P003“We are completely captured”: The influence of us foreign policy through the global gag rule on malawi's sexual and reproductive health and rights landscape

Abstract

<h3>Objectives</h3> Though existing literature discusses the impacts of the global gag rule (GGR) since President Reagan enacted the policy in 1984, limited research documents its influence in countries reliant on US global health assistance, particularly when the policy is revoked. We partnered with Fòs Feminista, a leader in GGR research on this policy, to analyze how the GGR influenced Malawi's sexual and reproductive health and rights (SRHR) landscape from 2017 to 2021. <h3>Methods</h3> We conducted 17 semi-structured interviews with current and past recipients of US global health assistance in Malawi and civil society organizations working in SRHR. We recruited participants via purposive and snowball sampling and thematically analyzed interview transcripts in MAXQDA using inductive and deductive codes. <h3>Results</h3> The GGR stalled the passage of a liberalized abortion law, cemented conservative anti-abortion attitudes, and damaged national sovereignty in Malawi. In some cases, mis-implementation of the policy restricted legal access to post-abortion and contraceptive care. The revocation signaled increased freedom for SRHR, but did not reverse the fueling of anti-abortion sentiment. Participants noted that the threat of the GGR being reinstated by a future US president caused continued fear and hesitation about investing in SRHR programs and advocacy, and contributed to a weakening of national sovereignty. <h3>Conclusions</h3> The US GGR disrupted abortion law reform in Malawi from an advocacy and policy perspective, prevented organizations from providing safe abortion care, and reinforced stigmatizing norms about abortion. Importantly, these impacts endured even after its revocation. The US government should permanently repeal the GGR, to remain accountable to its goal of protecting SRHR for all.