That giant sucking sound you hear is hundreds of millions of dollars rushing out of clinics and health services around the world.
The loss of $600 million in family planning and reproductive rights grants as a result of the Trump administration’s reimposition of the Mexico City policy is just the beginning. The so-called “gag rule,” which bars U.S. funding from health organizations that even mention abortion, could also affect as much as $9.5 billion for broader health initiatives backed by any US government agency.
The decision by the Trump White House to restore the Mexico City policy was no surprise to many global family planning and health organizations. Every time the US presidency changes parties, the rule is either lifted or reinstated.
The surprise this time was new language in the memorandum, that has implications well beyond the approximately $600 million in family planning and reproductive rights grants from the US State Department and Agency for International Development.
The Kaiser Family Foundation foundation notes that the memo states that the policy will apply to all U.S. global health assistance to the extent allowable by law, not only family planning assistance. That includes the Department of State’s AIDS funding, the Centers for Disease Control and the National Institute of Health and even the Department of Defense. It’s still unclear if the expanded policy applies to all of those funding streams, Kaiser said.
The Netherlands has pledged to raise international funding to make up at least some of the shortfall.
Any cutback in reproductive health funding will have broader repercussions, because women’s health clinics provide a range of services. Marie Stopes International, one of the leading reproductive health ogranizations worldwide, said that the shortfall in its 2017 budget would directly impact the health services it provides to 1.5 million women worldwide.
“We estimate that without alternative funding, the loss of our services during Trump’s first term, between 2017 and 2020, could result in: 6.5 million unintended pregnancies, 2.2 million abortions, 2.1 million unsafe abortions and 21,700 maternal deaths,” the statement said.
The gag rule doesn’t just affect the women who would otherwise turn to these providers for care — it affects their entire communities. That’s because there is no separating family planning from broader health services. In far flung places where basic medical care is hard to reach, health facilities don’t have dedicated family planning staff, they just have staff — and often not enough. When global health resources are stretched that thin, many people who do reach doctors and nurses get their vaccines, diagnostics, medications, and their healthcare advice — including family planning — from the same source.
- In advanced economies like the US and Europe, there is one doctor for every 357 people. In sub-Saharan Africa, there is one doctor for every 5,000 people. In Asia, it’s one for every 1,667.
- For nurses and midwives, wealthy countries have one for every 135 people, but in Africa and Asia, it’s one for every 1,250 and 1,111 respectively.
- One hospital bed in the US and Europe serves 238 people; in Africa and Asia, one bed serves 1,667 people.
- The World Bank estimates that at least 400 million people worldwide have no access to healthcare at all.
“The administrative and bureaucratic burden [of separating reproductive health out of those operations] is staggering,” Suzanne Ehlers, the President and CEO of PAI, told Vox. “[Organizations] stand to lose massive funding from the US government” if they don’t commit to barring counseling on or the provision of abortion services, she notes. “If they do choose to sign, their whole patient load will be impacted.”
This is not hypothetical. The last time the Mexico City policy was reinstated, under President George W. Bush, reproductive health provider PAI and its partners released a series of reports documenting the impacts of the gag rule in several countries. In Kenya, which already has strict laws around the provision of abortion, two leading family health organizations — Marie Stopes and the Family Planning Association of Kenya — closed eight of their clinics between 2002 and 2005 due to loss of US government funding. Collectively they served 9,000 people.
“These clinics provided critical services to poor and underserved populations in urban, peri-urban and rural areas; those services included: family planning (including the provision of emergency contraception), voluntary counseling and testing (VCT) for HIV/AIDS, management of sexually transmitted infections, pharmaceutical services, laboratory services, post-abortion care, maternal and child health services, Pap smear tests, minor surgery, and well–baby services,” the report said. “In most cases, those shuttered clinics were the only source of health care for local communities.”
