Clinics in Crisis
With millions of women worldwide who wanted to prevent pregnancy but lacked modern contraception, the Global Gag Rule hurt an already-dire situation.
PAI documented the effects of the Bush administration’s Gag Rule with Access Denied, a film and series of case studies in six countries. What we found was consistent, and devastating.
In many countries, the Gag Rule forced providers that declined U.S. funding to close clinics, cut services and increase fees. Established health care referral networks collapsed as key family planning providers downsized and struggled to cope with budget cuts. For example, the Planned Parenthood Association of Ghana (PPAG), the country’s oldest and largest provider of reproductive health services, lost $200,000 in USAID funding in 2003 when they rejected the Gag Rule. As a result, PPAG laid off 67 key staff members and reduced nursing staff by 44 percent, leading to a 40 percent reduction in family planning use by those served by the organization. More than 1,327 communities in Ghana were affected by the cuts.
Similarly, Marie Stopes Kenya and the Family Planning Association of Kenya (FPAK), the counrty’s two leading reproductive health providers, refused to comply in 2001 and lost all U.S. funding. The policy forced MSI Kenya to close two clinics in 2002 and the organization was only able to keep further clinics from closing by laying off staff. Unable to raise enough funds to replace the USAID money lost, FPAK closed 15 clinics between 2001 and 2005.
Supplies Cut Short
The Global Gag Rule also led to a shortage of contraceptives and condoms in developing countries. Shortly after the reinstatement of the policy in 2001, shipments of U.S.-donated condoms and contraceptives completely ceased to 16 developing countries, primarily in Africa. Family planning providers in another 16 countries lost access to condoms and contraceptives as a result of their refusal to accept the policy’s restrictions.
For example, by refusing to comply with the Global Gag Rule, the Family Planning Association of Nepal lost $400,000 in USAID-funded contraceptives, two-thirds of its total stock, thus reducing the number of women they could serve. The Family Guidance Association of Ethiopia (FGAE), which also rejected the policy, stopped providing free condoms at their clinics due to recurring shortages. In 2003, FGAE’s branch office in Nazareth reported that they were about to run out of Depo-Provera, the birth control method used by 70 percent of their clients.
In many places, the Global Gag Rule likely increased abortions, as women lost access to contraceptives and the means to prevent unintended pregnancies. A 2011 study found the Global Gag Rule to be associated with increased abortion rates in sub-Saharan African countries. The odds of a woman having an abortion in countries that were most dependent on U.S. foreign aid were more than twice those observed in less-dependent countries. Abortion rates began to rise noticeably only after the Gag Rule was reinstated in 2001.
Un-American and Un-Democratic
In addition to these direct losses, the Global Gag Rule also had more indirect, insidious effects on reproductive health care. Prohibiting organizations from providing information, counseling and referrals on abortion hurt their ability to provide comprehensive health care requested by women and undermined trust between providers and patients. According to the American Congress of Obstetricians and Gynecologists, the policy’s restrictions “violate[d] basic medical ethics by jeopardizing a health care provider’s ability to recommend appropriate medical care.”
The Global Gag Rule also negatively impacted other U.S. global health priorities, including HIV/AIDS prevention and maternal and child health. In Kenya and Ethiopia, community-based outreach services were curtailed or even shut down, and these programs were often the only access rural men and women had to contraceptive supplies and education on HIV/AIDS.
The Global Gag Rule undermined a central tenet of U.S. foreign policy—the promotion of democracy abroad—and violated core democratic principles by restricting foreign organizations’ freedom to engage in public policy debates. For example, when the Global Gag Rule was in place, a family planning clinic or organization in a country where abortion is illegal could not advocate for legalization without losing U.S. funding.