In a first-ever study of its kind, public health researchers have found that prohibiting U.S. aid to any organization that performs or provides counseling on abortion actually increases abortions – and not just by a little.  According to a new study published in the Lancet Global Health Journal abortions – likely unsafe ones – have increased by 40 percent in sub-Saharan African countries that are more reliant on U.S. aid, while the so-called “Global Gag Rule” has been in effect.

 The Global Gag Rule, (or “Mexico City Policy” as it is formally known) was originally introduced by President Ronald Regan in the 1980s. It earned its moniker for the fact that groups that receive US funding are prohibited from even discussing abortion — let alone performing the medical procedure. Since then, every Democratic president has rescinded it, while every Republican president has reinstated it, including Donald Trump as one of his first acts as president.

But Trump didn’t only restrict U.S. funds for reproductive health programs. Two years ago, he expanded the rule to apply to all global health programs. That means programs for malaria, AIDS, maternal and child health, nutrition, cancer, etc. have all had their funding cut off if any other part of their organization – whether the hospital they’re in or the NGO they’re a part of – informs patients about abortion. This single rule affects an estimated $8.8 billion in U.S. foreign assistance funding.

The new study actually does not analyze the effect of the expanded policy since Trump. Instead it looks at 26 countries in sub-Saharan Africa over the span of nearly 20 years – from 1995 to 2014, during which there were two policy transitions from the Clinton to Bush to Obama administrations.

“The unintended consequences of increasing abortions may have to do with reducing organizations’ ability to supply modern contraceptives,” says Nina Brooks, one of the authors of the study.

The same organizations that provide abortion counseling in these countries are also often the ones offering family planning services. So, when their funding is cut, modern contraceptive use goes down, unintended pregnancies increase and women turn to abortion.

The study found that in when the global gag rule was in effect during the Bush administration, modern contraceptive use dropped 14 percent in countries highly impacted by the policy, pregnancy rates rose 12 percent and abortions increased 40 percent. The opposite occurred when the policy was not in effect (1995-2000 and 2009-2014).

Another analysis cited in the study estimates that a 10 percent decline in contraceptive use can lead to a 20 to 90 percent increase in abortions.

Besides having the opposite of the intended effect, the policy is also endangering women.

Abortions are an important cause of maternal mortality, the study says, which is why it should be a global health priority to ensure that they can be performed safely by experienced organizations and providers. But safe options are limited or unavailable under the policy. So not only are women getting more abortions under this policy, they are likely getting risky abortions, putting themselves at higher risk of death. Therefore, the study says its findings “provide only a partial estimate of the policy’s harm to maternal health.”

Women, young people and marginalized communities, including LGBTQ, rural, poor and religious minorities are also being cut off from other services that are often offered alongside abortion and contraceptive services. These include HIV/AIDS testing and treatment, cervical, breast and prostate cancer screenings and support for survivors of gender-based violence.

“Regardless of policymakers’ beliefs about the ethics of abortion, the results of our analysis represent undesirable and unintended – but reversible – consequences of restricting federal funding for abortion,” says Grant Miller, another of the study’s authors, director of the Stanford King Center for International Development and a non-resident fellow at the Center for Global Development.

According to the authors of the study, the reversal in trends when the policy was not in effect provides hope and perhaps a strategy moving forward: With greater support for family planning organizations – and, in particular, increasing the supply and use of modern contraception – we could undo the harm being done by the global gag rule.

“No matter your politics,” says Miller, “cutting down on unsafe abortions is an important goal.”

——

To learn more about the Global Gag Rule, listen to this episode of the Global Dispatches podcast

On the line to discuss the Global Gag Rule, it’s history and impact on women’s lives is Seema Jalan, the Executive Director of the Universal Access Project and Policy, Women and Population, at the United Nations Foundation.

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