Women’s health advocates across Asia have said Donald Trump’s decision to reinstate and beef up the “global gag rule” will result in hundreds of thousands of unwanted pregnancies and imperil programmes aimed at improving sanitation, treating Aids and protecting LGBT activists.
Health providers and advocacy groups in Delhi, Phnom Penh, Jakarta and beyond have been holding emergency meetings since Tuesday’s announcement that US aid funding was now contingent on organisations abandoning their abortion advocacy work, services or information.
The gag rule applies even if the abortion assistance is funded from other sources.
The impact of the decision would be felt more widely than when the Bush administration reinstated the rule, said the campaigners, because the executive order signed by Trump applies to all global health funding, not just money earmarked for reproductive health.
As well as abortion assistance, “programmes that address HIV and Aids, maternal and child health, cervical cancer screening [and] gender-based violence” would now be affected, said Kalpana Apte, the secretary general of the Family Planning Association of India.
The US invests roughly $20m (£159m) each year in Indian health programmes in areas that include family planning, yet also target tuberculosis, and improved nutrition and sanitation. Funding for all of these is now subject to the gag.
“We stand to face significant reduction in our core grants [and] expect that in times to come, we may have to close our outreach services, satellite centres and reduce the staff strength,” Apte said. “It will hit the programme very hard.”
One south Asia-based advocacy group said the decision would bar it from accessing the US state department emergency funding it used last April to evacuate LGBTQ activists from Bangladesh, after the founder of the country’s only LGBT magazine was murdered.
“In the short term, we would not have that resource available,” said an officer from the NGO, who asked that their name, and that of the organisation, be withheld, after they were threatened by an al-Qaida affiliate over the work.
Because homosexuality is illegal in India, health groups in the country have become increasingly reliant on US funding, often discreetly delivered, for programmes aimed at promoting LGBT rights and safety.
Rupsa Mallik, a director at the feminist human rights organisation Crea, said these groups would now have to make “a tough call” on whether to continue such work, if it meant also dropping any abortion services they provided.
At the same time, she said, the wide-reaching implications of the gag rule meant that it restricted rights that already exist in India, including having an abortion in the first 20 weeks of pregnancy (pdf).
“It’s an infringement of our constitutional guarantees that a foreign funder can say, with your own money, despite your constitutional guarantees, you can’t do this work,” Mallik said.
In south-east Asia, organisations dependent on USAid funding – like Marie Stopes International – provide much-needed sexual health information, condoms, birth control and abortions in countries where sex and contraception can be taboo subjects.
“Currently, USAid funding accounts for around 17% of our [total] donor income, which we use to expand access to contraception across Africa and Asia,” said Will Harris, a spokesman for Marie Stopes International.
“Without alternative funding, we estimate the [global gag rule] will deprive around 1.5 million women a year of the ability to choose whether and when to have children. That’s through our programmes alone. Not only will this be devastating for women individually, defunding family planning will also hamper wider development efforts.”
In Cambodia, USAid funding accounts for nearly half (45%) of all Marie Stopes’ services, said Harris. President Trump’s reinstated ruling is likely to result in nearly 12,000 unintended pregnancies, 6,600 abortions and an additional 5,100 unsafe abortions.
In Myanmar, where only one in three women currently has access to contraception, the global gag rule is likely to result in 22,300 unintended pregnancies, close to 13,000 abortions, an additional 8,000 unsafe abortions, and 17 maternal deaths, said Harris.
But Nepal would be the worst hit, according to the group’s estimates, with 136,800 unintended pregnancies in the next three years, more than 41,000 unsafe abortions and 133 maternal deaths.
Payal Shah, senior adviser for Asia at the Center for Reproductive Rights, an American non-profit organisation, said the cost of the “harmful policy” would be borne by some of the world’s poorest and most vulnerable women.
“For a country like India, where an estimated 3m unsafe abortions occur, and which receives millions in US foreign assistance, this policy will lead to more suffering for women and their families,” she said.
