To absolutely no-one’s surprise (and as I wrote a few blog posts back), on his first working day in the presidential office Donald Trump signed an executive order reinstating the Mexico City Policy. Also known as the Global Gag, the policy restricts US funding for NGOs and other organisations who ‘perform or promote’ abortion services.
The Global Gag is, of course, a moral issue, embedded not just in debates around sexual and reproductive health, but also in women’s rights, equality and equity, participation in planning health services and packages, and questions of power (power of donors to control what goes on in other countries, power of a group of overwhelmingly middle-aged white men to determine the fate of overwhelmingly non-white, often young women). But engaging with the morality of the Mexico City Policy is to invite a response from proponents in which they simply assert the primacy of their own moral universe.
With that in mind, rather than engage with the politics, the morality, the rights issues at the heart of the Global Gag (critical though these are), let us focus instead on whether it works. If we accept that the premise of the Gag is to reduce the number of abortions taking place globally, does it achieve that aim? If it does, then its supporters may have a case that as a policy it does have the desired effect (however much I may disagree with that objective). Of course, if it doesn’t, and if it not only fails in that but makes the problem substantially worse, then any justification for the policy simply vanishes.
A 2011 study examining the impact of the Global Gag on abortion rates concluded:
“Our study found robust empirical patterns suggesting that the Mexico City Policy is associated with increases in abortion rates in sub-Saharan African countries.”
Although the authors point out that their data cannot draw definitive conclusions about causes, the association between ‘highly exposed’ countries (where the policy had its biggest impacts) and the rise in abortion rates is ‘strong’. Moreover, the timing of the growing gap in abortion rates between high and low exposure countries coincides with the reinstatement of the Global Gag in 2001.
[Source Eran Bendavid, Patrick Avila & Grant Miller (2011), ‘United States aid policy and induced abortion in sub-Saharan Africa’, Bulletin of the World Health Organisation 89, 873-880C. Available here]
Other studies, such as this one in Ghana, have similarly found an association between the imposition of the Global Gag, and rising abortion rates. In other words, the Mexico City Policy is associated not with a decline in abortion rates, but with an increase. It quite clearly fails.
If the Global Gag is not reducing (and is, as the data suggests, increasing) abortion rates, it is doing so especially for unsafe abortions. There are around 36 million abortions each year. Of these, 21.6 million are categorised as ‘unsafe’, contributing to the deaths of 47,000 women each year as a result of complications arising from unsafe abortions (and accounting for around 13% of all maternal deaths). In 2005, the Ethiopian government reformed its abortion laws in an effort to reduce the numbers of women dying from unsafe abortions (estimated at over 10,000 each year). Highly dependent on aid for its health sector (and the US being by far and away the largest provider of aid for health), the Global Gag reduced the scope for putting the reforms into practice, and undermined progress in reducing maternal deaths. Ethiopia’s experience is not uncommon.
Because many of the organisations involved in abortion services and advice are also key actors in wider sexual and reproductive health services, the Mexico City Policy has a wider impact on health:
- A 2006 report on the impact of the Global Gag in Zambia found that the main NGO providing reproductive health clinics had lost 40% of its staff, been forced to scale back services and end community-based distribution of contraceptive supplies and wider health information.
- Another report for Kenya showed, that reproductive health care providers were also closing clinics and scaling-back services. In most cases, these clinics were the only sources of health care for those communities. Community-outreach services, essential for HIV and AIDS programmes, were being cut. And child-health services were also being curtailed.
- In Ghana, supplies of contraceptives increased when the Mexico City Policy was rescinded under President Clinton, and declined when it was reinstated by President George W Bush.
- In Lesotho, famously, US shipments of condoms to the country were stopped as the organisation responsible for disbursement (the Lesotho Planned Parenthood Associated) lost its funding as the Global Gag was reintroduced by Bush (at a time when an estimated one-in-four women were living with HIV).
So not only is the Global Gag undermining sexual and reproductive health services, with all the implications for maternal and child mortality that this creates, and the negative impact on efforts to control HIV and AIDS; it is actually making the problem worse. Around four-fifths of all contraceptive supplies in sub-Saharan Africa are provided by external organisations of precisely the type targeted by the Mexico City Policy. By restricting access to contraception (through denial of funding to those organisations), more unwanted pregnancies occur, more women therefore are pushed into having unsafe abortions, and more women die. By restricting sexual and reproductive health work, efforts to control HIV and AIDS are critically undermined.
The evidence is quite clear: the Global Gag does not work. More than just not working, indeed, it has an opposite effect to that intended. So if the purpose of the proponents of the Mexico City Policy is to try and lower the number of abortions, then its architects ought to think again (here’s an idea, why not refuse funding to those organisations who promote abstinence-only campaigns, or refuse to provide contraceptives?).
But they won’t. And not just because in the new US knowledge-economy ‘facts’ can be challenged with ‘alternative facts’ made-up to order. The Global Gag isn’t really about the acceptable use of aid, or the effort to ensure US aid reflects particular ‘values’. It’s not even really about the number of abortions undertaken around the world. The Mexico City Policy is a totemic signal that reflects and speaks to domestic US politics. Its negative impact may occur outside the US, but it is intended to broadcast the character of the incoming administration within the US, to appeal to certain groups of voters, and to attract the support of certain lobby groups.
Targeting vital services of the global poor and marginalised for domestic political gain is bad enough, no matter which government does it. To do so with a policy that exacerbates maternal mortality, creates more unwanted pregnancies and leads to more unsafe abortions; that undermines HIV and AIDS prevention work; that worsens the health of entire communities; and that undermines any meaningful idea of human rights and gender equity, is simply disgraceful.