New evidence shows far-reaching impact of expanded US “global gag rule”

Posted by Maria Codina on July 30, 2018 at 10:21 am



Studies lay out potential threats to HIV progress

27 July 2018 (Amsterdam, the Netherlands) – Researchers shared alarming evidence at the 22nd International AIDS Conference (AIDS 2018) today of negative impacts of the US Government’s “Mexico City Policy”, also known as the “global gag rule”.

US Representative Barbara Lee of California’s 13th Congressional District also spoke:

“The Trump-Pence Global Gag Rule is an ideological crusade that denies lifesaving care to women around the world and threatens decades of progress in the global HIV response,” she said. “The health care of women and children shouldn’t be used as a pawn to placate right-wing extremists.”

First put in place by President Ronald Reagan and reinstated last year by President Donald Trump, the policy denies US aid to organizations that provide information, referrals or services related to legal abortion or advocate for abortion, even with their own money.

Past iterations of the policy applied solely to US family planning assistance. Now, under the Trump Administration, it applies to almost all US global health bilateral assistance, including the President’s Emergency Plan for AIDS Relief (PEPFAR).

“The reach of the global gag rule has been greatly expanded, and has the potential to roll back progress on HIV,” Anton Pozniak, President-Elect of the International AIDS Society and Executive Director of HIV research and Director of HIV services, Chelsea and Westminster Hospital in the United Kingdom, said. “The evidence is clear: we need better integration of sexual and reproductive health and HIV services, not policies that make it harder for people to access healthcare.”

Today’s press conference highlighted four studies looking at different areas of the policy’s impact.

Note: Press summaries are based on abstracts; final data presented at the conference may change.

Hundreds of organizations receiving PEPFAR support will be impacted

The first study sought to understand the effect of the expanded Mexico City Policy on HIV programmes and services. The authors analysed data from ForeignAssistance.gov over the most recent three-year period for which such data were available (FY2013-2015) to estimate the number of non-governmental organization (NGO) recipients of PEPFAR funding that could be subject to the policy, as well as the amount of funding they receive.

Results, as presented by Jennifer Kates of the Kaiser Family Foundation, were that more than half of the countries that receive PEPFAR support allow for legal abortion. The authors identified 470 foreign NGO prime recipients of PEPFAR bilateral HIV funding, which received $873 million. In addition, they identified 274 US NGO prime recipients, accounting for $5.5 billion, which would be required to ensure that any foreign NGO sub-recipients were in compliance.

The researchers concluded that the expanded gag rule would likely affect hundreds of NGOs that receive PEPFAR support. [Summary based on submitted abstract; updated data may be presented on site.]

Abstract: The Mexico City Policy and PEPFAR: Estimating the impact on NGOs and funding

Session: Bound and gagged: Exposing the impact of the expanded Mexico City policy (Friday, 27 July, 11:00-12:30)

Organizations have already lost tens of millions of dollars in funding

The second study looked at the impact of the gag rule on organizations in Ethiopia and Zimbabwe that provide HIV services that are integrated with sexual and reproductive health. This mixed-methods study combined desk research, statistical forecasting and community engagement (focus groups, stakeholder meetings and semi-structured interviews).

Luisa Orza of the International HIV/AIDS Alliance presented preliminary findings, which point to funding loss as a result of the global gag rule. As a result, it is likely that sexual and reproductive health and HIV services will no longer be offered in an integrated manner, resulting in reduced access to HIV prevention, testing and treatment services and jeopardized health of key and vulnerable populations by restricting the package of services they can receive. The authors also predicted that advocacy efforts to maintain or liberalize abortion laws will be stifled due to confusion, uncertainty and fragmentation of civil society.

However, they also noted evidence of civil society seeking creative opportunities for new advocacy collaborations. [Summary based on submitted abstract; updated data may be presented on site.]

Abstract: A model of dis-integration: Unpacking the impact of the global gag rule on HIV-SRHR linkages

Session: Bound and gagged: Exposing the impact of the expanded Mexico City policy (Friday, 27 July, 11:00-12:30)

An exception to the rule

The third study assessed the global gag rule’s applicability in several African countries. Specifically, it looked at an exception in the US policy that applies when local laws affirmatively require healthcare providers to provide counselling and referrals for abortion.

The authors conducted a legal assessment of the applicability of the affirmative defence in several African countries. Findings, presented by Brian Honermann of amFAR, were that South Africa has particularly strong Constitutional protections for reproductive rights. South Africa also has strong informed consent requirements in its National Health Act, ethical guidelines, and robust case law that compel healthcare providers – including PEPFAR partners – to continue counselling about and referring for abortion services that cannot be circumvented by the policy. Evaluations in Mozambique, Zambia and Zimbabwe have found differing levels of protections.

The study concluded that South African law provides a template for advocates to replicate. [Summary based on submitted abstract; updated data may be presented on site.]

Abstract: Caught by ideology: HIV providers in the era of the protecting life in global health assistance policy (AKA Mexico City Policy)

Session: Bound and gagged: Exposing the impact of the expanded Mexico City policy (Friday, 27 July, 11:00-12:30)

The expanded global gag rule is already having a major impact in the HIV arena

The fourth study provided further evidence of the gag rule’s negative impact, both now and historically, and identifies strategies for sustaining global health progress in this environment.

The authors assessed lessons learned from previous iterations of the global gag rule from 2001-2009. Findings, presented by Chloe Cooney of Planned Parenthood Federation of America, were that the policy had a number of harmful impacts. These include USAID being forced to end condom shipments to Lesotho at a time when one in four women in the country was infected with HIV because the Lesotho Planned Parenthood Association, the primary conduit for condoms in the country, could no longer receive US funding under the global gag rule.

Another example is the termination of critical activities run by the Family Planning Association of Kenya and Marie Stopes International Kenya between 2002 and 2006. These are the leading providers of healthcare to people living in poor and rural communities in the country. [Summary based on submitted abstract; updated data may be presented on site.]

Abstract: Understanding the global gag rule: How to sustain global health progress amidst the new U.S. policy environment

Session: Bound and gagged: Exposing the impact of the expanded Mexico City policy (Friday, 27 July, 11:00-12:30)

Malawian advocate Tikahala Itaye of the AfriYAN youth network and the Global SheDecides Movement also spoke at the session, providing a community perspective of how the global gag rule restricts women from accessing healthcare.


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