An Unhappy Silence
With the three-year anniversary of Trump’s Global Gag Rule upon us, Beth Ward examines its catastrophic global implications on the women’s reproductive healthcare sector
In the three years since President Donald Trump took office, his record on women’s rights has ranged from bad to woeful. But it was in one of his first acts as Commander-In-Chief, three years ago today on January 23, 2017, that he set in motion a chain of funding cuts that would go on to harm the reproductive options of women globally.
Invoked by executive order three years ago Trump’s Global Gag Rule (GGR) commands that any foreign NGO that accepts U.S. global health funding—which totals almost $9 billion globally—is forbidden from providing abortion services or advocating for the protection and expansion of reproductive healthcare that includes abortion.
As Marie Stopes International (MSI), a London-based non-governmental organization (NGO) founded in 1976 that provides contraception and abortion care services to women in 37 countries, marks that anniversary today, it must also confront a hard truth. Because it chose not to comply with the dangerous and prohibitive rule and lost 17 percent of its donor income, many of the critical health services it offers, provided to some of the world’s most vulnerable women, will disappear.
“After refusing to comply with the gag rule’s terms, the resulting funding loss has really hit our work with the poorest, most marginalized communities —those without any other way to access contraception, particularly in sub-Saharan Africa,” says Sarah Shaw, MSI’s head of advocacy, policy and partnerships.
According to Shaw, 1.4 million women and girls previously served will also lose access to MSI’s critical reproductive health and family planning services. The charity also estimates that the funding gap will have resulted in 600,000 unsafe abortions, 1.8 million unintended pregnancies and 4,600 avoidable maternal deaths by this year.
More specifically, the loss of funding has meant that in Madagascar, MSI’s voucher program – which delivered free contraceptive counseling and care to more than 170,000 women and girls living in poverty – has been forced to close. It means that in Uganda, five of MSI’s outreach teams – health workers who provide contraceptive care to individuals living in remote, rural communities – will cease operations. The organization was also forced to reduce the number of healthcare outreach sites in Zimbabwe from 1,200 to 600.
What makes Trump’s Global Gag Rule different to the versions invoked by previous U.S. Republican presidents, says Shaw, is that it applies not only to what groups do with U.S. global health funding, but also to what they do with their own, non-U.S. government funds.
“Historically, the Global Gag Rule has only applied to foreign NGOs that access family planning funds from the U.S. aid budget,” she says. “This time, it applies to all of the global health budget. So any organization that takes funding to do work on nutrition, or child health or ZIKA is not allowed to refer to abortion services. If they take money from the UK government, or from Denmark, or they fundraise from the general public, they’re not able to use those funds to do any abortion-related work.”
What’s more, Trump’s gag rule has put many health NGOs that provided reproductive healthcare as part of a larger list of critical services, such as cancer screenings and HIV-testing, in a particularly compromised position. If they’d opted against compliance with the gag rule, it meant a loss of thousands and thousands of dollars in critical U.S. aid used to care for their patient populations. If they chose to comply with the gag rule, they’re now unable to provide those patients with a comprehensive spectrum of care.
According to the International Women’s Health Coalition 2019 report, Crisis in Care: Year Two Impact of Trump’s Global Gag Rule, not only is it now much more difficult for individuals to access safe abortions, post-abortion care and family planning services, it’s also much harder for them to access life-saving STD testing, cervical, breast and prostate cancer screenings and support services for gender-based violence.
The IWHC’s report also confirms what’s been known for decades – that restricting or eliminating abortion access has not reduced the number of abortions performed. Instead, it’s forced individuals to seek out unsafe abortion options, potentially risking their lives. Moreover, for those who chose to comply, the gag rule is also limiting the ability of providers and health organizations to prevent unwanted pregnancies to begin with, because it’s impacting their ability to provide contraceptives and family planning services.
This is also the case for many people in need of reproductive healthcare in the United States – particularly in the southern U.S., where Oriaku Njoku works as the executive director of Access Reproductive Care Southeast, or ARC Southeast.
“ARC Southeast makes sure that folks in the South have access to safe and compassionate abortion care through abortion funding and logistical support,” says Njoku. “That logistical support looks like rides, lodging, childcare, translation, interpretation, a wide variety of things. We also do work around abolishing stigma, especially in communities of color, and restoring dignity and faith in the whole accessing-healthcare process.”
Childbearing individuals in some of the states that ARC Southeast serves—Georgia, Alabama, Mississippi, Florida, Tennessee and South Carolina—have had to navigate a relentless siege of anti-choice legislation introduced in 2019 within the context of the U.S.’s own domestic gag rule in attempts to access that healthcare. Planned Parenthood, a leading organization providing abortion services, cancer screenings, well-woman exams, STD testing, infertility services, sex education and more, lost $60 million in family planning funding as a result of choosing not to comply with Trump’s domestic gag rule.
The rule, coupled with the introduction of these bills, is part of a concerted effort by anti-choice organizations and politicians to completely eliminate abortion access in the states and overturn the 1973 Roe versus Wade court ruling that legalized abortion in the U.S., says Njoku.
According to both Shaw and Njoku, invocation of the rule and the introduction of anti-choice legislation has also reintroduced fear and stigma around accessing reproductive services.
“I think the really insidious piece of this,” says Shaw, “is how it’s changing norms around gender and reproductive rights and sexuality. It’s sending this message that these services are not important. That the people that access them are second class and not deserving.”
Says Njoku, “a lot of [our work] was just reminding people that abortion is still legal in all 50 states in the United States of America. Even just the conversation of an abortion ban was creating this fear and shame and stigma around accessing care. And it’s creating this false sense of urgency. There was a lot of work on our end around letting people know what is actually still available, in addition to making sure they get to their appointments, where they want to go, no matter what.”
Still, despite these grim anti-choice realities, there are small glimmers of hope. Because MSI chose to operate independently of U.S health funding dollars, for example, it now no longer has to comply with certain rules about program messaging.
“Under the Obama administration, MSI did take U.S. aid funds,” says Shaw. “But because of the Helms Amendment in 1973, no U.S. government funds could be used to provide abortion services. So, we always had to be very clear in our messaging that all of the support we received from the U.S. government was purely around our family planning work. During that time, our abortion messaging did get diluted, did get watered down.
But now, she says, “the shackles are off…and we’ve been really out and loud about our pro-choice messaging. That’s actually been quite liberating.”
The invocation of the domestic and global gag rules has also seen the mobilization of pro-choice advocates the world over. Organizations like MSI, ARC Southeast and countless others are angry, galvanized and more committed than ever to protecting the populations they serve.
It’s something that Shaw hopes that women who may be scared or discouraged are able to remember. “To women who are out there, she says, “I think that they just need to know that there’s a lot of people fighting. There’s a lot of people fighting for them, for their rights, so don’t give up. This cannot be the future. And I do believe that we will look back on the past few years and say ‘what was all that about?’ The trend is always forward, even though sometimes it takes a few steps back.”