Since 1984, the global health community has been embroiled in one of the biggest volleys for free speech and constitutional fairness – but you may not think of it as such.

The Global Gag Rule (aka "The Mexico City Policy," so-named because of the location of a conference where the policy was originally announced) is at the center of a political game that has seemingly no end. The stakes have always been extremely high – not only do women's health and rights around the world depend partially on the crucial financial resources from the U.S. government, but free speech and a commitment to democratic ideals are alternately squashed or encouraged by this policy, depending on which U.S. presidential administration we're dealing with.

The Global Gag Rule was originally put in place by President Reagan, by executive order, to deny funding to international family planning organizations unless they agreed to specific curtailments as set by the United States on the medical services and information they provided to their patients. That is, health centers that operate in developing nations to help women and men plan their families and avoid unintended pregnancies, were told that they would not be allowed to provide abortions (regardless of whether or not it is legal in their country to do so), refer to abortion services, discuss abortion as an option, or even so much as hang a poster that mentions abortion without potentially being denied funds for the provision of health services that have nothing to do with abortion. In addition, if a reproductive health organization provides abortions anywhere in the world – or advocates for safe, legal abortion anywhere in the world – and also runs separate family planning clinics, which do not provide abortions their funding can be cut off.

According to Planned Parenthood:

"Overseas family planning agencies thus have to choose between accepting U.S. money, which is often their main source of support, or offering their clients comprehensive – and potentially life-saving – reproductive health services and information."

In 1993, when President Clinton moved into the White House the ball was thrown back to him and he did what one would expect – he rescinded the order and restored funding to the international family planning NGOs through USAID (United States Agency for International Development). By Clinton's reckoning, the "excessively broad anti-abortion conditions" as set by the Mexico City Policy were a ruse. The Foreign Assistance Act of 1961 already prohibits international agencies from using federal funds to pay for abortion provision or lobbying. The point of Reagan's order was to flaunt his ruthless politics – he was sucking the wind out of the reproductive rights community's sails by dictating what they could – and could not – support.

President Bush reinstated the order on his very first day in office as what can only be called a symbolic gift to his anti-choice supporters who not only worked hard to get him elected but who had been tirelessly working to preserve the policy by attempting (unsuccessfully) to enact it into law. When Bush restored the policy there was, of course, an outcry from reproductive rights activists who reasoned simply that denying funds for family planning agencies around the world thus denying birth control and contraceptive counseling to those who need them, under the auspices of an anti-abortion political stance, would in fact lead to an increase in unintended pregnancy and thus abortion rates. From the Senate Democrat's 1997 Joint Resolution:

"Giving funds to private foreign organizations that perform abortions with the requirement that they use those funds on pregnancy prevention programs is going to reduce the number of abortions that are performed. Years of experience in Latin America, in Eastern Europe, and countries in other areas confirms this fact. It does not matter if the groups dispensing contraceptives perform abortions or not–all that matters is that pregnancies are prevented, which results in fewer abortions being performed."

The evidence is mounting about how the global gag rule is limiting access to contraceptive services for some of the world's poorest citizens.

And now there is yet more proof that anti-choice forces, led by President Bush, are not merely against abortion but are full-stop opposed to contraception as well.

The ball is in play once again. In June of this year, Representative Nita Lowey (D-NY) led the charge in the House of Representatives to "partially" repeal the Global Gag Rule. While Lowey's amendment does not entirely lift the global gag rule, it provides for "free" contraception to be provided to the international NGOs who have been denied funds through the rule so that, at the very least, women and men would have access to a means of family planning. They correctly argued that broader access to contraceptives will help reduce the need for abortion.

Yet even this has invoked the ire of anti-choicers. Speaking out against Lowey's amendment, Colin Mason, of the extremely conservative Population Research Institute, said, "Contraception always leads to abortion, of course, so Lowey's argument is false on its face."

On September 6^th, buoyed by the success in the House, the Senate voted to fully repeal the Global Gag Rule through an amendment introduced by Senators Barbara Boxer (D-CA) and Olympia Snowe (R-ME) attached to a State Department foreign aid bill. Boxer relied on language she has used in years past when attempting to overturn the global gag rule. In 2003, interpreting the rule as a clear infringement on free speech, Boxer said:

"I cannot understand for the life of me how we can in good faith, as the leading democracy in the world…how we could put a Global Gag Rule on those organizations, when in this country you couldn't even consider it for two seconds because it would be completely unconstitutional."

Indeed, it is hard to imagine how such a harmful and restrictive policy such as this, a policy that has never been enacted into law simply because it has never had the congressional support to do so, has been able to survive. For fifteen non-consecutive years, women in some of the most poverty stricken segments of our world have been denied access to full reproductive health care because of the restrictions borne of this order. So the reproductive rights advocacy community is speaking out once again. But, as straight forward as this issue might seem, there are differing thoughts on how to approach it.

President Bush has already said he would veto both the House and Senate versions. So why was a House version, one that barely scratches the surface of this policy's detrimental effects, floated in the first place? Some reproductive health advocates have stood in support of the amendment as a simple measure that, with Bush's promise to veto, would highlight Bush's obvious anti-contraception stance and force him to explain how he could possibly be opposed to contraception abroad unless he was also opposed to it here in the states.

But, according to others in the reproductive health community, there was and is clearly plenty of support for a full repeal of the global gag rule. A compromise such as the contraceptive amendment passed by the House only served to muddy the waters with confusion and to weaken a strong position. They say the contraceptive amendment will have little impact on the larger issue of free speech and ensuring that family planning agencies are allowed to use their funds the way they see fit in order to best help women and families.

Many say a full repeal of the Global Gag Rule is the first and best place to begin if we are to hold firm to the principles behind the push to repeal. There has always been an outcry against this policy because it crushes the very democratic ideals this country is supposed stand for; because it imposes a double-standard, allowing family planning organizations in this country access to funding while denying it to international agencies which do the same thing; and most significantly because it devastates women's lives by denying them basic reproductive health care. Finally, a compromise such as the House amendment has the potential to sacrifice bargaining power. I can hear parents' advice to their young adult children ringing in my ear: you never start with your mid-tier offer, you start with what you want in the best of all possible circumstances leaving you room to dicker.

Regardless of Bush's threats to veto both the House contraception amendment and the Senate's full repeal, reproductive rights supporters across the board are urging us not to give up.

And despite the debate that rages within the reproductive health advocacy community pitting Lowey's "free contraception" amendment against the full-scale repeal set forth by Senator Boxer, there seems to be a desire, publicly, to continue forcing the issue – to see the global gag rule overturned completely.

Population Connection warns us, "The Boxer Amendment is a tremendous step forward, but there is still a long way to go…"

It is unlikely that there will be any significant movement in either the House or the Senate on this issue over the next several weeks. For now, the reproductive health advocacy community needs to convince itself that an abiding loyalty to our deepest-held values and a sense of trust in our progressive political and social ideals form a strong foundation for any political strategy. This is an issue that reaches beyond, though fully encompasses, reproductive health and rights. To ensure that women's health and lives, and a democratic commitment to free speech are not subject to the tides of presidential administrations, most advocates say it is crucial that we continue to prioritize a full repeal of the Global Gag Rule.

For more information on the Global Gag Rule, check out last week's episode of RealityCast, our weekly podcast with Amanda Marcotte.