Editorial

Trump's new global gag rule will devastate healthcare in poor countries

It is not surprising but it is deeply depressing that the Trump administration is reviving the “global gag rule” — so called because it bans U.S. financial assistance to non-governmental healthcare organizations in foreign countries if they provide abortions or even utter the word to their patients in counseling them or referring them elsewhere.

The rule was first put into place during the Reagan administration and since then has been repealed and revived alternately by Democratic and Republican administrations, including President Obama’s.

The rule was bad enough in its earlier form, when it barred aid to family planning organizations that offered abortion or abortion counseling. The last time it was in place, during the George W. Bush administration, family planning organizations receiving $600 million in funding were affected.

But the new Trump administration incarnation of the rule is far more expansive. Instead of applying specifically to family planing programs, it will now cover approximately $8.8 billion in funds given out to healthcare providers of all sorts through the Department of State, the U.S. Agency for International Development, and the Department of Defense. Healthcare providers overseas working in HIV/AIDS, maternal and child health, malaria, global health security and other fields will be required to sign on the agreement. And many of those providers also offer abortion or abortion counseling.

The rule creates particular problems for healthcare providers treating people with HIV and AIDS. Signing the agreement would mean, for example, never being able to give a pregnant woman infected with HIV counseling on abortion.

State Department officials say that the gag rule is necessary to ensure that U.S. tax dollars do not support foreign organizations that “perform or actively promote abortion as a method of family planning.”

But there is already a law in place that prohibits the use of U.S. funds for abortions. So the gag rule is not necessary for that. It’s just a way to pressure — and ultimately punish — organizations that provide abortions or abortion counseling.

What’s worse is that the rule threatens to cripple the provision of all kinds of healthcare to underserved, wretchedly poor parts of the world. Most of the current funding for HIV and AIDS assistance as well as maternal care and family planning goes to about about 30 African countries.

For healthcare organizations to stop providing abortions would be neither easy nor the right thing to do. In many places, one clinic serves multiple functions — taking care of women and children, treating HIV, testing for sexually transmitted diseases, offering family planning and contraceptives and sometimes abortions or abortion counseling — all extremely important functions.

In some countries, particularly in Africa, a legal abortion can mean life or death for a young woman who gets pregnant unintentionally. If she can’t get a legal and safe abortion, she may opt for an illegal and dangerous one. In the case of an unmarried female, she may have to face the wrath of her family. Although State Department officials say that an abortion referral in the case of rape, incest, or to save the life of the woman is exempted from the rule, many providers are expected to refuse to sign on to an agreement that will generally restrict them from offering abortion services to those who need them.

So providers are faced with a horrible choice: either refuse to provide patients with necessary information or important reproductive rights services or sacrifice desperately needed funding from the U.S.

The State Department says that if current recipients of U.S. funding decline to take take any further aid because of the new policy, it will find other organizations to provide the non-abortion-related healthcare services. But healthcare advocates say it won’t be easy to find other providers in the developing world to pick up the slack.

In the end, it’s possible that this anti-abortion policy will result in more abortions, not fewer. Stanford University researchers found that abortions significantly increased in Africa when the gag rule was in effect during the George W. Bush administration, perhaps because of lost funding for programs offering contraceptives and family planning counseling.

The global gag rule will hamper the delivery of desperately needed healthcare in the developing world. If the administration truly cares about protecting life, it should scrap this policy immediately.

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