Moral Imperialism in Global Health: Trump’s Global Gag Rule

Over three decades ago, in Mexico City, at the UN International Conference on Population and Development, then-US president Ronald Reagan established the “Mexico City Policy.” The policy ruled that in order for NGOs to receive US federal funding, they must certify that they would not “perform or actively promote abortion.” The policy was rescinded by Clinton in 1993, reinstated by Bush in 2001, and again overturned by Obama in 2009. Since it forbids NGO workers from so much as discussing abortion with patients, critics refer to the policy as the “Global Gag Rule.” 

On January 23rd, 2017, three days after his inauguration, Donald Trump reinstituted a dramatically expanded version of the Global Gag Rule. While it previously applied only to the $600 million available annually for US family planning funding, it now covers all US federal global health funds, to the tune of almost $9 billion: a mammoth share of all available global health funding. If an NGO accepts any US funds for global health, it cannot provide abortions or abortion advice using any of its budget, even using money from other sources.  

Trump’s reboot of the policy came with a new name: “Protecting Life in Global Health Assistance,” which smacks of irony when it endangers the lives of so many. As it is, around 80 women die every day due to unsafe abortions. Marie Stopes International estimates that cuts to its services under the new policy will lead to an additional 6.5 million unintended pregnancies, 2.1 million unsafe abortions, and over 21 thousand maternal deaths. Health providers are faced with a moral dilemma. They must decide whether to cease provision, counselling, referrals, and advocacy around abortions, or decline US funding altogether, to the detriment of their other healthcare services.  

The Global Gag Rule has never been shown to reduce the number of abortions, rather, studies show that abortion rates increase as family planning funding dwindles. Healthcare workers are “gagged” from advising women about seeking safe abortions, so the number of unsafe abortions rises. Further, the policy has been shown to have devastating effects on HIV/AIDS prevention and care. Alarmingly, two-thirds of the funding threatened by the new policy is earmarked for HIV/AIDS programmes, which are often integrated into broader family planning efforts.  

It is too early to discern the long-term effects of the expanded Global Gag Rule, but the initial signs are disturbing. To take just one example, Family Health Options Kenya, the country’s largest provider of sexual and reproductive health services, has lost sixty percent of its funding. It has been forced to close two clinics, leaving vulnerable populations, including sex workers and religious minorities, without family planning and sexual health services. A mobile outreach programme has also been withdrawn, leaving 76,000 women each year without access to free sexual and reproductive health services.  The organisation’s other health services—vaccination programmes; HIV/AIDS education, screening, and care; cervical cancer screening; maternity and paediatric care—have also been scaled back.     

So it is that those living in the slums of Nairobi and the rural areas of Kajiado County, along with countless others globally, pay the price of political grandstanding almost 14,000 miles away. The Global Gag Rule is a form of moral imperialism. It imposes the values of the current US administration on the people of the Global South, forcing them to conform to the whims of the powerful people upon whose wealth they depend. It is far from ideal that we live in a world in which so many people’s basic wellbeing must be provided by precarious NGOs, but even so, it is a travesty that any state should attempt to restrict women’s bodily autonomy, let alone beyond its own borders, let alone at the cost of undermining the health outcomes of some of the world’s poorest people.  

Arianne Shahvisi is a lecturer in ethics at the Brighton and Sussex Medical School. She conducts research across a range of topics in applied philosophy, with current projects focussed on reproductive justice, migration and borders, and global health ethics. Arianne has written commentary for the New Statesman, Jacobin, and The Conversation, has featured on BBC Radio and Channel 4 News, and has advised politicians on abortion provision and women’s health. 

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