President Trump, during Tuesday's State of the Union, announced, with few details, that the administration would be "launching the first ever government-wide initiative focused on economic empowerment for women in developing countries."
But while we share the goal of empowering women in developing countries, the overall health and socioeconomic wellbeing of women and girls depend in no small part on the availability of evidence-based health care services and information.
The administration has adopted a dangerous and politicized approach to the health and rights of the very women it now offers to empower, using U.S. aid for global health initiatives as a way to limit medical services to women that do not align with its political views.
Republican administrations have, from Ronald Reagan forward, prohibited non-U.S. non-profit organizations that assist with women's health programs in the developing world and take U.S. aid from even mentioning the existence of safe, legal abortion services — even if U.S. funds don't go towards those services. Known as the "Global Gag Rule," it's meant that even non-American organizations that want to provide reproductive health and family planning services to women abroad have to choose between lying to or keeping information from their patients, or forfeiting any money that comes from the U.S. government.
But as bad as the rule has been for women historically, the Trump Administration made it worse.
Rather than simply reinstating the gag rule as it applied to women's health services, the Trump administration expanded it to apply to all global health programs. Now, implementers of efforts to treat HIV/AIDS, malaria, maternal and child health, nutrition, tuberculosis and more must devote resources and time to understanding the parameters of a policy that has never affected them before — and agree to abide by such a draconian policy or lose all U.S. financial support.
This strategy turns back the clock on global health efforts, and threatens America’s legacy of global health leadership.
Responsible lawmakers, on the other hand, understand that the benefits of comprehensive health care, including comprehensive reproductive health care, go beyond just improved patient outcomes. The security of nations, the economic development and productivity of states, and stability of societies are all linked to the health and rights of women. Simply put: Access to reproductive health care allows women to more fully participate in their respective societies and economies, improves both child and maternal mortality and empowers women to make decisions about their futures and those of their children. You cannot economically empower women if you refuse to empower them to make decisions about their own bodies.
Many in Congress recognize that imposing one’s own ideology on policy to restrict those women's rights is reckless and runs counter to American values.
And, while the gag rule aims to prevent women in developing nations from gaining access to abortions, previous implementations of this policy have had the opposite effect. Research shows that the rule's presence is strongly correlated with an increase in abortions.
Further studies have demonstrated that the rule goes even further than its proponents claim in reducing women's access to reproductive health care: It can and does reduce access to contraception in developing countries, leading to more unwanted and high-risk pregnancies and maternal illness and mortality. It also prevents the U.S. from working with many of our most trusted and experienced implementers of general reproductive health care, reducing the quality and efficiency of the programs we do fund despite the gag rule.
For defenders of the gag rule, the policy’s inaccurately-perceived success in thwarting abortion trumps the very real harm it causes to these broader health services.
That's only gotten worse under the Trump's administration's expansion. In a preliminary analysis of its impacts, research shows that rural or underserved women, children and young people and key populations affected by HIV are not getting the same quality health services as before. Another study found that a significant number of organizations funded through the President’s Emergency Plan for AIDS Relief have altered how they operate and the services they provide because of the Global Gag Rule — despite the president's State of the Union promise to "defeat AIDS in America and beyond."
Other investigations have found that providers are so fearful of losing funding and confused by the requirements that they are over-complying, creating inefficiencies in their delivery of services and ultimately, backing away from desperately needed services they could be providing.
We can end this: Congress must exercise its legislative authority to end the Global Gag Rule and prevent its future reinstatement by executive action.
We are therefore reintroducing the Global Health, Empowerment, and Rights (HER) Act to codify into law the permanent repeal of the Global Gag Rule. If enacted, foreign NGOs would no longer be ineligible for U.S. foreign assistance on the basis of health or medical services, including counseling about abortion and referrals to legal abortion providers. The organizations, though, would have to do so with non-U.S. funds, and could only do so on the condition that those services do not violate the laws of the country in which they are being provided and would not violate U.S. law if provided to patients here.
The need to pass this legislation has never been as clear or urgent. We cannot defend free speech, improve health and sustainable development outcomes for developing countries and ensure the security and stability of vulnerable populations by silencing medical professionals and subverting the private and sensitive physician-patient relationship. Forcing doctors to essentially commit malpractice is weakening the effectiveness of our foreign assistance by severing long-standing relationships and collaborations.
By passing the HER Act, Congress can ensure that the health of vulnerable women and families around the world no longer rests on the president’s machinations but in the hands of our most capable and effective international partners. And then those women can take advantage of the economic empowerment programs the president seems so keen to promote.