Americans who pay attention to the reports of rape as a tool of war in ongoing conflicts in Africa and the Middle East react with understandable horror. We recoil as well to reports of gang rapes in India and the high incidence of rape in South Africa, even as we acknowledge we are far from free of such crimes at home. Few of us know, however, that current U.S. international family planning policy harms survivors of rape -- and risks their lives -- by misapplying a foreign assistance funding ban in a way that denies them abortion services, despite any legal requirement to do so. This gross misinterpretation of U.S. law also withholds abortion care from women who have survived incest and in cases where a pregnancy endangers a woman's life. It doesn't have to be that way, and to change this dangerous status quo doesn't require changing U.S. law. It just requires President Obama to direct federal agencies to adhere to existing statutes.
The current policy goes back 42 years. In one of the very first moves to limit access to abortion after Roe v. Wade, even before the Hyde amendment, Senator Jesse Helms of North Carolina succeeded in banning the use of U.S. foreign aid for abortions "as a method of family planning." The legislative proposal was opposed by the Nixon administration as contrary to the existing U.S. commitment to uphold the right of other countries to adopt their own policies regarding population growth and family planning. Nevertheless, since 1973 every president has gone far beyond the actual Helms language, wrongly enforcing a complete ban on abortion without any exceptions -- even to save a woman's life.
Helms provided the ideological platform for what followed -- the notorious "global gag rule," adopted by President Reagan in 1984. The gag rule barred foreign nongovernmental organizations receiving U.S. family planning assistance not only from using such funds for abortions, but also from receiving U.S. funds at all if they used money from other sources to provide abortion services, information, counseling, or referrals, or if they advocated on behalf of access to abortion. Since 1984, the global gag rule was maintained by both Presidents Bush and in turn dropped by Presidents Clinton and Obama. But no president hewed to the policy actually expressed in Helms -- that the restriction only applied to abortions used for family planning purposes and thus does allow exceptions in cases of rape, incest, and to save a woman's life.
Domestically, restrictions that generally deny abortion coverage to women enrolled in publicly funded health plans and programs do include such exceptions. If such exceptions are sanctioned on U.S. soil, why wouldn't we allow them when U.S. government funds are involved overseas? To be clear: U.S. policy should not deny any woman anywhere the comprehensive reproductive health care she seeks for any reason. All bans on abortion coverage should be ended. But at minimum, there certainly ought to be no controversy about allowing federal funds to be used in the same way abroad as they are at home. And at minimum, the foreign assistance policies we support should not endanger women's lives.
The consequences of current policy are deadly. Every year, it is estimated that 47,000 women die from unsafe abortions and millions more suffer serious injuries. Almost all of these deaths and injuries occur in the developing world. Indeed unsafe abortion accounts for 13 percent of maternal deaths worldwide and is one of four major causes of pregnancy-related mortality and morbidity. By the standards of the World Health Organization (WHO), almost all abortions are unsafe in certain regions, such as Africa or Central and South America. WHO defines an abortion as unsafe if it is performed by someone without the required skills, or in an environment that does not conform to minimum medical standards, or both. If abortion care were made available with U.S. aid as it is in the U.S., a significant number of women's lives would be saved.
Last week we marked International Women's Day, intended to call attention to the rights of women and to their socioeconomic situation. Both of these topics are tightly intertwined with a woman's ability to make her own decisions about her reproductive health and her future. President Obama has an opportunity to bring some rationality and humanity to U.S. policy on this topic. Eighty organizations, including the National Council of Jewish Women, wrote him a letter to this effect last August. Calling on the president as a "champion for women's health and human rights," the organizations urged "immediate action to correct the unduly restrictive implementation of the Helms Amendment" -- specifically that the president direct U.S. aid programs and the State Department to allow abortion services for women who are the victims of rape, incest, or whose life is endangered by an untenable pregnancy.
So far, President Obama has not acted. Continued failure to act means millions of women in developing countries risk injury and death year in and year out -- women whose lives could be saved if the U.S. simply applied the law as it is written.
We urge the president to act now.
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