In one of his first acts in office, Republican President Donald Trump reinstated the “global gag rule”, a policy that removes funding from health services that offer, or advise on, abortion.

The global gag rule, also known as the Mexico City policy, was a Ronald Reagan-era policy that makes foreign non-governmental organizations (NGOs) certify that they will not “perform or actively promote abortion as a method of family planning” in order to receive family planning aid from the US.

The rule has been in and out of favour in successive US governments. Every Democrat president has rescinded it, while every Republican president has reintroduced it. The actions of the latest administration come as no surprise.

Image: Guttmacher

However, this latest reincarnation goes further than previous efforts. In the past, non-US organizations only had to adhere to the policy if they received funding from the family planning assistance budget. Now, the policy will apply to all US global health assistance to foreign organizations.

What does that mean?

It means that the funding cut does not just affect abortion services, it affects all healthcare services, such as HIV testing and counseling, comprehensive sex education, and contraceptive services – and affects the people who need them the most.

The US is the biggest contributor to international family planning programmes. In 2015 it provided $638 million to low and middle income countries.

NGOs and family planning groups argue that the global gag rule will have devastating consequences.

The International Planned Parenthood Foundation, for instance, says that the $100 million they would have received from the US government could have prevented 20,000 maternal deaths, 4.8 million unintended pregnancies and 1.7 million unsafe abortions.

Image: IPPF

It could also have provided treatment to 275,000 pregnant women living with HIV, 70 million condoms to prevent unintended pregnancies, HIV and other STIs, 725,000 HIV tests and treated 525,000 sexually transmitted infections.

The UN Foundation says that the global gag rule jeopardizes the health and well-being of the world’s most vulnerable girls and women, and that more women and infants will die as a result of pregnancy-related complications.

Proponents of the global gag rule point to the fact that they are protecting the most vulnerable in society – the unborn child.

But EngenderHealth, which has helped document the impact of the global gag rule in such countries as Nepal, Kenya and Zambia, says that previous policies have not reduced abortions. The lack of access to all-round family planning actually leads to an increase in unwanted pregnancies.

Others fill the gap

Other countries have stepped up to try and fill the gap in funding caused by the reinstatement of the global gag rule.

A conference in Brussels in January was hastily arranged as an immediate response to the re-introduction of the rule. It brought together over 45 countries and raised €181 million ($190 million) under a global initiative entitled ‘She Decides’.

The four hosts of the conference – the Netherlands, Belgium, Sweden and Denmark – committed to contributing at least €10 million ($11 million) each.

Sweden then increased its pledge to €20 million ($21 million). Canada and Finland each promised around €20 million ($21 million). Norway pledged €10 million ($11 million) and Luxembourg pledged €10 million ($11 million).

Philanthropists also joined in. For example, the Bill & Melinda Gates Foundation pledged $20 million.

One anonymous US donor committed $50 million, and Sir Chris Hohn, founder of the Children's Investment Fund Foundation, pledged $10 million.

The UK didn’t make a pledge, but highlighted the fact that it has a budget of £200 million ($250 million) for family planning. The UK Government will also be hosting a summit in the summer to discuss the issue further.

Australia was present at the conference but didn’t pledge any funds, with representatives saying that “Australia has a long-standing commitment to the promotion and delivery of sexual and reproductive health services in our foreign policy and aid programmes”.

The money raised by She Decides will be given to the organizations most affected by the global gag rule, which are working on sexual and reproductive health initiatives in developing countries. The campaign’s aim is to raise $600 million.

Critics say that the funding effectively promotes abortion, but Alexander de Croo, the Belgian foreign minister and one of the hosts of the conference said: “To be clear, any abortion that takes place is one too many. But if it has to take place, then I think it should be available and it should be available in a safe way.”

In an Address to a Joint Session of Congress given in February, Trump said that women’s health was still a priority in his government: “[The] administration wants to work with members in both parties to make childcare accessible and affordable, to help ensure new parents have paid family leave, to invest in women's health, and to promote clean air and clear water.”