Billions of dollars in US aid to groups combating diseases worldwide could be at risk from Donald’s Trump’s “unprecedented and far-reaching” reversal of abortion-related policy, campaigners warned on Tuesday.
Trump signed an executive order on Monday reinstating the “global gag rule”, which bans funding for groups that offer abortions or abortion advocacy, even if they use their own funds to do so.
Campaigners fear the move could affect a wide range of groups providing lifesaving treatment, such as those working to combat HIV and Zika, as well as those helping prevent child and maternal deaths and unwanted pregnancies worldwide.
The policy has been repealed and reinstated several times in the past, but women’s reproductive rights groups said Trump had signed the “most extreme” and sweeping order of its kind.
The policy has been expanded to affect “all global health assistance furnished by all departments or agencies”, according to a White House statement published on Monday.
The US is the most generous bilateral donor to reproductive rights causes worldwide – with current funding at $575m. What is still unclear is to what extent the gag rule will affect the US’s wider global health funding, which the reproductive rights campaigners PAI estimate to be more than $9bn.
Groups are still unpicking what funding “global health assistance” refers to. For example, humanitarian assistance may be exempt because it is funded in a different way.
Suzanne Ehlers, president and CEO of PAI, described the expanded version of the law as “irrational and backward”.
“Our preliminary analysis,” Ehlers said, “based on the presidential memorandum yesterday, is that [the global gag rule] is not only more severe and sweeping, but it’s more expansive than that introduced by previous presidents.
“Family planning assistance funding by USAid is a budget of around $610m. But if our reading of this memorandum is accurate, it will cover all global health assistance. That is in the ball park of $9.4bn.”
The global gag rule, also called the Mexico City policy, denies foreign organisations US family planning funding if they provide abortion information, referrals or services, or if they engage in any abortion rights advocacy with their own funds.
Projects on the ground are faced with a stark choice – to refuse US funding or to take the funding and end abortion advice. First introduced by the Reagan administration, the measure was repealed by Bill Clinton, reinstated by George W Bush and repealed again by Barack Obama.
But Monday’s White House memorandum suggests the rule will apply not just to family planning funding but to “all global health assistance”.
Ehlers said: “We are talking about work on HIV, tuberculosis, malaria, public and child health.
“So let’s say I’m a US organisation involved in global health assistance in Malawi worth $1m. I’m working with 12 or 15 different NGO partners in a malaria programme. All of those partners have to sign a Mexico City policy to say they are not doing anything at all with any of their own private funds to do with abortion.
“What business is it of the US government to determine what groups across the world, working in what might very well be legal in their own countries, do with their own money?
“This is not a pro-life policy,” said Ehlers. “There is already no US-taxpayer assistance going to pay for abortion. This is a policy denying women life-saving services. It will cut off funding for groups providing HIV testing kits to teenagers, it will cut malaria programmes. We are imperilling and endangering global health programmes.”
A spokeswoman for Planned Parenthood said: “This is the most extreme executive order that we have ever seen, in the global health space, under any Republican administration.
“It will not just affect family planning services, but organisations that are working to combat Zika, to combat HIV and Aids. We at Planned Parenthood are very concerned and astonished, coming after a weekend when hundreds of thousands of Americans took to the streets in a historic show of strength, that this administration would target the world’s most vulnerable women in this way.”
Caroline Crosbie, acting CEO of Pathfinder, a health programme which works globally, said the policy “risks the lives of millions of people around the world”.
“This vastly expanded gag rule jeopardises millions of lives, and will only serve to undercut decades of American global health leadership.
“While we examine what the precise negative effects the expanded policy will have on our partners in the countries where we work, we do know that it will do more than silence organisations from talking about abortion – it will mean these organisations will not be able to provide HIV prevention, care and treatment services, integrated maternal health care and contraceptive services or counselling on the potential risks of Zika infection, among others, if they intend to receive US government funds.”
Amanda Klasing, a senior researcher in women’s rights at Human Rights Watch, said the expanded rule introduced by the Trump administration would have a chilling impact on freedom of speech and would “dramatically increase” the number of groups affected.
“One of our concerns is that it is a dramatic expansion of the US trying to govern free speech abroad,” said Klasing. “What they are trying to do is hold funding captive.”
Klasing said the effect of the rule would be that organisations that operate in countries that restrict women’s rights and women’s access to services, if in receipt of US funding, would no longer be able to speak out.
“They can’t advocate around loosening those restrictions if they want to continue to receive US funding. How far does this go? Can the groups participate in harm reduction models?”
Anu Kumar, chief strategist of Ipas, an organisation working to combat deaths from unsafe abortion, said: “We are not entirely certain what pot of money will be affected. But it if is global, then even HIV funding could be jeopardised.
“We already know is the gag rule results in cuts to services and clinics are forced to close. Every day there are 840 women who die from pregnancy-related cases. We know there are 225 million women in developing countries who don’t want to be pregnant.
“The scale of the problem is enormous.”
Analysis by the Guttmacher Institute found that last year’s US aid budget for family planning gave 27 million women and couples access to contraceptives, prevented more than 2m unsafe abortions and 6 million unintended pregnancies, and helped prevent 11,000 maternal deaths worldwide.
