In one of a number of sharp reversals from the Obama era, US president Donald Trump on Monday signed an executive order banning international NGOs from providing abortion services or offering information about abortions if they receive US funding.
The rule will put thousands of international healthcare workers in the difficult position of deciding whether to continue to offer family planning care that includes abortion at the expense of a critical funding stream.
The US is the single largest donor to global health efforts, providing nearly $3 billion (€2.8 billion) toward health efforts through the United States Agency for International Development (USAid) alone. The state department and groups like the Peace Corps offer additional funding.
Many international health advocates insist that their efforts are not comprehensive without abortion services. Unsafe abortions are a major cause of maternal mortality and kill tens of thousands of women every year.
"President Trump's reinstatement of the global gag rule ignores decades of research, instead favoring ideological politics over women and families," said Senator Jeanne Shaheen, a New Hampshire Democrat who serves on the foreign relations committee.
“We know that when family planning services and contraceptives are easily accessible, there are fewer unplanned pregnancies, maternal deaths, and abortions.
“And when women have control over their reproductive health, it improves the long-term health of mothers and children and creates a lasting economic benefit.”
Reagan-era rule
Mr Trump’s signature reinstates a Reagan-era rule that was not in effect for most of the Obama administration. The order does not eliminate international aid for abortions, which is already prohibited by federal law under the Helms amendment. Rather, the gag rule takes the Helms amendment one step further by preventing NGOs from using private funds to offer abortions or even refer women to groups that provide abortions.
The gag rule also prevents health workers in foreign countries from advocating for abortion rights, which includes testifying about the impacts of illegal abortion.
The rule does not enjoy uniform support along party lines. In 2015, Senate legislation introduced by Ms Shaheen that would have made the gag rule impossible to reinstate by executive order attracted support from several moderate Republicans.
Still, the reinstatement of the global gag rule, also known as the Mexico City policy, has been long sought by opponents of abortion rights. To their eyes, funding groups that perform or even discuss abortions is tantamount to funding the procedure.
"President Trump is continuing Ronald Reagan's legacy by taking immediate action on day one to stop the promotion of abortion through our tax dollars overseas." said Marjorie Dannenfelser, president of the anti-abortion political advocacy group Susan B Anthony List.
“President Trump’s immediate action to promote respect for all human life, including vulnerable unborn children abroad, as well as conscience rights, sends a strong signal about his administration’s pro-life priorities.”
Bush order
Mr Trump is not the first president to reinstate the rule after it was suspended. George W Bush signed a similar order when he entered office in 2001.
As a result, more than 20 developing countries in Asia, Africa, and the Middle East lost access to contraceptives provided by the US and many NGOs were forced to shut down or lay off staff, according to EngenderHealth, a global women’s health organisation that supports abortion rights.
EngenderHealth observed the impact in three places – Kenya, Nepal and Zambia – and found that in these countries, the gag rule reduced the availability of family planning services, HIV programs and maternal and child health programs.
Guardian service