Three Years Later, Trump’s Global ‘Gag Rule’ Continues to Devastate Global Health

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Analysis Law and Policy

Three Years Later, Trump’s Global ‘Gag Rule’ Continues to Devastate Global Health

Monica Kerrigan & Nelly Munyasia

Even after the global gag rule has been dumped, we will have years of work ahead of us to undo the damage it has wrought.

Thursday marks three years since the Trump-Pence administration reinstated and radically expanded the global “gag rule.” Flanked by a row of white men, Trump signed this dangerous policy into law two days after the historic Women’s March in 2017.

The global gag rule was the first of many attacks the administration leveled against women, sexual and reproductive rights, and health access for people around the world. Amid these challenging times, we continue to march, resist, and rise up to fight for our reproductive rights.

We are Monica Kerrigan and Nelly Munyasia, and we lead Planned Parenthood Global and Reproductive Health Network Kenya, respectively—two organizations fighting back against the global gag rule.

First, some basics: The global gag rule (also known as the “Mexico City policy“) was a bad/terrible/atrocious policy first implemented by the Reagan administration in 1984 that unfairly targeted family planning programs and blocked millions of women and youth from access to contraception that can transform their lives. The Trump-Pence administration dramatically expanded its unethical directive and used it to deny funding for HIV/AIDS prevention and treatment, nutrition, maternal health, family planning, and malaria.

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The evidence is clear that the gag rule threatens the health, lives, and rights of the most vulnerable populations—the poor, young people, and LGBTQ people. This policy is not supported by any evidence base and threatens the efficacy of the U.S. government’s $9 billion of investment to achieve global health impact.

As the recipient of foreign assistance from the U.S. government, Reproductive Health Network Kenya (RHNK) was in a difficult position: Abide by the global gag rule (which would end their safe abortion services, permitted by Kenyan law) or reject the rule and lose critical funding. Abortion is legal in particular circumstances in Kenya, but accessing abortion and post-abortion care is still challenging for many people outside Nairobi, the capital city.

RHNK operates in 43 out of the 47 counties in the country, and caving in to the global gag rule would have meant turning our backs on these marginalized groups and going against our very mandate as an organization. RHNK refused to accept gagged funds so that we could continue to provide vulnerable patients with services they wouldn’t be able to get elsewhere. But as a result of our noncompliance, we lost all our funding.

For women and girls from heavily populated urban slums and other marginalized parts of the country, this was essentially a loss of information and services, including HIV testing and counseling, cancer screening, and family planning. In the longer term, we saw an increase in unplanned pregnancies, which in turn resulted in increased maternal mortalities due to unsafe abortions. We managed to scrape together alternate funding, but the program cuts we have been forced to make resulted in 15,000 fewer people able to get the health services they need.

Over the past three years, we have seen the devastating impact of this policy on global health and reproductive rights around the world. Planned Parenthood Global has documented that impact, and we have seen how the policy has harmed already fragile health systems. Some organizations have reported a chilling effect on partners who now avoid working with them for fear of retaliation by the U.S. government. Fundamentally, this breakdown has resulted in a failure by the United States to meet its global goals on HIV, maternal, and newborn health, and family planning, as well as women’s economic empowerment and gender equality, because we can’t harness and align all partners to ensure impact.

The global gag rule threatens access to a range of health services, silences local advocacy, and emboldens opponents of human rights. It must be repealed. We will continue to work closely with Planned Parenthood Federation of America to build support in Congress and across diverse coalition partners to support the Global HER Act, which would end the global gag rule for good.

But even after the gag rule has been dumped, we will have years of work ahead of us to undo the damage it has wrought. As countries around the world grapple with how to achieve health care for all people, we need to ensure sexual and reproductive health is included—and abortion must be a part of that. Because abortion is health care, and health care is a human right. And despite the Trump-Pence administration’s efforts to gag us, we won’t be silent.