/ 13 July 2018

US gag rule ties SA’s hands

When the Trump administration formally reinstated the gag rule
When the Trump administration formally reinstated the gag rule


South Africa institutionalised liberal abortion laws more than two decades ago, but on January 23 2017, United States President Donald Trump essentially took away my right to write even a word about abortion.

As a doctor in South Africa, I have provided abortion services for more than a decade. As part of my work, I often edit educational material for a nongovernmental organisation that works to prevent HIV.

For young South African women, these texts offer lifesaving information about issues related to sexual and reproductive health.

READ MORE: Download our easy-to-use safe abortion graphics in six languages for free

But two days after the US presidential election in November 2016 — and more than two months before Trump’s inauguration — the NGO I was working for halted distribution of a reproductive health guide because it contained information on South Africa’s constitutionally guaranteed right to abortion. The guide has since been reprinted, with all references to abortion deleted.

The cause of this self-censorship is a US policy known as the “global gag rule”. First introduced in the 1980s and revived by every Republican administration since, the policy blocks US foreign aid to organisations that offer abortion services, counselling, referrals or advocacy. When the Trump administration formally reinstated the rule, it expanded the list of international aid programmes that made funding conditional on meeting anti-abortion criteria.

Like many developing countries, South Africa receives hundreds of millions of dollars from the US every year. In 2016, my country received $531-million from the US Agency for International Development (USAid) to fund “health and population” programmes. But, although this assistance has done plenty of good, the attached strings are tying our hands.

South Africans are no strangers to healthcare meddling by the US; we have lived with the global gag rule before. During George Bush Jnr’s administration, reproductive health suffered and abortion-related education services were decimated. Healthcare providers receiving USAid money were barred from discussing abortion even with pregnant women who were HIV-positive. It is with this history in mind that healthcare professionals in South Africa, and far beyond, are raising the alarm about Trump’s expanded policy.

Even when US funding has been restored under Democrat administrations, women in South Africa have struggled to gain access to abortion services. Although abortions have been constitutionally protected since 1996, just 5% of public clinics and hospitals offer the procedure, and as many as half of all abortions are conducted in unsafe facilities.

Flyers advertising illegal abortions dot the country, including at the entrances to the national department of health in Pretoria. These providers promise dangerous “same-day abortions”, which can put women at risk of incomplete abortions, sepsis and even death.

Last year, Amnesty International produced a report detailing what must be done to ensure that abortions in South Africa are safe, timely and in compliance with local law. The recommendations included increasing affordable transportation to family-planning facilities, expanding access to contraception, increasing the availability of sex education and developing strategies to reduce the stigma of abortions. And yet, as a result of US policy, none of these changes will come easily. If countries like South Africa are ever to escape the assault on reproductive freedom by the US, new strategies are needed to fight the global gag rule.

Solutions start at home, which is why developing countries need to begin moving away from conditional aid that restricts health providers’ ability to work in accordance with local laws. Local NGOs, together with responsible global partners, must find new support for programmes that educate women about their rights and provide access to safe abortion services. The point of Trump’s global gag rule is to silence advocates and medical professionals. We must not bend to this pressure.

READ MORE: A grim anniversary: Hundreds of clinics close as Trump’s gag rule turns one

But just as important as domestic support is backing from US lawmakers, who have the power to reverse Trump’s dangerous policy. The Global Health, Empowerment and Rights Act, introduced last year, would prohibit the application of restrictive eligibility requirements for foreign NGOs that receive US assistance. Best of all, a passage of the Act would create a permanent legislative repeal of the global gag rule, and return a sense of apolitical morality to US foreign aid.

In South Africa, every woman has the legal right to control her reproductive health. But that right is being trampled by a form of neocolonialism that ties aid to the political whims of the US. South Africa’s people have decided to enact one of the world’s most liberal abortion laws; politicians 12 000km away should not be allowed to reverse their choice. — © Project Syndicate

Tlaleng Mofokeng is vice-chairperson of the Sexual and Reproductive Justice Coalition of South Africa