health care entities that act consistently to save lives, rather than promoting and performing abortion”. Representative Chris Smith of New Jersey described the Mexico City Policy as “a humane policy (which) seeks to respect and protect the lives of unborn girls and boys from the violence of abortion. However, if the true goals of the policy are to protect the lives of the unborn, it has not been successful.
Studies have shown that following the reinstatement of the policy has actually caused abortion rates to increase in developing countries that are most affected by the Mexico City policy. A 2011 study examined the effects of the Mexico City Policy on abortion rates in sub-Saharan Africa between 1994 and 2008. The countries were separated based on their exposure level, which was defined by the amount of US foreign aid they received for family planning and reproductive health during the years were the Mexico City Policy was not applied. In low exposure countries, abortion rates remain relatively stable over time. However, in high exposure countries, abortion rates remain relatively low during the Clinton Administration, but when the policy was reinstated in 2001, abortion rates steadily began to rise. In high exposure countries, women were 2.73 times more likely to receive an abortion while the policy was reinstated than they were before the policy was reinstated. In addition, for each additional year that the policy was in place, abortion rates were 1.21 times higher. This is likely due to the fact that the prevalence of contraceptive use leveled out in high exposure countries while the policy was in place, while low exposure countries continued to experience and increase in contraceptive use. By cutting funding to family planning organizations, women have less access to contraception and reproductive health education, therefore causing an increase in unplanned pregnancies and abortion rates. There are no studies that examine the effects of Trump’s most recent policy expansion, but by looking at past research on the Mexico City we can assume that there will be similar outcomes.
Access to family planning services and contraception are the main methods of abortion prevention worldwide. A 2016 study examined global abortion rates between 1990 and 2014. It was found that abortion rates in the developed world dropped significantly, with 46 abortions occurring per 1000 women from 1990-1994, to 27 per 1000 women from 2010-2014. However, it the developing world, there was no significant change. In order, to ensure that abortion rates in developing countries decrease, it is important that women are able to access necessary family planning service to prevent unintended pregnancies. Foreign NGOs are forced to either restrict the types of services they provide or forgo US funding. In many cases, the consequences of the Mexico City Policy has prevented family planning organizations from providing contraception to marginalized communities. Marie Stopes International has estimated that “over 2 million women will no longer have access to contraception from a Marie Stopes International provider.” This gap is predicted to result in 2.5 million unintended pregnancies, 870,000 unsafe abortions, and 6,900 avoidable maternal deaths. This rise in unintended pregnancies has been confirmed in Ghana’s 2007 Demographic and Health Survey. It was found that the reinstatement of the global gag rule in 2001 caused a disruption in contraception access that resulted in a 12 percent rise in unintended pregnancy, 25 percent of which resulted in abortion.
However, the Mexico City policy affects more than just abortion rates. Based on information from the 2007 Ghana survey, it was found that children who were born while the policy was in place had a lower height and weight compared to children who were born while the policy was not in place. As previously stated, the implementation of the policy is likely to result in decreased access to contraception. Without access to contraception, mothers are likely to experience decreases in child spacing. The health of both the mother and all of her children are affected by child spacing, due to insufficient nutrition and decreased investment in the development of all children in a family. Increases in maternal mortality are also linked to the implementation of the Mexico City Policy. In the past, the policy has led to increases in unintended pregnancies, which are more likely to end in abortion. If those abortions are unsafe, they are likely to result in maternal mortality. Because the policy also requires organizations to refrain from lobbying for relaxed abortion laws, many women in developing countries are preventing from achieving the right to a safe abortion.
Trump’s latest expanded version of the Mexico City Policy, Protecting Life in Global Health Assistance (PLGHA), not only restricts funding for family planning and reproductive health services, but all US health funding. This includes programs such as the President’s Emergency Plan for Aids Relief (PEPFAR), Centers for Disease Control and Prevention (CDC), and National Institutes for Health (NIH). This has had significant effects in South Africa, a country which is significantly affected by HIV and is a major recipient of US funds. While South Africans have the right to reproductive decision-making, and healthcare providers are required to make referrals when patients are seeking an abortion, funds could be put at risk if patients at AIDS clinics ask for help in terminating their pregnancy, but seeking to abide by PLGHA’s demands could cause healthcare providers to break the law if they do not accurately inform their patient. In addition, lack of family planning services could cause increased transmission from mothers to their children and causing severe health consequences. The changed caused by reductions in funding disproportionately affects rural women, who are more likely to be affected by clinic closures and reduced outreach by organizations, and reduced distribution of condoms in some cases, which can both prevent unintended pregnancy and the transmission of HIV/AIDS. PEPFAR has been incredibly successful since its launch in 2003, providing 11 million people with anti-retroviral treatment and testing to 74 million people in over 63 different countries. However, this could all change due to PLGHA, and HIV/AIDS clinics could be forced to restrict their services in order to continue to receive funding.
While many Americans are in favor of the Mexico City Policy, there are many pieces of United States legislation that prevent the use of US taxpayer money from paying for abortion overseas. Having this policy in place, and furthermore, having Trump’s expanded policy in place prevents people all over the world from receiving contraception and other family planning services, as well as HIV/AIDS, malaria, and tuberculosis relief. While pro-life Americans hope that the policy will aid in their fight to reduce abortion rates worldwide, it has been shown that the gaps in reproductive services caused by the Mexico City Policy have caused abortion rates to increase during the years it is in place, and cause negative effects in maternal and child health, as well as HIV/AIDS patients. In order to address this issue, the Mexico City Policy must be rescinded, as foreign NGOs would still be allowed to provide vital services such as contraception, counseling, and other health services without using US funds to pay for abortion. In any case, a long-term solution to this problem is necessary, as constant policy changes cause even more difficulty for foreign NGOs and the millions of people that rely on them.