The ‘Global Gag Rule’ must go forever

Much to the exultation of health groups across the globe, US President Joe Biden has, through a series of executive orders, started to roll back various anti-abortion measures put in place by the Trump administration. Most significantly, he reversed one of Trump’s most controversial orders -- the so-called “Mexico City Policy”.

The policy, which under earlier Republican administrations were applicable only to US family planning assistance, was expanded in scope by in January 2017, renaming it “Protecting Life in Global Health Assistance”. It required any foreign NGO receiving US global health assistance to certify that they do not use their funds to provide abortion services, counsel patients about the option of abortion or refer them for abortion, or advocate for the liberalisation of abortion laws. It came to be called the ‘global gag rule’ (GGR) as it placed restrictions on organisations from using even their own (non-US government) funds to enable safe abortion access to their constituencies and tied their hands in facilitating conversations on progressive abortion laws and policies in their own countries.

In 2019, the GGR was further expanded to withhold funds from foreign NGOs that give money to other groups providing abortions, in a bid to thwart what the Trump administration called “backdoor funding schemes”. The GGR thus forced healthcare providers across the globe to make the immensely difficult choice between either providing an inclusive range of reproductive healthcare services or enjoying continued access to critical funding from the US. It extended restrictions to an estimated $8.8 billion in US assistance, including funding support for family planning and reproductive health, maternal and child health, nutrition, HIV/AIDS, infectious diseases, neglected tropical diseases, and even to water, sanitation and hygiene programmes.

A devastating consequence of this policy was that women from some of the most underprivileged countries in the world lost access to family planning services, were denied critical information on maternal health, rendered vulnerable to unintended pregnancies and unsafe abortions, which contributed to a rise in maternal mortality.

Ironically, as a study by Stanford Researchers (2019) revealed, the reduction in access to contraception as a result of the GGR led to a rise in abortions. The Foundation for AIDS Research in its study (2019) reported that organisations rooted in diverse geographical locations, who were implementing partners of the President’s Emergency Plan for AIDS Relief (PEPFAR), underwent serious organisational changes due to the gag order, leading to a reduction in the provision of critical non-abortion-related information, including for contraception and HIV. The International Women’s Health Coalition has noted that the policy has been particularly harmful to the health and well-being of women, young people, and marginalised communities such as LGBTQI, the rural poor and religious minorities.

While the rescinding of the GGR by the Biden administration is a welcome move, is it enough? Health groups and advocates across the globe fear that the next Republican government that comes to power may reinstate GGR, plunging the health sector once again into uncertainty.

Last week, the Global Health, Empowerment and Rights (HER) bill was reintroduced in the US Congress for the third time. The legislation, if passed, would permanently end the Global Gag Rule. The Global HER Act would remove eligibility restrictions on recipients of US foreign assistance, guarantee that US foreign assistance prioritises women’s health, and NGOs on foreign soil receiving US funding would not have to do so at the cost of their free speech. Most importantly, the passing of the Act will prevent a future US president from unilaterally reinstating the GGR.

The re-introduction of the bill in the US Congress has come as hope for women’s health and reproductive rights globally. This has come at a time when we are witnessing restrictions on women’s reproductive freedom in various parts of the globe. Recently, Poland declared a near-total ban on abortion, backed by the ruling Law and Justice Party (PiS), which had placed anti-abortion rhetoric at the heart of its socially conservative agenda. Massive protest movements have erupted across the country and thousands of women have taken to the streets, defying law enforcement directives, to assert their right over their bodies.

For the religious conservatives in the US, the GGR is a sensitive issue. Recently, more than 100 Republican lawmakers sent a letter to Biden asking him to reconsider the repeal of the GGR as it would mean complicity of the US taxpayer in global abortion. Until the Global Her bill is passed, the threat of the GGR returning will always loom large over the global health sector. Whether the Biden administration is successful in getting the required support for this bill is going to be a real test of their commitment to undoing the devastating impacts of the GGR on global reproductive freedom.

(The writer is a Professor at Jindal Global Law School, OP Jindal Global University, Sonipat)