How the US presidential election could impact women’s health worldwide

President Donald Trump wasted no time to reinstate what’s often called the “Mexico City policy,” or what critics refer to as the “global gag rule,” during his first week in office. 

The policy prohibits groups from around the world that get US aid for family planning from using separate funding to engage in any abortion-related services, whether that be counseling, education, doctor referrals or local advocacy campaigns.

The US is the largest funder of global health and family planning programs worldwide. Democratic contender Joe Biden is at complete odds with Trump on this and other policies, and so the outcome of the upcoming election could carry big implications for women around the world. 

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Global reproductive rights advocates contend that the policy, and what Trump has done to expand it, goes well beyond abortion itself, and has harmful implications for women’s health overall.

Dr. Carole Sekimpi is the director of the Marie Stopes International program in Uganda, the largest provider of reproductive and sexual health services in the country.

In Uganda, which has one of the highest rates of teen pregnancy in sub-Saharan Africa, and abortions are illegal under most circumstances, Sekimpi’s group works to prevent unwanted pregnancies and unsafe abortions, and as part of that, offers abortion counseling.

“I think what really helps is to empower women with information to make informed choices concerning their bodies.”

“I think what really helps is to empower women with information to make informed choices concerning their bodies,” she said.

But when Trump reinstated the Mexico City policy, Sekimpi faced a tough decision: forfeit some $20 million in US aid but continue to offer services like abortion counseling, or take the funding but compromise what they do. Her group forfeited the funding, as did MSI clinics around the globe, some of which offer abortions where it is legal. Grants from USAID, which went exclusively toward contraception services, represented 17% of their overall budget. 

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“That really means a change in how you work, a change in how you deliver services to women and girls,” she said, adding that they had to scale down clinic partnerships and outreach services, especially in rural areas. 

Under a Biden presidency, it’s likely that MSI wouldn’t have to do this. Biden’s campaign has said that if elected, he would use his executive action on his first day in office to withdraw the Mexico City policy. 

Biden wouldn’t be the first to reverse the policy. Although direct US aid for abortion services has been restricted since the 1970s, President Ronald Reagan introduced the Mexico City policy in 1984, during a conference in Mexico City. 

Since then, presidents have immediately repealed or reinstated it along party lines. 

A worrying trend

This yo-yo-ing back and forth has allowed researchers like Nina Brooks, at Stanford University, to run comparisons to better assess the impact of the policy on abortion and women’s health in affected communities.

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Brooks and her team identified a worrying trend.

“When the policy is in effect, the abortion rate increased by 40% in countries that were most vulnerable to the Mexico City policy’s funding restrictions relative to countries that were less reliant on US aid for family planning.”

“When the policy is in effect, the abortion rate increased by 40% in countries that were most vulnerable to the Mexico City policy’s funding restrictions relative to countries that were less reliant on US aid for family planning,” she said. 

Brooks theorizes that when groups like Sekimpi’s lose US aid, family planning services take a hit, and women lose access to modern contraceptives. Pregnancies go up, as do abortions, and often in riskier circumstances.

“So, it really speaks to the broad outreach of US policies on health outcomes worldwide,” Brooks said. 

About 25 million unsafe abortions are performed each year, according to the World Health Organization. It’s a leading cause of death during pregnancy and results in some 7 million women being hospitalized.

Despite the counterintuitive findings, Trump has expanded the Mexico City policy since taking office. Previously, the condition applied to about $600 million in family planning funds. Under Protecting Life in Global Health Assistance, nearly any organization that receives US funding for health care, representing upward of $7 billion in aid, is barred from offering abortion-related services, even when using separate funds. 

It doesn’t matter if an agency’s focus is on preventing malaria or improving childhood nutrition. If it has direct affiliations with programs that offer sexual and reproductive health services, and within that, abortion-related services, it can’t get US funding. 

“We don’t want to see any woman going without services, but we feel that they could divert money in other ways,” said Jennifer Popik, legislative director at National Right to Life Committee, which backs the expansion.

She points to a US government report that found that under the expanded policy in the first year, NGOs declined funding in 50 instances, though the condition applied to more than 1,300 projects. 

Losing critical HIV services  

Independent research has found that the policy expansion is already affecting a critical area of health care: the fight against HIV and AIDS.  

“HIV becomes the casualty to a war where it was not the enemy.”

“HIV becomes the casualty to a war where it was not the enemy,” said Kenneth Juma, a researcher at the African Population and Health Research Center in Kenya, who is collaborating with researchers at Columbia University to evaluate what the expansion has meant across the globe.

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Over the years, HIV services have become integrated with reproductive health services, and that’s a good thing, Juma said. People don’t have to go to separate clinics and pharmacies for all their different needs. 

According to his research in Kenya, and that in other regions by The Foundation for AIDS Research, the expansion has resulted in a loss in critical HIV services.

“It has made a bad situation worse and the effects are most severe amongst the poorest and more marginalized communities where they benefit more severely from this stream of funding,” Juma said.

Women’s health advocates also contend that Trump’s expanded policy is emboldening activists across the world who are opposed to any kind of family planning. 

“So, it’s a lot of things at play — over interpretation, fear, misinformation — and this really works toward advancing a very oppressive agenda on women’s rights,” said Tabitha Saoyo, a reproductive health activist and lawyer in Kenya. 

Recently, the Trump administration proposed even tighter restrictions on global health funding that would apply the policy to subcontracts. It all raises the stakes and grows the divide when it comes to global reproductive health policy in the upcoming presidential election, one which many around the world will be watching closely.