US curtailment of information on, and access to, contraception and abortion care is a human rights violation
On 24 January, US President Donald Trump issued guidance to reinstate the Global Gag Rule (GGR). This policy will lead to harm and human rights violations for women, girls and people of all genders worldwide, affecting their sexual and reproductive rights and well-being.
The GGR, formally known as Mexico City Policy or the Protecting Life in Global Health Assistance policy, originally put in place by former president Ronald Reagan and expanded under the first Trump administration, says organisations that receive US funding may not provide information about abortion or abortion care. Non-US based NGOs are ineligible for US government global health funding if they use their own funds to provide, refer for or promote access to abortion.
Critically, the ban does not only apply to activities funded with US dollars but also to work supported by other donors. Its impact extends beyond the specific provisions because it leads organisations to not even say the word “abortion” for fear of losing US funding.
The GGR violates individual human rights, organisational and individual free speech and the sovereignty of countries across the globe.
All people have the right to accurate information about contraception and abortion care, and sexual and reproductive healthcare is critical to our health, and the well-being of individuals, families and communities. Decades of rigorous evidence has demonstrated that access to safe abortion, in addition to being a human rights imperative, saves lives.
The GGR flies in the face of both human rights and evidence-based public health. When it was in place during previous administrations, research demonstrated clear increases in deaths and poor health outcomes linked to the policy.
The GGR does not prevent abortion from happening but rather increases barriers to abortion access, reduces access to contraception, increasing risk of unintended pregnancy, and could increase unsafe abortions, a key driver of maternal deaths around the world.
Its effect is felt keenly by organisations that provide comprehensive sexual and reproductive healthcare — including contraception and abortion care — around the world such as MSI Reproductive Choices and the International Planned Parenthood Federation which refuse to abide by the terms because they support the human rights of all people and which will not withhold information or critical reproductive healthcare from individuals who need it.
They therefore are likely to see reduced funding from USAid, which in turn leads to scaling back critical contraception and abortion care, leaving people at risk of a range of negative reproductive outcomes including unintended pregnancy, forced birth and parenting and unsafe abortion.
This is true in contexts where abortion is broadly legal and in contexts where legal access to abortion is only available in cases of rape or life- or health-threatening emergencies, when abortion care is almost always allowed.
The effects of the GGR also ripple far beyond the administration implementing it, creating a long-term cycle of violations. For example, the evidence-based Kenya Standards and Guidelines on abortion were withdrawn during the Barack Obama administration when the GGR had been rescinded.
In addition, organisations in Kenya do not receive clear guidance on the GGR and US officials might over-interpret the rule leading to less access to evidence-based, life-saving healthcare that providers are trained and eager to provide.
In addition, the impact of the GGR spreads beyond access to contraception and abortion, affecting other critical services like HIV prevention, treatment and care.
Abortion is essential healthcare and the technology needed to provide this care is widely available. The World Health Organisation Safe Abortion Guidelines recommend both procedural and medication options. Individuals ideally should be able to choose the method that best suits their needs and preferences.
Where access to abortion becomes restricted, people need to know that medication abortion (either using misoprostol alone or in combination with mifepristone) is safe and effective, when used both within and outside of the formal health sector, and innovative service delivery models, such as accompaniment or hotline providers, are options in many places.
Ibis’s research has shown that self-management of medication abortion is safe and effective and accompaniment- and hotline-provided care is high quality and highly acceptable. (For evidence-based information about abortion, download the Euki app, which keeps user data and browsing private and secure.)
While we know it is unlikely that the new Trump administration, which has consistently shown a disdain for evidence, will all of a sudden acknowledge the robust body of evidence in support of access to comprehensive sexual and reproductive health information and care, we must redouble our efforts to ensure people have the information, services and products that they need.
Work must continue to permanently repeal the GGR. Individuals and organisations working in this field must continue raising awareness about the GGR’s harms to build public knowledge about the policy and support for legislation to ensure that people can legally access high-quality reproductive healthcare, including abortion and contraception.
We hope that we will soon see an end to the harmful US restrictions on information about and access to abortion care that violate people’s human rights, and endanger their health, around the world. In the meantime, we all have the right to share information and ensure people know that they have safe and effective options to access the abortion care they need, even if misguided and malicious US policy pushes those services out of the formal healthcare sector for many more people over the next four years.
We will continue our work towards a world characterised by reproductive justice for all and where all people have access to high-quality, comprehensive, evidence-based sexual and reproductive healthcare.
Kelly Blanchard is the president of Ibis Reproductive Health and Evelyn Opondo is an Ibis board member and Africa director at the International Center for Research on Women.