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Choked by the Global Gag Rule (Hindu.)

The Trump administration has set back women’s health programmes worldwide

On his first day in office, U.S. President Donald Trump reinstated what is known as the Global Gag Rule, or the Mexico City Policy. This rule, which was first introduced by President Ronald Reagan in 1984 at the time of the International Population Conference in Mexico City, has been revoked by successive Democratic Presidents and reinstated by successive Republican Presidents, so Mr. Tump’s action was not unexpected.

Very briefly, the Global Gag Rule states that U.S. government funding cannot be given to international NGOs, either directly or through U.S. non-governmental partners of these NGOs, unless these foreign NGOs sign an undertaking to not provide abortion services or even information or advocacy on abortion to their clients even in countries in which abortion is legal and even with money that does not come from the United States Agency for International Development’s budget. Whenever this ruling has been in place, it has severely handicapped a host of non-governmental agencies in poor countries that provide family planning information and services to women because these agencies also often help women to deal with unplanned and unwanted pregnancies in countries where it is legal to do.

Not just about abortion

The U.S. government has every right to decide how to allocate its foreign aid and if the present one is against the use of tax dollars to promote abortion, however tangentially, that is its prerogative. But the international reproductive health community is naturally upset at an action that may be technically legal but is morally and ethically questionable in that is penalises women and organisations in ways that go well beyond abortion access — in principle, the ruling can cut off funds for crucial activities like HIV/AIDS prevention, contraceptive access, sexuality information, maternal and child health, and so on, simply because the agencies that work in these areas might give up working in them because of restrictions from their funding sources.

Such impacts will be particularly strongly felt in countries in Africa, where the unmet demand for health, reproductive and contraceptive information and services is high because governments do not have the resources to meet these demands.

What about India? According to the most recent survey data available (National Family Health Survey, 2005-2006), close to three fourths of Indian women get their contraceptive services from the government sector. But this is because some 67% of contraceptive use in India is accounted for by female sterilisation, which is promoted primarily by the government’s family planning programme. For other temporary methods of birth control, the non-governmental sector (by which we actually mean a mix of private and non-profit agencies) accounts for more than half the contraceptive use. How this non-governmental sector will fare under the Gag Rule remains to be seen.

But there is more. Much of the assistance that the U.S. government provides to India is through what are called public-private/NGO partnerships to address the problem on hand — whether it is urban health or school cleanliness drives or rural child mortality. It is not clear how these partnerships will play out under the new ruling. Given that the Indian government is clearly not opposed to abortion and that the Gag Rule does not restrict aid to governments whatever their stance on abortion, the net impact might be in fact to strengthen the hand of a government that is already clamping down on NGOs in the country for its own reasons.

India could also experience other kinds of impacts of this rule because there are several aspects of sex and reproduction that the government refuses to touch for politically reactionary reasons and the NGO sector is all we have to address these. Sex education for adolescents falls in this category. An important part of such sexuality education includes explaining all the available options for birth control and if abortion is deliberately left out of this list, a disservice will have been done.

On the other hand, fairness demands that we look at the few positive features of the Gag Rule that might be good for India and its people if they are imposed on governments, NGOs and, through them, on communities and families. The Executive Order forbids aid to any entities that support coercive abortions or involuntary sterilisations — both actions that pop their heads repeatedly in India. Maybe USAID pressure will give a fresh lease of life and publicity to efforts to combat shameful practices ranging from tribal women being forced by government hospitals to undergo post-partum sterilisation (and sometimes dying from the hurriedly and unhygienically performed procedure) to pregnant women being forced by their families to abort female fetuses. If that happens, the Global Gag Rule might have a small bright side to it.

Important caveats

Also worth keeping in mind is that the Gag Rule only applies to the promotion of abortion as a means of family planning, not abortion after a sexual attack or abortion to save the life of a pregnant woman. Moreover the ruling does not apply to post-abortion care for women who have post-abortion complications, legal or not. These are important caveats and NGOs must not get frightened off helping such women just because of the rule. The fear unfortunately is that many NGOs will either bow to the rule by leaving abortion completely out of their ambit or will retreat from family planning related work altogether.

In any case, it is worth keeping in mind that India does not have the same tradition of pro-choice and pro-life arguments that polarise debates in the U.S. and paying too much attention to what the Trump administration decrees is not in our interest; it will be even less necessary if the effective tradition of NGO activity in India can count a little more on the active support and encouragement of the government instead of being hounded for imagined brushes with some vague law or the other.

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