The Trump Administration is set on undoing public health progress with policies that restrict sexual and reproductive health and rights in the U.S. and around the world.
I am haunted by the face of an 11-year-old Kenyan girl. Her beautiful, clouded eyes, and her searching, troubled expression. Early in July, I listened as her mother spoke haltingly of the family member who raped her daughter. She shook her head, saying, “I believe God is good. I should forgive him.”
All I could think about was how a pregnancy could have killed the girl and made her yet another maternal mortality statistic. There is a crisis of pregnancy-related maternal mortality in Kenya, and adolescent girls bear the brunt. Thankfully, this girl and her mother were able to get counseling at one of the country’s only gender-based violence centers. Sometime later she was able to end her pregnancy.
“Signed by President Trump in his first week in office, an expanded version of the Global Gag Rule policy threatens women’s health in more than 60 countries...”
Sadly, many other girls in similar situations in Kenya and elsewhere will now be less able to end unwanted pregnancies due to a set of policies that devalue women and their health by restricting their reproductive health and rights.
Signed by President Trump in his first week in office, an expanded version of the Global Gag Rule policy threatens women’s health in more than 60 countries in developing world, affecting $8.8 billion in foreign aid—a massive increase from $600 million when the Gag Rule was implemented during the administration of President George W. Bush. The Trump Administration’s Gag Rule-on-steroids goes so far as to penalize any aid group that refuses to sever all links anywhere in the world to abortion services and counseling—even if they don’t themselves provide family planning services.
In Kenya, I listened to aid workers tell me about how, in recent years, they’ve made significant headway against an epidemic of sexual and physical violence and of unsafe abortion-related mortality. Since adopting a new constitution in 2010, the country has allowed abortion in cases of rape, incest, and life endangerment. Now, under the expanded Gag Rule, funding will be withdrawn for NGOs connected to any kind abortion. Aid workers told me they face a terrible choice: sever all financial ties with family planning providers like Planned Parenthood or lose all U.S. government funding.
The effects of the expanded Gag Rule would be further exacerbated by proposed cuts to US AID and the UN Population Fund, which provides contraceptives. The likely result is thousands more women and girls who will die in childbirth or due to unsafe abortion, and millions of unintended pregnancies. The Kaiser Foundation estimates more than half a billion dollars in aid are at risk in Kenya alone.
“Here at home, Americans too are feeling the negative consequences of the Trump Administration’s anti-woman agenda.”
Here at home, Americans too are feeling the negative consequences of the Trump Administration’s anti-woman agenda.
On July 14, the Center for Investigative Reporting revealed that the Department of Health and Human Services is axing $213 million in teen pregnancy prevention programs and research at more than 80 institutions in the United States, including my own Columbia University Medical Center and Heilbrunn Department of Population and Family Health, part of the Mailman School of Public Health.
Of course, the real victims are the country’s girls. In the U.S, more than a quarter of girls become pregnant by 20, and nearly one-third those who drop out of school cite pregnancy as the reason. While the teen birth rate has declined over the last 20 years—thanks largely to better access to contraception—rates remain high compared with other industrialized nations, particularly for girls of color.
The new HHS cuts will end five-year grants designed to find scientifically valid ways to help teenagers make health decisions that avoid unwanted pregnancies—even if no abortion counseling was provided. All 81 projects that were awarded five-year grants in 2015 have been halted. Researchers now lack the resources to analyze the data they have already collected.
If the Trump Administration wants to stem abortion, the Gag Rule will have the opposite impact. The last time the Gag Rule was in place during the George W. Bush presidency, abortion rates in Sub-Saharan Africa climbed sharply. If they want to end teen pregnancy in the U.S., stopping the research that helps us avoid unwanted pregnancies is not the way to do it. Clearly, these policies have nothing to do with science or sound public health strategies.
In more than 30 years working in the field of human rights and women’s health, I have never seen an Administration so hell-bent on violating the rights of girls and women. They are setting the stage for an epidemic of unwanted pregnancies, even in cases of rape like the one experienced by the 11-year-old Kenyan girl I met.
The Trump Administration seems to think they can do anything they want. I am not so sure. Hold tight as science, human dignity, and resistance prevail.
Terry McGovern, a human rights lawyer, is interim chair and professor of Population and Family Health at Columbia University’s Mailman School of Public Health.