Exactly one year ago today, Donald Trump signed the Global Gag Rule, thereby conditioning access to all US development aid dedicated to health: any foreign organization wishing to receive US federal aid funding must certify that it does not provide any services or engage in any counseling or advocacy activities aimed at promoting access to safe, medical abortion, including with non-US funding.
Introduced by Republican Ronald Reagan in 1984, this rule known as the "Mexico City Policy" but renamed the "Global Gag Rule" (GGR) by its opponents has been successively buried and resurrected as Democrats and Republicans have alternated in power. President Trump has extended its scope: until now, it has conditioned access to US funds dedicated to family planning, amounting to $575 million (€490 million). Now, it conditions access to the entire health budget, or $9.4 billion. This rule threatens many initiatives and programs in developing countries.
Added to this is the US State Department's decision to stop contributing to the United Nations Population Fund (UNFPA). The country was the third largest contributor, with $63 million in 2016 and $75 million in 2015. According to the UN agency, these sums made it possible to save the lives of 2,340 women, prevent 947,000 unwanted pregnancies, and avert 295,000 clandestine abortions each year.
A development aid policy that threatens women's rights and health
By cutting funding to grassroots organizations that provide access to services and information, particularly to the most disadvantaged women and girls, the GGR is exacerbating an already alarming situation. An estimated 214 million women who wish to avoid or delay pregnancy do not have access to modern contraceptive methods. There are 25 million unsafe abortions (45% of all abortions) per year, 3 million of which involve young girls. The majority of unsafe abortions, 97%, were performed in developing countries in Africa, Asia, and Latin America. Complications from unsafe abortions are the third leading cause of maternal mortality overall and the second leading cause of death among girls aged 15 to 19. These deaths could all be prevented if the availability of and access to quality services were guaranteed.
Several studies have shown that restrictions on the right to access safe abortion have no effect on the number of abortions performed, but do affect women's morbidity and mortality rates. Indeed, a woman who has decided to terminate her pregnancy will do so, even if it is illegal and in unsuitable sanitary conditions, at the risk of endangering her life.
Family planning in West Africa: immense needs and limited progress
West Africa, where maternal mortality rates remain particularly high and contraceptive prevalence struggles to reach 20%, is particularly affected by the budget cuts imposed by the Global Gag Rule.
Launched in 2011 with the aim of increasing access to contraception in French-speaking Africa, the Ouagadougou Partnership brings together nine countries (Benin, Burkina Faso, Côte d'Ivoire, Guinea, Mali, Mauritania, Niger, Senegal, and Togo) and major donors. USAID, the US Agency for International Development, is by far the largest of these, having spent more than $46 million in these countries on family planning programs in 2016, representing nearly 50% of the total amount invested in the region for this purpose.
France's necessary commitment to SRHR
US development aid represents the largest contribution to global health and makes the GGR's impact on sexual and reproductive health and rights (SRHR) needs and progress all the more significant. Countries pursuing progressive development policies, notably those united within the SheDecides movement launched in March 2017 by the Netherlands and Belgium in direct opposition to the GGR, must mobilize over the long term to counter the effects of the GGR and maintain momentum in favor of SRHR. France, which has not contributed financially to SheDecides, nevertheless has a responsibility to assume.
"I want young girls everywhere in Africa to have the choice not to be married at 13 or 14 and start having children,"insisted Emmanuel Macron during his speech on November 29 in Burkina Faso. This stated priority is in line with several political commitments made by the previous government. In October 2016, the Ministry of Foreign Affairs published its first reference strategy on the subject: "France's external action on population, sexual and reproductive health and rights 2016-2020," then launched the Paris Pledge on March 8, 2017, which aimed to remobilize the international community in support of women's rights.
In this fight for development, we also need to support the role of women, culture, and freedom of expression. Wherever the role of women is questioned or violated, development is blocked, and the ability of a society to emancipate itself and take its rightful place is also blocked. These are not trivial social issues; they are a profound struggle for civilization. They are our struggle, our values, and they are not relative; they are eminently universal across all continents and all latitudes[1]." We agree! SRHRs are an essential prerequisite for gender equality and a powerful lever for social transformation.But political will alone is not enough. It must be accompanied by substantial resources in order to translate into concrete action and bring about effective and lasting change.
Our organizations call on France to respond urgently and to:
- Respect and implement the presidential commitments to gender equality. These must be reflected in thepriorities for official development assistance, particularly at theInterministerial Committee for International Cooperation and Development(CICID)meetingnext February.
- Denounce US aid policy andconfirm its support, including financial support, for SheDecides.
- Reaffirm its leadership on the European and international stage in defending sexual and reproductive rights. At the United Nations, the upcoming sessions of theCommission on the Status of Women (March 2018) and theCommission on Population and Development(April 2018) should be key moments for the French delegation to mobilize against conservative forces.
- Finally, and most importantly, make a financial commitment to enable the implementation of the roadmap on sexual and reproductive health and rights. This investment must be commensurate with political announcements, but above all with the existing challenges, in order to achieve real and lasting progress.
This article, written by the Collectif Santé Mondiale (Global Health Collective), of which Equilibres et Populations is a member, is also available on thecollective's website.
[1] Emmanuel Macron, President of the Republic – Speech to the 72nd United Nations General Assembly, New York, September 19, 2017.
