On January 22, 2001—the 28th anniversary of Roe v. Wade—George W. Bush inaugurated his term as President of the United States by reinstating an anti-abortion funding policy known to activists as the "global gag rule." The policy, similar to President Ronald Reagan’s "Mexico City Policy," prevents foreign non-governmental organizations (NGOs) that receive family planning funds from the U.S. Agency for International Development (USAID) from using their own, non-U.S. funds to advocate for or provide comprehensive reproductive health services that include abortion. The Bush gag rule imposes no similar restrictions on anti-choice organizations.
Specifically, the global gag rule prohibits foreign NGOs from:
- Providing safe abortion services to the extent that they are legal;
- Imparting accurate medical counseling about, or referrals for, abortion;
- Petitioning their own governments to loosen restrictive abortion laws;
- Advocating against attempts to restrict abortion laws;
- Engaging in public information initiatives and similar educational measures to ensure that where abortion is legal, women know how to access it safely.
The gag rule’s (PDF) curb on the right of women to lobby for abortion law reform or access abortion—even in countries where the procedure is legal—has perpetuated the global epidemic of unsafe abortion.
Worldwide, unsafe abortions claim the lives of some 70,000 women every year. For each of these deaths, an estimated thirty more women suffer serious complications, often resulting in permanent disabilities. According to the World Health Organization (WHO), "unsafe abortion is one of the most easily preventable and treatable causes of maternal mortality and morbidity." More than 95% of the unsafe abortions performed worldwide occur in developing countries.
Historical evidence from the United States and other countries shows that when abortion services are safe, legal and accessible, abortion-related deaths and injuries are greatly reduced. But the Bush global gag rule is fast making unsafe abortion one of the most intractable health problems for women around the world.
Most recently, the Bush Administration extended the global gag rule to all branches of the U.S. State Department that provide voluntary family planning assistance.
"The President should end this war on women and restore a woman’s right to life-saving health care," said Nancy Northup, President of the Center for Reproductive Rights. "The global gag rule undercuts women’s health and must be repealed."
EFFECTS OF THE GLOBAL GAG RULE: A LITANY OF HARMS
The global gag rule has penalized hundreds of NGOs that receive family planning assistance from the United States in nearly sixty countries around the world. The effects of the gag rule differ by country and according to both the legal status of abortion and the extent to which USAID funds local NGOs. But in all instances, the global gag rule restricts NGOs’ rights to free speech and association, and their ability to freely participate in civil society and democratic institutions for the purposes of expanding the legality of abortion and improving access to the procedure.
USAID is the world’s largest donor of family planning assistance at $446.5 million in 2003 alone. As a result, foreign NGO priorities, agendas and modes of operation – such as collaborating with colleagues in the field – are greatly influenced by the global gag rule. It is an externally imposed agenda that cripples the efforts of local health-care providers, advocates and officials seeking to address an acknowledged public health crisis within their own countries.
For cash-strapped NGOs dependent on USAID funding, however, there are few options. The gag rule forces them either to accept its anti-abortion constraints and neglect the health needs of women in their countries, or jeopardize their existence by relinquishing all U.S. family planning assistance.
Indirectly, the gag rule has also curtailed non-abortion related health services such as emergency contraception and post-abortion care. Often, NGO representatives and health-care professionals are not aware of the exceptions included in the gag rule or they feel pressured to avoid all activities that may be associated with abortion.
In addition, the gag rule undermines fundamental cornerstones of U.S. foreign policy, including the promotion of democracy, civil society and freedom of speech.
For instance, in countries where abortion services and counseling are legal or where there are specific exceptions to a ban on abortion, the global gag rule forbids local health-care organizations from providing these services or related information. Moreover, in countries where restrictive abortion laws may eventually be liberalized, the gag rule impedes the ability of local NGOs to advocate for law reform, thereby perpetuating the epidemic of unsafe abortion.
GAG RULE SIDELINES RUSSIA’S PRO-CHOICE GROUPS DURING ABORTION RIGHTS DEBATE
On August 11, the Russian government announced its first new restrictions on abortion in almost half a century. Before any public debate could take place, the government narrowed the list of non-medical grounds for having a legal abortion after the first trimester of pregnancy, from thirteen to four: when a court rules the woman is unfit to be a mother; when a woman has been raped; when the father is severely disabled or has died; and when the mother has been sent to prison.
Anti-choice officials restricted the abortion law in a move that sought to capitalize on nationalistic fears stoked by falling fertility rates for the majority white population—down from 1.7 children per woman in 1991 to 1.2 in 2001. This despite Russia’s falling abortion rate, which was down from 2,045 abortions per 1,000 live births in 1980, to 1,536 abortions per 1,000 live births in 2001, according to the United Nations.
And yet, the reaction from reproductive rights groups in Russia has been silence, with the global gag rule (PDF) as their censor. USAID family planning funds ($3.9 million in 2003) are the lifeblood of Russian groups working to promote access to contraception and to reproductive health care. Even the groups that do not receive USAID funds—and are free from the constraints of the global gag rule—are desperate for aid and fear that speaking out against the new restrictions will scuttle their chances of receiving U.S. support.
"These restrictions could represent the first in a series of broader attacks on the reproductive rights of Russian women," said Inga Grebesheva of the Russian Family Planning Association. "Meanwhile, the global gag rule is preventing many organizations, including NGOs, from voicing their opposition, because they are afraid of losing funds from the American government."
Just as troubling is an attempt by anti-choice members of the Duma, the lower house of Parliament, to introduce two pieces of legislation that would further restrict and endanger Russian women’s reproductive rights. The first bill would recognize the right to life of the fetus, and calls upon the Russian government to criminalize abortion. The second would mandate that all women undergo psychological counseling before having an abortion.
The Center for Reproductive Rights has offered a critical analysis of both bills to the Duma. "Pro-choice members of the Duma now have the international legal arguments against these abortion restrictions," said Christina Zampas, the Center’s legal adviser for Europe. "But gagged Russian NGOs will not be able to participate in the debate over further restrictions to abortion."
The coming December elections in the Duma prompted lawmakers to keep the controversial bills off the agenda, but these bills could reemerge in the 2004 session. The gag rule would sideline a majority of Russia’s reproductive rights groups when the bills are debated.
The global gag rule is not only stifling public debate on abortion in Russia, it is undermining the very goals of USAID-funded projects. For example, USAID funds the Advocacy Network for Reproductive Health, a coalition of twenty Russian reproductive health groups, whose goal is to promote maternal health. The gag rule will force many of these groups to stay out of the abortion rights debate, which could have broad implications for maternal health in Russia. Despite Russia’s once liberal abortion law and the wide availability of abortion services, unsafe abortion remains the main cause of maternal mortality in Russia, accounting for 24.3% of all maternal deaths in 1997, according to the World Health Organization.
NEW CENTER STUDY DOCUMENTS THE DEVASTATING IMPACT OF THE GAG RULE IN FOUR COUNTRIES
In 2002, the Center for Reproductive Rights undertook fact-finding missions to Ethiopia, Kenya, Peru and Uganda to investigate the effect of the Bush Administration’s global gag rule on countries with restrictive abortion laws. Unsafe abortion is a public health disaster in all of these countries, and all of them receive substantial USAID family planning assistance:
- In Ethiopia, which receives $5.3 million from USAID, unsafe abortion is the second leading cause of death for women of reproductive age, accounting for 55% of maternal mortality and causing one-fifth of all hospital admissions.
- In Kenya, which receives $6 million from USAID, it is estimated that 40% of maternal mortality is due to unsafe abortion, causing more than 5,000 deaths each year.
- In Peru, which receives $14.5 million from USAID, approximately 350,000 clandestine abortions are performed annually, resulting in complications for one in seven women.
- In Uganda, which receives $5.2 million from USAID, 5,000 women and girls are admitted into hospitals for incomplete abortions every year. Unsafe abortion causes approximately one-third of the maternal deaths in the country.
Under the protection of anonymity, reproductive health-care advocates and providers from each of these four countries told our investigators—often in graphic detail—of the life-and-death decisions that the Bush Administration is forcing them to make. These providers must choose between receiving U.S. financial support for family planning services—their largest source of aid—and helping to address the public health crisis of unsafe abortion.
An obstetrician and gynecologist in Kenya told our investigators of a poor, 17-year-old girl who sought a clandestine abortion:
"[T]he person she went to did not know the anus from the vagina. He destroyed her anus, rectum, uterus and some of the small intestine. This girl came to Kenyatta and they had to operate—to open her abdomen, remove the uterus, intestines and reconstruct. The anus and the rectum were destroyed beyond repair. The girl now has a permanent colostomy. All because she didn’t have the information and means to have a safe procedure. If only she had a chance to talk to someone. She said to me, ‘Doctor, do you know what it means to have a pregnancy you don’t want.’"
In Uganda one hundred trainers and 65 health-care providers working on a USAID-funded project were told to stop counseling about abortion to comply with the global gag rule. One USAID-funded NGO in Uganda said that, because of the global gag rule, it is "closing its eyes to abortion."
"Unsafe abortion and back street abortion is very common," an international NGO working in Uganda told our investigators. "There is little talk because of the dependence on donor funding. People don’t want to talk about legalizing abortion because they fear risking donor funding. If the U.S. government is against abortion, they don’t want to speak up. No organization will have the courage to speak. Women doctors have since spoken. But somebody has gagged the rest."
In Ethiopia, where some parliamentarians and religious leaders view unsafe abortion as an urban plight, the global gag rule is stifling public education efforts on the need for safe abortion services in rural areas. Gagged representatives of a religious NGO in rural Ethiopia—representing 1.5 million people who visit their 52 health institutions in rural areas—are being left out of the public debate.
"The needed ‘informed debate’ on unsafe abortion [in Ethiopia] will suffer," an Ethiopian government official told our investigators. "We talk in hiding, whispering to each other. This will continue until the global gag rule is ended or we have other means of funds."
One NGO representative from Peru told Center researchers that "[the global gag rule] generates fear…because it is so general and so concrete at the same time, and you never know if you are in the wrong with this or not."
The Center’s report on the impact of the global gag rule on four countries will be released on October 22 in Washington, D.C.
