Trump's Expanded Mexico City Policy Could Affect Fight Against Zika, HIV/AIDS

Healthcare professionals were surprised by Trump’s expansion of the rule

Most presidents decide in their first week whether to keep or scrap the so-called Mexico City Policy that bans U.S. aid from going to groups abroad that provide access or information about abortion.

President Donald Trump’s executive action on Jan. 23 to bring back the policy was not itself surprising for a Republican president. But reproductive health advocates are alarmed by the rule's expansion, with some claiming that it goes against American values.

“We’re telling organizations that they can’t use their own money to advocate for supportive and more liberalized policies,” said Jonathan Rucks, director of advocacy at reproductive health champion PAI. “This is an incredible overreach on the part of the U.S. government.” 

The Mexico City Policy originated with Ronald Reagan in 1984 and has been called a political football. Whether it is enforced depends on the party controlling the White House. It was last applied under George W. Bush, before Barack Obama rescinded it in 2009. Dubbed the “global gag rule” by critics, the policy not only restricts foreign U.S. aid recipients from providing abortions, but also prohibits their staff from educating clients about abortion as a reproductive health option or publicly advocating for or against the medical operation.

Under past administrations, the policy has only impacted U.S. family planning funds abroad, which totals about $575 million, according to PAI. But under Trump’s version of the rule the revision extends the gag rule to also affect NGOs that primarily combat HIV/AIDS, malaria, Zika, cancer, tuberculosis, and other dangerous or life-threatening diseases that attack both genders and all ages.

It could influence the distribution of up to $9.5 billion if groups don't agree to change their abortion stance in return for U.S. aid, experts say. 

Françoise Girard, president of the International Women’s Health Coalition, thinks even the earlier rule was a violation of American values.

“We’re exporting our abortion madness to these countries with the intent of stifling democratic speech,” she said.

In a recent Marist poll, 83 percent of those surveyed opposed subsidizing abortions in other countries, which the U.S. has not done for decades. Previous regulations from the 1970s and '80s already forbid the allocation of foreign aid to abortion services, and the reason for the executive action is not to ban American-funded abortions abroad, but to impede discussion about the practice.  

For anti-abortion organizations, Trump’s move came as welcome news. “We’re very happy with it,” said Stephen Phelan, director of missions communications at Human Life International. “By reinstating the Mexico City Policy, a lot of lives will be saved.” 

Vice President Mike Pence addressed a crowd of tens of thousands of abortion opponents Friday at the annual March for Life in Washington, reassuring them "life is winning" because of Trump's election.

But the practical results of the rule may actually lead to more abortions. In a bulletin published by the World Health Organization in 2011, researchers at Stanford University concluded that under the Bush administration, abortion increased in sub-Saharan African regions that were affected by the Mexico City Policy. Because some international organizations refused to comply, they lost funding that had gone toward condoms and other methods of contraception. When locals could no longer prevent pregnancy, they aborted unwanted fetuses.

Sub-Saharan Africa is a big place, said Grant Miller, co-author of the bulletin. From 30 surveys in 20 countries, Miller and his team deduced that abortion rates rose from 10.4 induced abortions per 10,000 women between 1994 and 2001 to 14.5 between 2001 and 2008, when Bush instituted the Mexico City Policy. The rate in regions that were comparatively unexposed to the rule stayed stable between 1994-2008, while locations that were heavily impacted saw a significant increase in abortions.

The study may point to larger trends. In 2016, Miller collaborated on another project that studied abortion legalization in Nepal, where he found that modern contraception and abortion were used interchangeably. By giving women access to preventative forms of birth control, like those provided by most NGOs that face ramifications from the Mexico City Policy, abortion rates decrease.

Regardless of political affiliation, few Americans want there to be more abortions, said Miller. “This really shouldn’t be a partisan debate. It’s about a policy that has perverse, unintended consequences,” he added. “A policy that is having exactly the unintended effect... just seems like an unambiguously bad thing." 

Esther Vicente, president of International Planned Parenthood Federation’s western hemisphere region, started volunteering at IPPF in 2003. Unlike Trump, Bush modified his version of the Mexico City Policy to protect AIDS relief funds, but it still wreaked havoc on family planning groups like IPPF and its member organizations that relied on American grants. Because of financial strains, clinics closed on a national level.

“Though we did receive additional funding from other sources at that time, it was not enough to substitute the amount that we lost,” Vicente said. “It takes time for the other governments to commit to provide more funding.”

Now, when foreign aid is overstretched by the refugee crisis in Europe, it will be especially challenging for global health programs to survive financially. The Netherlands has announced an international safe abortion fund to counter the effects of Trump’s executive action, but their assistance may not be able to refill the void left by the United States.

When Bush was in office, Marie Stopes International ran a much smaller operation. During the Obama presidency, it has expanded to in-need areas like West Africa. MSI now receives 17 percent of its aid from the U.S. Agency for International Development, about $30 million annually.

“It’s going to be very tough to find that level of replacement,” said Maaike van Min, MSI director of strategy & development. “We’re talking to a lot of existing and new partners to see if we can manage to fill the gap.” 

“It’s probably not going to be easy to raise amounts of money that would even come close to what organization are going to lose,” echoed Girard.

Through its impact calculator, MSI has estimated that because of Trump's memorandum, there will be 6.5 million more unintentional pregnancies, 2.2 million more abortions, and 21,700 more deaths of women who would have been protected by MSI's services. 

Charles Kenny, a senior fellow at the Center for Global Development, noted that with the Mexico City Policy in place, foreign NGOs are forced to choose between private and European donors, who require full access to reproductive care that includes abortion, and American aid. This cuts the overall resources at their disposal.

“You are asking them to make a choice about, ‘Are we going to let some of our clients die?’” he said. “It’s a moral conundrum that I think is horrible.”

Kenny also recognized that restricting abortions usually doesn’t stem demand. Young women without legal options tend to seek illegal, unsafe, or traditional alternatives that often lead to health complications, he said. 

“It seems a policy without any kind of empirical justification and with all sorts of terrible effects,” Kenny said. “Just google stick abortions. It’s not pleasant.”

A spokesperson for the World Health Organization told NBC the group was concerned about the policy's "potential impact on the ability of NGOs to support family planning needs globally.” When women can't access safe abortion providers, that "can lead to disability and death.”

In the past, the Mexico City Policy has made exceptions for victims of rape or incest. It's unclear whether that's still the case. 

“I do not see any mention of this provision remaining in, so those are always concerns,” said Wendy Grube, interim director of the Center for Global Women’s Health at the University of Pennsylvania.

Phelan, with Human Life International, said he hoped those provisions were no longer included. “How that person came into existence doesn’t in our case allow that person to be killed,” he explained, referring to a rape victim’s fetus.

For most NGOs influenced by the policy, abortion is not their main priority. In Vicente’s IPPF region, only one percent of non-U.S. funding went toward abortions in Latin America and the Caribbean. But after the election in November, the IPPF governing council came together and decided that it would not adhere to the Mexico City Policy because it goes against IPPF’s core values to provide women with all the healthcare they need.

“I think the United States is a democratic country,” Vicente said. “It’s a country that advocates for human rights globally. And I hope the people in power in the United States will review these policies, and take into consideration the effects that they’re having globally, and change. I hope they will change their position.”

Legislative efforts in Congress to get rid of the Mexico City Policy have failed. 

The White House has not responded to a request for comment on why Trump decided to expand it.

When asked whether it would follow the rule, a USAID spokesperson told NBC that the agency is “currently reviewing the presidential memorandum, and we are consulting with the Departments of State and other agencies regarding its implementation.”

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