Global Gag Research Articles

South African government responses to Trump's Global Gag Rule: Silence, ignorance, and avoidance

In 2017, Donald Trump signed the Protecting Life in Global Health Assistance (PLGHA), thereby reinstating the Global Gag Rule. The policy restricted all United States foreign funding from abortion-related activities. Little research reports the responses of recipients of this bilateral assistance. The study documents the South African government's responses to the PLGHA. We accessed Hansard parliamentary debates, interviewed four parliamentarians alongside one government official, and reviewed a USAID-funded initiative developed while the policy was in effect. We analysed the data using interpretive content analysis through a global social policy and gendered coloniality lens. Our research documents silence, ignorance, avoidance, and possible over-interpretation of the PLGHA within the South African government. The colonialist politics of global redistribution created the grounds for gendered regulation, resulting in a fundamental undermining of reproductive rights. Ironically, the solution – advocacy and parliamentarian briefing regarding sexual and reproductive issues – is generally led by civil society, the bodies weakened by the PLGHA.

U.S. global health aid policy and family planning in sub-Saharan Africa.

The Trump administration reinstated and expanded the Mexico City Policy (MCP) in 2017 as the Protecting Life in Global Health Assistance (PLGHA) policy, forbidding international organizations receiving all U.S. health assistance from promoting abortion. Existing evidence suggests that abortion rates rise under the MCP, but the direct effect of U.S. funding restrictions on supply and use of family planning has received less attention. By studying PLGHA's impact on health service delivery providers and women in eight sub-Saharan African countries, we are able to fill this gap. We find that health facilities provide fewer family planning services, including emergency contraception, and that women are less likely to use contraception and more likely to have given birth recently under the policy. These findings suggest that PLGHA has important unintended consequences that are detrimental to reproductive health and the autonomous decision-making of health service providers and women.

Filling the “Decency Gap”? Donors’ Reaction to US Policy on International Family Planning Aid

Abstract The impact of US allocation of family planning aid on other donors is studied in order to gain new insights into donor interactions. Within this context, the dominant player in the sector is the United States, whose policies on family planning undergo changes influenced by domestic debates surrounding abortion. By utilizing the Mexico City Policy and considering exposure to this particular policy as an instrumental factor, it has been observed that other donors do not immediately react to policy changes made by the United States, either contemporaneously or within one year. However, a noticeable shift occurs after a two-year period, indicating that these donors eventually align their allocation strategies with those of the United States. Further analysis of this phenomenon reveals varying patterns among different types of donors. While smaller donors exhibit a clear intention to compensate for US policy changes, larger donors display a mix of competitive tendencies and herding behavior, thereby reinforcing the impact of the Mexico City Policy after the two-year time frame.

Digital Norm Contestation and Feminist Foreign Policy

Abstract This article examines the role of digital norm contestation in feminist foreign policy (FFP). It analyzes how states that participate in digital diplomacy are involved in challenging and resisting norms, values and expectations related to feminist positionings in the digital environment. The article presents an analytical framework for the study of digital norm contestation and conducts an empirical case study of Sweden as the first country in the world to brand its foreign policy “feminist.” This triggered a process of digital norm contestation, particularly visible in the area of sexual and reproductive health and rights. Three empirical vignettes of digital norm contestation are analyzed. The first example illustrates how the Swedish government was able to exercise global leadership to visually perform and digitally advocate the contestation of the US global gag rule. The second example underlines how the Swedish government harnessed its leadership by connecting it to grassroots contestations of the global gag rule through digital advocacy networks. The third example illuminates how the Swedish government’s visit to Iran backfired because of a lost sense of control over visual performative effects in the digital environment. By way of conclusion, we suggest three avenues that can be pursued to further the research agenda on gender, digital norm contestation, and foreign policy.

Potential Impacts of Roe v. Wade repeal on Sexual and Reproductive Health in Sub‐Saharan Africa

AbstractThe United States (US) Supreme Court's decision to repeal Roe v. Wade has had significant implications for abortion care in the US, especially for emergency care. This ruling may also have an impact on sub‐Saharan Africa, where restrictive laws and policies limit women's access to safe and legal abortions. Sub‐Saharan Africa is the region with the highest rate of unwanted pregnancies and unsafe abortions, resulting in 15,000 preventable deaths annually. Although every country in sub‐Saharan Africa has at least one legal basis for abortion, they remain limited. In Nigeria, where 29% of pregnancies are unintended, 48% of these led to abortions, amounting to over 1.4 million abortions between 2015 and 2019. Unsafe abortions are prevalent in the region due to socioreligious stigma, particularly for unmarried women. Criminal charges can result from violating these limitations, with prison terms ranging from 3 to 14 years. The reversal of Roe v. Wade could have significant consequences in abortion‐related policies and politics in sub‐Saharan Africa, encouraging nations to adopt restrictive policies and legitimizing them. The landmark decision of Roe v. Wade may also impact the rate of unsafe abortions in the region, much like the US Mexico City Policy. With the high probability of foreign assistance funds for safe abortions depleted, sub‐Saharan African countries must prepare for this financial vacuum in health response. Therefore, the repeal of Roe v. Wade may lead to increased maternal morbidity and mortality in sub‐Saharan Africa, where access to safe and legal abortions is already limited.

Impact of the global gag rule on women’s contraceptive use and reproductive health outcomes in Ethiopia: a pre–post and difference-in-difference analysis

ObjectiveTo assess the impacts of the Protecting Life through Global Health Assistance policy (otherwise known as the expanded global gag rule (GGR)) on women’s sexual and reproductive health (SRH) in...

Exclusion by Design: Locating Power in Mansbridge’s Account of Descriptive Representation

A much-circulated image during the Donald Trump administration showed Vice President Mike Pence and members of the Republican House Freedom Caucus discussing the removal of maternity coverage from the Affordable Care Act—with not a single woman or person of color among them. In another image, white men watched approvingly as Trump signed an executive order reinstating the global gag rule, which bans foreign nongovernmental organizations that receive American aid from supporting abortion access. These images contrast with one from early in Joe Biden’s presidency. In his first address to Congress, Biden was backed by two women occupying the second- and third-most-powerful positions in the country, Vice President Kamala Harris and Speaker of the House Nancy Pelosi, respectively. After acknowledging “Madame Speaker, Madame Vice President,” Biden said, “No president ever said those words and it is about time.”

Postabortion and safe abortion care coverage, capacity, and caseloads during the global gag rule policy period in Ethiopia and Uganda

BackgroundAbortion-related complications contribute to preventable maternal mortality, accounting for 9.8% of maternal deaths globally, and 15.6% in sub-Saharan Africa. High-quality postabortion care (PAC) can mitigate the negative health outcomes associated with unsafe abortion. While the expanded Global Gag Rule policy did not prohibit the provision of PAC, other research has suggested that over-implementation of the policy has resulted in impacts on these services. The purpose of this study was to assess health facilities’ capacity to provide PAC services in Uganda and PAC and safe abortion care (SAC) in Ethiopia during the time in which the policy was in effect.MethodsWe collected abortion care data between 2018 and 2020 from public health facilities in Ethiopia (N = 282) and Uganda (N = 223). We adapted a signal functions approach to create composite indicators of health facilities’ capacity to provide basic and comprehensive PAC and SAC and present descriptive statistics documenting the state of service provision both before and after the GGR went into effect. We also investigate trends in caseloads over the time-period.ResultsIn both countries, service coverage was high and improved over time, but facilities’ capacity to provide basic PAC services was low in Uganda (17.8% in 2019) and Ethiopia (15.0% in 2020). The number of PAC cases increased by 15.5% over time in Uganda and decreased by 7% in Ethiopia. Basic SAC capacity increased substantially in Ethiopia from 66.7 to 82.8% overall, due in part to an increase in the provision of medication abortion, and the number of safe abortions increased in Ethiopia by 9.7%.ConclusionsThe findings from this analysis suggest that public health systems in both Ethiopia and Uganda were able to maintain essential PAC/SAC services during the GGR period. In Ethiopia, there were improvements in the availability of safe abortion services and an overall improvement in the safety of abortion during this time-period. Despite loss of partnerships and potential disruptions in referral chains, lower-level facilities were able to expand their capacity to provide PAC services. However, PAC caseloads increased in Uganda which could indicate that, as hypothesized, abortion became more stigmatized, less accessible and less safe.

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

<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.

An investigation of the impact of the Global Gag Rule on women’s sexual and reproductive health outcomes in Uganda: a difference-in-differences analysis

In 2017, the Trump administration reinstated the Global Gag Rule (GGR), making non-U.S. non-governmental organisations ineligible for US government global health assistance if they provide access to or information about abortion. Little is known about the impact of the Trump administration’s GGR on women’s outcomes. Data for this analysis come from a panel of women surveyed in 2018 and 2019 in Uganda (n = 2755). We also used data from meetings with key stakeholders to create a detailed measure of exposure to the GGR within Uganda, classifying districts as more or less exposed to the GGR. Multivariable regression models were used to assess changes in contraceptive use, all births, unplanned births, and abortion from before to during implementation of the GGR. Difference-in-differences (DID) estimates were determined by calculating predicted probabilities from interaction terms for exposure/survey round. Descriptive analyses showed long-acting reversible contraceptive use increased more rapidly among women in less exposed districts after GGR implementation. DID estimates for contraceptive use were small. We observed a DID estimate of 3.5 (95% CI −0.9, 7.9) for all births and 2.9 (95% CI −0.2, 6.0) for unplanned births for women in more exposed districts during the period the policy was in effect. Our results suggest that the GGR may have attenuated Uganda’s recent progress in improving SRHR outcomes, with women in less exposed districts continuing to benefit from this progress, while previously increasing trends for women in more exposed districts levelled off. Although the GGR was rescinded in January 2021, the impact of these disruptions may be felt for years to come.

Beyond abortion: impacts of the expanded global gag rule in Kenya, Madagascar and Nepal

Since 1984, Republican administrations in the US have enacted the global gag rule (GGR), which prohibits non-US-based non-governmental organisations (NGOs) from providing, referring for, or counselling on abortion as a...

The U.S. Global Gag Rule in Ethiopia: a foreign policy challenging domestic sexual and reproductive health and rights gains

BackgroundEthiopia’s government and civil society have driven crosscutting initiatives in the last 15 years to improve sexual and reproductive health outcomes, including passing a 2005 abortion law that facilitated reduced rates of maternal death due to unsafe abortion. However, both the government and nongovernmental organizations have relied on external funding for sexual and reproductive health and rights, particularly from the U.S. government, which has been Ethiopia’s largest global health donor. This article explores how the implementation and expansion of the 2017–2021 U.S. foreign policy “Protecting Life in Global Health Assistance,” also known as the Global Gag Rule—which attached itself to a nongovernmental organization’s funding—impacted sexual and reproductive health and rights, including safe abortion care, in Ethiopia.MethodsThis article is based on research conducted by PAI staff in Ethiopia in 2018 with follow-up in 2019. PAI held in-depth semistructured interviews with representatives of 30 organizations in Ethiopia’s capital, Addis Ababa. Among these groups were U.S.-based and non-U.S. nongovernmental organizations, including community-based organizations, non-U.S. government donors, and Ethiopian government officials.ResultsNongovernmental organizations have been essential to sexual and reproductive health service provision and advocacy in Ethiopia. Because of the sector’s reliance on U.S. global health assistance, these organizations; their activities; and, consequently, the wider health system were negatively impacted by the Global Gag Rule. Certain vulnerable groups, particularly adolescents and youth, have traditionally relied on the private sector for sexual and reproductive health services. PAI’s research demonstrates that U.S. policy disrupted activities and service delivery, threatened the closure of private clinics, stalled mobile outreach, and impacted safe abortion training of health personnel. Additionally, the Global Gag Rule dismantled partnerships, affected non-U.S. government donors’ investments, and caused confusion that limited activities permissible under the policy.ConclusionsThe Trump administration’s Global Gag Rule forced non-U.S. organizations to choose between providing comprehensive care or losing U.S. global health assistance, ultimately impacting populations in need of services. Ethiopia provides a clear example of how the Global Gag Rule can threaten a country’s domestic health agenda by targeting nongovernmental organizations that are vital to health service delivery and safe abortion care.

Impact of the Trump Administration's Expanded Global Gag Rule Policy on Family Planning Service Provision in Ethiopia.

The Global Gag Rule (GGR) makes non‐U.S. nongovernmental organizations (NGOs) ineligible for U.S. Government global health funding if they provide, refer, or promote access to abortion. This study quantitatively examines the impacts of the GGR on family planning service provision in Ethiopia. Using a panel of health facilities (2017–2020), we conduct a pre–post analysis to investigate the overall changes in family planning service provision before and after the policy came into effect in Ethiopia. Our pre–post analyses revealed post‐GGR reductions in the proportions of facilities reporting family planning provision through community health volunteers (−5.6, 95% CI [−10.2, −1.0]), mobile outreach visits (−13.1, 95% CI [−17.8, −8.4]), and family planning and postabortion care service integration (−4.8, 95% CI: [−9.1, −0.5]), as well as a 6.1 percentage points increase in contraceptive stock‐outs over the past three months (95% CI [−0.6, 12.8]). We further investigate the impacts of the GGR on facilities exposed to noncompliant organizations that did not sign the policy and lost U.S. funding. We do not find any significant additional impacts on facilities in regions more exposed to noncompliant organizations. Overall, while the GGR was slow to fully impact NGOs in Ethiopia, it ultimately resulted in negative impacts on family planning service provision.

US foreign aid restrictions and maternal and children’s health: Evidence from the “Mexico City Policy”

This paper analyzes the link between foreign aid for family planning services and a broad set of health outcomes. More specifically, it documents the harmful effects of the so-called “Mexico City Policy” (MCP), which restricts US funding for nongovernmental organizations that provide abortion-related services abroad. First enacted in 1985, the MCP is implemented along partisan lines; it is enforced only when a Republican administration is in office and quickly rescinded when a Democrat wins the presidency. Although previous research has shown that MCP causes significant disruption to family planning programs worldwide, its consequences for health outcomes, such as mortality and HIV rates, remain underexplored. The independence of the MCP’s implementation from the situation in recipient countries allows us to systematically study its impact. Using country-level data from 134 countries between 1990 and 2015, we first show that the MCP is associated with higher maternal and child mortality and HIV incidence rates. These effects are magnified by dependence on US aid while mitigated by funds from non-US donors. Next, we complement these results using individual-level data from 30 low- and middle-income countries and show that, under the MCP, women have less access to modern contraception and are less exposed to information on family planning and AIDS via in-person channels. Moreover, pregnant women are more likely to report that their pregnancy is not desired. Our findings highlight the importance of mitigating the harmful effects of MCP by redesigning or counteracting this policy.

Control, alt, delete: Patriarchal populist attacks on international women’s rights

AbstractThe rise of patriarchal populist leaders over the past decade has fortified a long-standing campaign by conservative governments and advocacy groups to undermine women’s international human rights. Their efforts have increasingly focused on revising language as a means to challenge and weaken the international norms and organizations essential to women’s and girls’ equality and health. Through our textual analysis of UN records, governmental and nongovernmental publications, media coverage of disputes over language, and background interviews with activists, we identify and delineate the significance of this ‘norm spoiling’ strategy and trace its expansion during the Trump administration. We find that women’s rights challengers have pursued three distinct spoiling tactics based in language: controlling what women’s rights advocates can say through policies such as the United States’ ‘global gag rule’; altering the meaning of women’s rights by reframing them as an attack on other rights, such as religious freedom; and deleting foundational words, such as ‘gender’ and ‘sexual and reproductive health and rights’, from international agreements. The role of language in today’s patriarchal populism goes beyond populist leaders’ speeches, rallies and tweets. Their governments and allies systematically control, alter or delete words central to women’s rights.

Biocolonial pregnancies: Louise Erdrich’s Future Home of the Living God (2017)

This article argues that the health humanities must examine biocolonialism (and representations thereof) if it is to attend to Native American experiences of reproductive healthcare in the USA. Reproductive healthcare...

Catholic Medical Association Expresses Concerns After Biden Administration Rescinds Mexico City Policy.

Catholic Medical Association Expresses Concerns After Biden Administration Rescinds Mexico City Policy.

Permanently Repealing the Global Gag Rule Will Internationally Advance Reproductive and Sexual Health

The Global Gag Rule bans foreign nongovernmental organizations (NGOs) that receive U.S. global health assistance funding from providing abortion services and referrals, advocating for abortion rights, or funding other organizations that provide abortion-related services. The rule presents a double bind: if NGOs elect to continue providing abortion-related care, they must forgo U.S. funding, requiring them to roll back services across the board. This reduces access to contraceptives, family planning resources, and maternal and child healthcare. The alternate option is to shut down abortion-related care to retain U.S. funding. Thus, the rule is ineffective in its purpose as it creates barriers to comprehensive sexual and reproductive healthcare, leading to increases in unintended pregnancies, abortions, and newborn and maternal death rates. In addition, restricted funding has negative implications for HIV/AIDS and reproductive cancer screening and treatment. The rule is currently implemented and repealed by each incoming president using executive orders. The United States Congress should pass the Global Health, Empowerment, and Rights Act and repeal the Helms Amendment. This will permanently revoke the Global Gag Rule and reduce unintended pregnancies, abortions, and child and maternal mortality rates across the world.

“If you don’t help me, I’m going to take my life”: the devastating impact of the US’s global gag rule and the COVID-19 pandemic on women’s sexual and reproductive health in Kenya

The 17-year-old girl walked into the facility seeking access to the abortion pill to terminate her pregnancy and uttered these words to the director: “If you don’t help me, I’m going to take my lif...

Ending unjust HIV criminalization: leave no-one behind.

Ending unjust HIV criminalization: leave no-one behind.