Trump’s global gag rule silences doctors and midwives and harms their patients

By Catharine Taylor

Catharine Taylor is Vice President for health programs at Management Sciences for Health. This post originally appeared on STAT News

Midwifery students in Sierra Leone, which has one of the highest maternal mortality rates in the world. Funding for safe pregnancy and delivery worldwide is threatened by President Trump’s reinstatement of the global gag rule. (Photo by MARCO LONGARI/AFP/Getty Images)

President Trump’s reinstatement of the Mexico City Policy, better known as the global gag rule, came as no surprise to anyone working in the field of global health. We have been through this before — in 1984, when the policy was first put into effect by President Reagan, and then in 1993, 2001, and 2009, when it was repealed, reinstated, and repealed again.

The Mexico City Policy is called a gag rule because it limits not just what organizations and health providers do but what they are permitted to say. It prevents foreign organizations that receive US government funding from performing abortions — even if they are using funds from non-US government sources and even if abortion is completely legal in their countries.

The global gag rule also steps right between a woman and her doctor, nurse, or midwife, preventing these frontline health providers from telling their patients about the full, legal range of health options available to them. It forbids trusted advisers from giving honest, comprehensive health advice and information. I started my career as a nurse-midwife, and then worked in maternal and newborn health programs in Africa and Asia, so I know what this will mean for the lives and health of women and their families.

For more than half a century, the US has invested, with great success, in programs to increase access to family planning and improve maternal, newborn, and child health, as well as prevent malaria, tuberculosis, HIV/AIDS, and other infectious diseases. The evidence couldn’t be clearer: America’s commitment has prevented millions of unintended pregnancies and saved millions of lives. It has reaped substantial savings in health care costs from each dollar invested in building strong, sustainable health systems. US-funded programs have strengthened families and communities, increased stability and prosperity, and contributed to improved health security for the entire world, and for our country as well.

My organization, Management Sciences for Health, works in partnership with countries around the world on behalf of the American people to efficiently and effectively invest US funding in projects and programs that work to save lives, increase well-being, and build more stable and secure societies.

While my organization will continue to comply with US-government policy, we are deeply concerned about the impact of the reinstatement and expansion of the global gag rule. It will force foreign organizations — many of them our project partners — to make a terrible choice: accept US funds but withhold full, accurate health information from their patients, or reject US funds and thus provide care to far fewer women.

When the global gag rule was previously in force, it applied only to foreign organizations that received funds from the US budget for family planning assistance. That meant the effects were mostly limited to organizations focused on contraceptive services.

But President Trump’s expanded policy will apply to any foreign organization that receives any US global health funding. That could mean endangering maternal and child health programs, efforts to fight the Zika virus, and the expansive PEPFAR program to stop HIV/AIDS, perhaps the most successful health aid program in US history.

Here’s what happened when the narrower policy was in place before: Clinics were closed, services were reduced, and there were more unintended pregnancies and unsafe abortions.

Under the Trump version of the global gag rule, millions of women in some of the poorest places in the world will lose access to affordable, high-quality, comprehensive reproductive health care, and will be less able to make informed health choices. Health systems in countries that are now showing real, sustainable progress in improving population health will be weakened. Good organizations that do effective, lifesaving work will have to cut back their activities or go out of business. The US investment in global health will be much less effective.

Global health experts know that access to family planning and accurate, comprehensive health information saves lives. By restricting that access, the global gag rule does the opposite, harming the well-being and resiliency of families, communities, nations, and economies.

Organizations should not be disqualified from participating in US-funded health projects because they use their own funds to provide the accurate, comprehensive health information that their patients need, and services that are legal in their own countries. If they are, it is women who will pay the price.


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