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Déjà Rule: The Health Damaging Consequences of Reinstating the Global Gag Rule in 2015

We all care about women's lives, and PEPFAR under President Bush and President Obama has vastly improved the health of women and their families, while building vital healthcare system infrastructure. Let's continue the success, without being undermined by the Global Gag Rule.
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This year, the Foreign Operations Bill proposed by the House of Representatives includes the restoration of $300 million in funding for the successful President's Emergency Plan for AIDS Relief (PEPFAR), which has been chronically underfunded in recent years. The restored funding would prevent an estimated 62,000 AIDS related deaths, place over 54,000 HIV positive pregnant women on antiretroviral treatment in low-income countries, and prevent as many as 16,800 infant HIV infections. Unfortunately, the proposed legislation also contains a discredited policy that could undercut the health impact of these additional funds.

The Global Gag Rule, also known as the Mexico City Policy, was repealed by President Obama during his first week in office, but has since been written back into the proposed House bill for fiscal year 2015. While the use of U.S. funds for abortion services is already prohibited by the Helms amendment (1973), this policy would ban any organization providing abortions, counseling or referrals for abortions, or advocating for abortion access in its own country from receiving U.S. aid. This restriction on speech applies even if the organization is using its own funds for these activities. The result is that foreign organizations must choose between providing comprehensive women's health services or losing U.S. funding, which could lead to their closure.

The irony of the Global Gag Rule's resurgence is that the last time it was in place it not only failed to reduce abortions, but in fact led to more unwanted pregnancies and HIV infections due to inadequate service delivery in affected areas including; Nepal, Zambia and Kenya. In the fight against HIV, preventing unintended pregnancies is a critical component of reducing mother-to-child transmission. Women and families need comprehensive information on family planning services, including access to contraceptives, as part of HIV prevention and care.

At a time when all evidence-based practices call for greater integration of sexual and reproductive health services with HIV care, the Global Gag Rule runs contrary to scientific evidence and harms women's health. Each time the policy is in place, it moves well beyond restricting access to abortion, affecting delivery of services including family planning, contraceptives and HIV care. The effects of the policy have been shown to be far reaching, contributing to clinic closures and staff layoffs, which weaken the wider health care system and jeopardize women's health. We are once again at a critical political crossroads with the Global Gag Rule, which, if passed, will have immense negative consequences for women's health, HIV transmission, and broader community health.

We Have a Choice:
The following scenarios are based on true events, including the closure of the Mathare Valley clinic in Nairobi, Kenya, following loss of funding after the Global Gag Rule was reinstated in 2001. Asha's story illustrates some of the common effects of the Global Gag Rule on the lives of women.

Asha's story under the Global Gag Rule:
Asha, a mother of three living in one of the poorest communities in Nairobi, Kenya, was one of 300,000 people whose only access to health care was from a clinic in Mathare Valley. After the Global Gag Rule was reinstated, this facility, which refused to stop providing women with comprehensive family planning counseling, lost U.S. funding and was forced to close, leaving Asha and thousands of others without access to proper health care. This clinic not only provided HIV services and contraceptives, but also malaria screenings and childhood immunizations. After the clinic was closed, the community suffered a sharp rise in unwanted pregnancies, HIV infections and preventable childhood illnesses. A year later, Asha contracted HIV, but was unaware of her status. Despite wanting to prevent a fourth pregnancy, Asha did not have access to modern contraceptives and became pregnant again. Her fourth child was born HIV positive and Asha, unable to access lifesaving treatment in time, died from AIDS soon after the birth of her infant.

Asha's life free from the Global Gag Rule:
Asha, a mother of three, lives near the Mathare Valley health clinic in Nairobi, Kenya. Although the clinic is often crowded, serving 300,000 people in the community, Asha has been able to access comprehensive maternal and child health services for herself and her family. After her third child, Asha began using a hormonal contraceptive to avoid an unwanted pregnancy. Her ability to space her children allowed her to begin working part time with her cousin's tailoring business making custom clothing. The money that she earned helped fund her children's education. A year later, Asha contracted HIV; however, she was diagnosed at the Mathare Valley health clinic soon after acquiring the virus and began antiretroviral medications. Through consistent adherence to this therapy, Asha now maintains an undetectable viral load and lives a healthy and productive life. She later chose to have a fourth child, who was born HIV negative due to the medications she was taking to prevent mother to child transmission of the virus.

The fight against HIV will not be won if women like Asha are denied access to comprehensive health services and if clinics such as the Mathare Valley health facility are unable to stay open under the restrictions of the Global Gag Rule. The additional funding for HIV services proposed under the U.S. House of Representative's Foreign Operations bill has the potential to save thousands of lives. However, reinstating the Global Gag Rule with next year's Foreign Operations bill would be a failure for public health, creating significant barriers to the prevention and treatment of HIV, to achieving women's health equity, and social justice. Instead, lifesaving progress to advance women's health should be supported, including passage of the Global Democracy Promotion Act, which would permanently repeal the Global Gag Rule, sending the message worldwide that the United States prioritizes women's access to comprehensive medical care.

We all care about women's lives, and PEPFAR under President Bush and President Obama has vastly improved the health of women and their families, while building vital healthcare system infrastructure. Let's continue the success of PEPFAR, without being undermined by the Global Gag Rule. Let's have science and compassion dictate policy rather than ideology. All women lose otherwise.

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