On his first full day in office in 2017, President Donald Trump re-implemented the “global gag rule,” which prohibits the use of federal funds for family planning clinics that refer women for abortions or provide them with information about the procedure. Reproductive rights and women’s health advocates greeted his decision with understandable alarm. In Kenya, one clinic called it a “death sentence” for women.
Now, the global gag rule has come home to roost. Trump proposed a domestic version of the gag rule Tuesday that would withhold Title X family planning funds from programs and facilities that perform abortions. It would also prohibit medical providers that receive these federal funds from informing patients where they can obtain safe, legal abortion.
One only needs to look to the effects of the global gag rule on women around the world to predict the damage a domestic gag rule would have. This policy has closed clinics and diverted funds away from the ones that remain open. All this means fewer ― or no ― facilities providing health care for women.
The impact is especially acute in rural areas and underserved communities. In Ethiopia, health organizations worry that the global gag rule has led to increased maternal mortality and morbidity rates. In Africa, the closures have had disastrous consequences for HIV/AIDS prevention and treatment and counseling on sexual violence like rape and female genital mutilation.
“The domestic gag rule won’t just cut off access to safe and legal abortion; it will also restrict access to the kind of health care that ensures a healthy pregnancy and delivery.”
Trump’s re-implementation of the global gag rule in 2017 amounted to $8.8 billion in worldwide health assistance cuts ― cuts that also impacted treatment for non-reproductive health issues, such as tuberculosis, malaria and malnutrition. Eugenia López Uribe, director of Mexican NGO Balance Promoción para el Desarrollo y Juventud, said in a 2017 op-ed that organizations like hers would “have to decide between receiving funds from USAID or continue providing comprehensive care based on the needs of their population.” This comprehensive care includes everything from vaccinations to sex education and from HIV/AIDS care to postpartum treatment.
All this in the name of “protecting life.”
The global gag rule is formally known as the Mexico City Policy, as it was first announced by the Reagan administration at the 2nd International Conference on Population, held in Mexico City in 1984. And in Mexico, where I am based, this policy has limited sexual and reproductive services in the 24 states where abortion is legal. I once interviewed a young woman from rural Mexico who had no access to sexual and reproductive health care. She had recently given birth.
“I passed out,” she said. “They say that my baby was found lifeless on the hillside. Everything was so fast, and I still don’t understand many things.”
When the Trump administration brought back the global gag rule in 2017, it was renamed “Protecting Life in Global Health Assistance.” Now that the U.S. government has exported its anti-choice policies abroad, it’s bringing them back home, where it will surely have deadly consequences.
“Now that the U.S. government has exported its anti-choice policies abroad, it’s bringing them back home, where it will surely have deadly consequences.”
The U.S. already has the worst maternal mortality rate in the developed world, and as a ProPublica investigation showed, 60 percent of those deaths are preventable. The domestic gag rule won’t just cut off access to safe and legal abortion; it will also restrict access to the kind of health care that ensures a healthy pregnancy and delivery. And by defunding organizations like Planned Parenthood, which provides sexual and reproductive health care to 5 million U.S. citizens annually, President Trump is slashing access to basic services like Pap smears, cancer screenings and STI testing. In rural America, in places like my home state of Arkansas, Planned Parenthood is one of the few organizations that offers affordable health care to women.
History has already shown us women who don’t have access to safe and legal abortions often resort to “back alley” procedures. Women in Mexico have told me stories of resorting to herbal remedies, drugs, chemical substances and even inserting knitting needles and other sharp objects into their bodies out of desperation due to lack of access to abortion care. In states like Montana, Texas, Wyoming, North Dakota, South Dakota, Nebraska and Kansas, women already have to travel on average more than 180 miles to reach an abortion clinic.
When women face restricted health care access, including reproductive options, they don’t have autonomy over the most basic aspects of their bodies and their lives. When women don’t have full autonomy over their bodies, their health and well-being are put at risk, they are deprived of the opportunity to make choices that could allow them to achieve social and economic equality.
The proposed domestic gag rule is not merely a matter of abortion ― though abortion is no mere thing. This policy would deny entire communities a wide range of lifesaving health care services.
Alice Driver is a freelance journalist and translator based in Mexico City. She is the author of More or Less Dead.