In the wake of the US elections, attention has focused on the consequences for the right to abortion in the United Statesand whether this will affect state initiatives to roll back restrictive legislation.
What has received far less attention is what will happen to abortion services, sexual and reproductive health and, more broadly, health in many parts of the world, as a direct result of decision that President Trump is likely to make on his first day in office. .
The United States is by far the largest donor of global health aid, providing US$15.8 billion (£7.8 billion) in 2022, compared to the rest of the world. the next three biggest donors Germany ($4.4 billion), Japan ($3.2 billion) and the United Kingdom ($2 billion). This means that restrictions and reductions in this aid can have enormous consequences around the world.
In 1984, President Reagan implemented the Mexico City Policy (which became widely known as the “Mexico City Policy”). global gag rule), under which any organization providing abortion services (defined broadly from providing abortions to basic counseling) was barred from receiving U.S. aid – even if that funding was not spent for abortion services. Since then, Democratic administrations have removed this rule, but successive Republican presidents have reinstated it.
Given his track record in his first presidency, Trump is likely to reinstate this type of restriction on aid when he returns to the White House. His first administration reintroduced this policy and significantly expanded the scope its scope extends well beyond family planning services to more broadly include HIV/AIDS treatment, sanitation and public health.
The amount of funding affected by these rules has increased from approximately $600 million under the operation of the global gag rule in the Bush era to approximately $12 billion. The decision will apply not only to organizations directly receiving USAID funding, but also to any organization they work with, even if they use non-USAID funds for that work.
The potential impact of these restrictions on how countries can use their public health funding is significant; the performance of the previous Trump administration suggests that health organizations are right to be concerned about what might happen.
Research over decades shows that when the global gag rule is in place, the health of women and children in particular is put at risk.
A study in Kenyafor example, found that sexual and reproductive health services (which may include abortion services, but also provide critically important services for pregnant and new mothers, infants and children) were closed . Contraceptive supplies also declined due to these restrictions on how aid was spent. In Ugandaorganizations have reportedly stopped providing services intended to reduce deaths from unsafe abortions, fearing that even that would fall within vague definitions of “abortion services.”
Leading international reproductive health charity Marie Stopes International saw its overall funding drop 17% in 2017 during Trump’s first term, due to his refusal to accept the terms of the global gag rule. In some countries, abortion rates have increased by up to 40%and many of them are expected to be unsafe, as U.S. funding for safe abortion centers has disappeared.
There will likely be an increase in maternal and child mortality. The mortality rate from safe abortions is very low (around 1 per 100,000 births). On the other hand, unsafe abortions are incredibly dangerous, with a mortality rate of 200 per 100,000 abortions.
This type of restriction on how U.S. aid can be spent doesn’t just affect abortion services. It also undermines broader sexual and reproductive health services, including access to information and family planning. The result is that rates of unintended pregnancy are increasing at the same time that abortion services are being cut, with the inevitable consequence of pushing many women to resort to unsafe and unsafe abortion procedures. A study suggested that 30,000 additional maternal and infant deaths occurred each year as a direct result.
A goodbye Results of research into the impact of these public health restrictions conducted by the political organization KFF showed a decline in the use of modern contraception, an increase in pregnancies and rates of unsafe abortion.
The impact on counseling and availability of modern contraception, particularly condoms, also leads to additional health concerns. Best practices have long suggested that integrating sexual health services with other health services, including HIV testing and treatment, screening for certain cancers, and prenatal care, can improve health outcomes .
Undermining one aspect of these services impacts all. A 2022 study suggested that in countries heavily dependent on U.S. aid, there were an additional 90,000 new HIV infections each year when the global gag rule was in effect.
Reduced access to contraception
Nepal, which has enshrined the right to abortion and requires all public health facilities to provide free abortion services in its Safe Motherhood and Reproductive Health Rights Act 2018, is a country which could be particularly hard hit. The United States is the largest bilateral donor for health in Nepal and has provided more than three fifths of the aid for family planning and reproductive health under President Biden. A study found that maternal and child health services in Nepal as a whole have deteriorated under Trump’s last term, not just those related to abortion services.
Contraceptive services declined and supplies often ran out, increasing the risks of unwanted pregnancies. Organizations working on abortion have also often been excluded from consultations with the Ministry of Public Health, although abortion is legal in the country, due to government fears about the consequences for US aid flow.
When these types of restrictions are in place, the number of abortions has increased. And much of this increase is occurring in unsafe and unregulated places, increasing the risk of death for pregnant women.
What could happen next?
Under previous US presidents, other donors have increased their commitments to try to protect sexual and reproductive health services and broader public health from the devastating consequences of the epidemic. impact of American politics.
It is essential that donors, particularly those in Europe (including the UK), announce their plans now on how they will scale up their support to protect women’s health and access to safe abortions , in order to avoid the closure of these vital services. Not just for the next four years, but longer term.
These restrictions create the exact opposite of what they sought to achieve, leading to more abortions and more deaths. But more than that, they are deeply damaging and dangerous for women who have no say in policy that puts their lives at risk.
(Author: Michael Jenningsprofessor of global development, SOAS, University of London)
(Disclosure Statement: Michael Jennings does not work for, consult, own shares in, or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond his nomination university.)
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