The Consequences of US Elections for Women’s Health Globally.
The Consequences of US Elections for Women’s Health Globally
A new viewpoint by BUSPH and Stanford University researchers highlights the profound consequences of US policy decisions on abortion for women in countries reliant on American global health aid.
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By Nina Brooks, Eran Bendavid, and Grant Miller
Abortion is on the ballot in the 2024 US presidential election. After the Dobbs decision overturned Roe v. Wade, numerous states have voted on ballot initiatives to expand or restrict access to abortion—with seven states voting on such measures in November. But hundreds of millions of women who live in countries that receive global health aid from the United States will also be affected by the November election—despite having no say in choosing the next president.
The Mexico City Policy, so called because it was announced at the United Nations International Conference on Population and Development held in Mexico City, was introduced by the Reagan Administration in 1984. When in effect, the policy restricts international non-governmental organizations (NGOs) from discussing, promoting, or advocating abortion to receive US funding (relatedly, the Helms Amendment prohibits US funds from use to perform abortions).
Since 1984, every newly elected president from the opposing party reversed the previous administration’s position on the policy by executive order within the first few days in office.
In 2017, the incoming Trump administration went beyond simply reinstating the policy. Between 2017-2021, the policy placed not only family planning funding at risk, but also other forms of US global health aid (under its new name “Protecting Life in Global Health Assistance”), including funding for HIV/AIDS, maternal and child health, malaria, and pandemic preparedness. And, in March 2019, this restriction was further expanded to prohibit NGOs from providing funds from any source (including non-US sources) to partners, unless those partners also complied with the policy.
When the policy is in effect, NGOs face a choice: comply with the policy, stop abortion-related activities, and continue to receive US aid, or refuse to comply, continue mission-critical programs, and lose access to millions of dollars in aid. Typically, some of the biggest players in global women’s health—for example, International Planned Parenthood Federation and Marie Stopes International—refuse to comply because the policy is at odds with their mission.
Refusing to comply with the policy has important—and underappreciated—implications for NGOs’ abilities to provide health services. An NGO that operated in 50 percent of Ugandan refugee camps had to cut back its reproductive health programs in humanitarian settings after losing US funding for refusal to comply with the policy, despite the fact that humanitarian assistance is exempt from these funding restrictions.
We and others have studied this policy’s implications for women’s health, and existing evidence shows that when the policy is in effect, abortion rises.
While it may be surprising that a policy which intends to restrict abortion-related activities increases abortions, these findings are actually logical.
Many organizations losing US funding under the policy are important providers of contraceptives and family planning. So when the policy is active and US funding is forgone, the supply of these services falls. Our recent research shows how health facilities in sub-Saharan Africa were less likely to provide all methods of family planning under the policy, and in parallel, women were less likely to use family planning, leading to less contraceptive use, more pregnancies, including unwanted pregnancies, and more abortion. Regardless of one’s position on abortion, this is an undesirable consequence.
Given that many abortions are performed under unsafe circumstances, and that unsafe abortion is a leading cause of maternal mortality in lower-income countries, it is also unsurprising that recent research finds an increase in maternal mortality associated with the policy.
A hopeful pattern we observe is that these increases in abortion reverse when the policy is revoked. However, the flip-flopping with every change of party in the White House creates turmoil for NGOs working in global health. History suggests that a Democratic administration would likely not reinstate the policy, while a Republican administration would (as the Trump administration did between 2017-2021).
A platform that reinstates MCP/PLGHA funding restrictions must reckon with an important paradox: Preventing US taxpayer funds from supporting organizations that provide abortion-related services comes at the price of increasing abortions. Implicitly, to withdraw US financial support is to enable more abortions. We ask that whichever candidate wins the November election consider new policy options to achieve their goals that promote the health of women and reduce the uncertainty for NGOs in the process.
Dr. Nina Brooks is an assistant professor of global health at Boston University School of Public Health and a core faculty member of the Human Capital Initiative at the Boston University Global Development Policy Center.
Dr. Eran Bendavid is a professor of health policy and medicine at Stanford University School of Medicine.
Dr. Grant Miller is the Henry J. Kaiser, Jr. Professor of Health Policy at Stanford University School of Medicine.
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