The U.S. government’s capricious stance on foreign aid has likely worsened the reproductive care and health of women living in poorer affected countries, according to a new report out Thursday.
During periods when the so-called global gag rule, which bars federal funding to overseas health care organizations that provide abortions, was active, researchers found, women in sub-Saharan Africa were less able to access birth control and had more pregnancies. Ironically, given the conservative backing of the rule, women were also more likely to get abortions. But these abortions were probably less safe and more life-threatening than they would have been otherwise.
Also known as the Mexico City policy, the global gag rule was first enacted by the Ronald Reagan administration in the 1980s. It’s historically called for suspending all aid funding to non-governmental organizations (NGOs) operating in countries that “perform or actively promote” abortion services. The rule applies even if the funding would be earmarked for other health services often provided alongside abortions, such as gynecological check-ups or birth control. Reflecting the partisan nature of the rule, each change in the political affiliation of the White House has seen it respectively torn down or reinstated ever since its enaction.
But because of these constant changes in the implementation of the gag rule, it was possible for the authors of the current study, published in the Lancet Thursday, to track how they affected women’s overall access to reproductive health care services. The authors compared countries in sub-Saharan Africa where organizations affected by the gag rule were most commonly found to those where their presence was low. In these countries (26 in total), they looked specifically for rates of reported contraceptive use, pregnancies, and abortions between 1995 to 2014.
During the years the rule was suspended—that is, when the U.S. permitted federal funding to organizations that provide abortions outside the U.S.—women in exposed countries were 13.5 percent more likely to report using contraceptives, and 12 percent less likely to have a pregnancy. Women also reported fewer abortions when funding was available—about a 40 percent decrease in the rate compared to periods when the gag rule was in effect and to countries where effects of the rule were insignificant.
The study can’t directly prove that the rule led to these differences in the contraception, pregnancy, and abortion rate. But the changes weren’t just relative to the periods when the rule was in effect, but also to the countries where the rule wasn’t very relevant, meaning they should account for other factors that affected the region as a whole.
To people seldom affected by access to reproductive care, women getting more abortions under the gag rule might seem strange. But the authors noted that abortion providers, of course, rarely only offer abortions; they’re also a primary source of health care in general for many women. And with less funding for these providers, in countries where the healthcare system is already struggling, fewer women are able to reach any of these services, including birth control and ways to protect themselves from sexually transmitted infections, like condoms. That then leads to more unplanned pregnancies. While more women might then indeed go through with their pregnancy, others will still pursue abortions, even if they’re more dangerous. And more women will undoubtedly die or face serious health issues as a result.
“The health of mothers is a global priority. Our findings suggest how a U.S. policy that aims to restrict federal funding for abortion services can lead, unintentionally to more—and probably riskier—abortions in poor countries,” lead author Nina Brooks, a researcher at Stanford University, said in a release by the Lancet.
Women in African countries already have a hard enough time accessing necessary health services as it is. According to the Guttmacher Institute, 93 percent of women of reproductive age live in countries with restrictive abortion laws.
In the best short-term scenario, the gag rule is once again struck down by the next presidential administration. But for now, things are only poised to get worse. President Trump has gone even further than his Republican predecessors, expanding the rule to include third-party NGOs that fund other organizations that offer abortion care; a change that’s reportedly already forced clinics to close. He’s also instituted a domestic version of the rule that prevents Title X funding to local providers that offer abortions in addition to their other services, unless there are separate facilities for each type of service—an expensive, effectively impossible change for many providers that operate in low-income areas with tiny budgets.
This new version is especially cruel and meaningless since, under the Hyde Amendment, federal funding has long been banned from being used for abortions within the U.S. And it’s likely the same pattern of worse health care for women will follow in its wake, according to study author Eran Bendavid, a fellow researcher at Stanford.
“A key issue with the Mexico City Policy is that the funding restrictions do not discriminate between abortion-providing organizations and family planning organizations,” Bendavid told Gizmodo via email. “To the extent that the domestic restrictions share this feature and curb support for organizations that provide family planning services, especially contraceptives, it could have the same downstream consequences we see in Africa.”
This article has been updated with comments from study author Eran Bendavid.