Mr. Trump’s ‘Gag Rule’ Will Harm Global Health

http://www.nytimes.com/2017/01/26/opinion/mr-trumps-gag-rule-will-harm-global-health.html

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With a single memorandum, President Trump may well have made it harder for health workers around the world to fight cancer, H.I.V., Zika and Ebola. The memorandum, signed on Monday, reinstates and expands a policy barring health organizations abroad, many of which provide an array of services, from receiving federal funds if they even talk to women about abortion as a method of family planning.

The so-called Mexico City policy, also known as the global gag rule, was established by President Ronald Reagan in 1984, and has since been supported by every Republican president and opposed by every Democratic one; Barack Obama renounced it in 2009. Mr. Trump has not only reinstated it but greatly broadened its impact.

In the past, the policy has applied only to international family-planning funds, which currently total around $600 million. Mr. Trump’s memorandum, however, would apply the policy to “global health assistance furnished by all departments or agencies.” Although reproductive health groups are still studying the memorandum, this language would appear to apply to any international health funding, around $9 billion, used to fight malaria, H.I.V., Zika, Ebola and many other global health threats. This would seem to go well beyond family-planning aid from the Agency for International Development and the State Department, to also include money from all American governmental agencies and departments.

Federal funding for abortions abroad has been banned since 1973, except in cases of rape, incest or a threat to the mother’s life. Mr. Trump’s gag rule goes far beyond the 1973 ban to bar funding to all organizations that provide abortion or abortion referrals, even if they do so with their own funds and even if abortion is not the focus of their work.

By cutting off family-planning funds to reproductive health care providers, the gag rule eliminated contraceptive and maternal health services to countless women around the world. After losing funding during the Bush administration, a group known as Family Health Options Kenya had to close six clinics, leaving 9,000 people with little access to health care.

Perversely, the gag rule appears to have led to an increase in abortions, which its proponents obviously did not intend, and would be likely to do so in the future. In one 2011 study, African countries that relied heavily on aid from the United States experienced increased abortion rates when the policy was in effect, relative to countries that got less funding from the United States.

The policy will also limit access to providers of safe abortions. Under the Bush-era policy, the International Planned Parenthood Association of Ghana reported a 50 percent increase in the number of women needing treatment following unsafe abortions.

Though the potential damage from Mr. Trump’s memorandum is still being tallied up, the International Planned Parenthood Federation calculates that it may lose $100 million over four years, leading to reductions in services in at least 30 countries.

President Trump’s decision will limit health organizations’ ability to fight disease and promote reproductive health, and other governments will have to pitch in to help. On Wednesday, the Dutch government announced plans to establish an international fund to help fill the gap left by the reinstatement of the policy, paying for contraception, abortion and education for women. Representative Nita Lowey, Democrat of New York, and Senator Jeanne Shaheen, Democrat of New Hampshire, have introduced bills that would permanently repeal the Mexico City policy. Neither, regrettably, is likely to pass.