Foreign Policy In Focus

Of the many crises President Barack Obama faces, few are more urgent than preventing the needless deaths of half a million people this year. This is the number of women who die annually from a lack of basic reproductive health services. Unlike the global recession, climate change, and other disasters compounded by George W. Bush, the crisis of maternal mortality is easily resolved. Last week, Obama took an important first step by rescinding the "global gag rule."

Formally known as the Mexico City Policy for the place where it was first announced, the gag rule cut U.S. funding to foreign healthcare organizations that provide abortions or abortion counseling, or advocate legalizing abortion in their own countries (though in true Bush-era fashion, anti-abortion advocacy was permitted).

The policy was nicknamed the “global gag rule” because it stifles free speech and public debate, violating healthcare workers' right to press to change the laws that lead to nearly 70,000 abortion-related deaths each year. The gag rule was thus an attack on women's health, democratic process, and free speech. Rescinding it is a fitting farewell to the Bush era, but it's only the first step in a needed overhaul of U.S. reproductive health policy.

An Attack on Poor Women

For decades, the United States was the single biggest funder of family planning programs in the Global South. When the Bush administration imposed the gag rule, clinics there faced a stark choice: lose their biggest stream of funding or compromise patients' care by denying them the option of terminating a pregnancy.

But the gag rule didn't just target abortion providers. Many of the clinics that lost funding provided crucial primary health care to some of the world's poorest women and their families. In Kenya, at least eight clinics were forced to close when they refused to submit to the gag rule. Thousands of poor women relied on these clinics for Pap smears, vaccinations for their children, malaria screening, HIV/AIDS services, and other basic health care. 

Three of the Kenyan clinics were affiliates of the International Planned Parenthood Federation. In total, Federation clinics in 100 poor countries lost over $100 million because of the gag rule. The Federation estimates this sum could have prevented 36 million unintended pregnancies and 15 million abortions. And the life-saving health services denied by the gag rule could have prevented the deaths of more than 80,000 women and 2.5 million infants and children in the areas covered by their grassroots national affiliates.

In fact, the gag rule actually condemned more women to illegal, unsafe abortion by cutting funding for the very family planning programs needed to avoid unwanted pregnancies in the first place. In Ghana, after the national Planned Parenthood Association lost U.S. funding, its condom distribution dropped by 40%, impacting family planning and HI/AIDS prevention programs. In some areas formerly served by the Association, incidence of unsafe abortions rose 50%.

A New Agenda

The gag rule’s repeal is welcome news. So is Obama's announcement that he will restore funding to the UN Population Fund and join "180 other donor nations working collaboratively to reduce poverty, improve the health of women and children, prevent HIV/AIDS and provide family planning assistance to women in 154 countries."

But these are only the first of many changes needed in U.S. reproductive health policy. Remember, the Bush administration set the bar extremely low, denying emergency contraception to girls raped during the war in Kosovo and barring access to condoms and sexual education in AIDS-ravaged Africa. Here are a few starting points for undoing the damage:

• Advance women's human rights. Poverty and gender discrimination are the root causes of most maternal deaths. Protecting women's social and economic rights, therefore, goes a long way toward reducing maternal mortality. As a start, the United States should ratify the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) and the Convention on the Rights of the Child, and honor its commitments to the 1994 International Conference on Population and Development, where governments first recognized reproductive choice as a human right.
• Promote science and respect for democratic process over dogma, and repeal the Loyalty Oath requiring organizations receiving U.S. HIV/AIDS funds to state their opposition to prostitution. This totalitarian-minded provision goes even further than the gag rule in dictating not just what organizations can say and do, but what they can believe. U.S. policy should recognize sex workers as a key constituency in HIV/AIDS prevention strategies, and work to protect their human rights. The United States should also stop privileging sexual abstinence as a form of HIV prevention and base AIDS prevention strategies on what we know works: comprehensive education and condom distribution.
• Restore U.S. investment in reproductive health services. In real terms, U.S. funding for international family planning services has fallen by 40% since 1995. Money is needed to ensure safe pregnancy and childbirth — not just in the Global North, but around the world. And money is needed to meet an urgent need for voluntary contraception, which could prevent 52 million unwanted pregnancies, 22 million abortions, and 1.4 million infant deaths each year. That last staggering figure represents children who die simply because the burden of unplanned births on their families means less food, health care, and other necessary resources for each child.

Reproductive Rights as Development

Funding women's reproductive health initiatives isn't an act of charity; it's a cornerstone of global economic development. According to the UN Population Fund, family planning "has the potential to reduce poverty and hunger, and avert 25-35% of all maternal deaths and nearly 10% of all childhood deaths. It would also contribute substantially to women's empowerment, achievement of universal primary schooling and long-term environmental sustainability."

That's because women's ability to control their fertility is a precondition for exercising autonomy in other realms of life. When women can decide when to have children, they generally choose to have smaller families. They participate more productively in their countries' economies and political processes, are healthier, and raise and educate healthier children. These are the foundations of a more peaceful and prosperous world. Despite the serious challenges we face, that more peaceful and prosperous world is within reach. Lifting the global gag rule and implementing human-rights-based policy in reproductive health and universally is a good start.