Here we go again. The bad old days of United States foreign assistance are coming back, now that President Donald Trump signed an executive order reinstating the global gag rule on overseas discussion of abortion by individuals and organizations receiving federal funding. We have been here twice before -- under Presidents Ronald Reagan and George W. Bush -- and we know that this order often backfires, leading to increased abortion rates.
Since 1973, under the Helms Amendment, it has been illegal to use US government money to directly fund abortions overseas. The global gag rule, introduced by President Ronald Reagan in 1984 as part of his Mexico City Policy, made discussion of abortion by a group receiving federal support for any purpose illegal.
"The United States does not consider abortion an acceptable element of family planning programs and will no longer contribute to those of which it is a part," read the rule. "The United States will no longer contribute to separate nongovernmental organizations which perform or actively promote abortion as a method of family planning in other nations."
Implementation of the global gag rule went well beyond abortion to effectively limit all discussions of family planning, including condom use to prevent HIV infection and multiyear spacing of pregnancies to avoid maternal deaths. Organizations as diverse as the World Health Organization, the United Nations Population Fund and Family Health International lost millions of dollars in support from the US government during the years the gag rule was enforced.
In 1993, President Bill Clinton rescinded the global gag rule. However, in 2001, President George W. Bush not only reinstated it, but appointed Bill Steiger, head of the Office of Global Health Affairs in the Department of Health and Human Services, to act as its enforcer. Even as the historic President's Emergency Program for AIDS Relief, or PEPFAR, unfolded, Steiger's team made sure AIDS groups promoting condom and birth control strategies lost government funding. In the original 2003 language of PEPFAR, the Bush administration added still more teeth to the global gag rule, prohibiting funding of any group that "promotes or advocates" legalization and practice of prostitution and sex trafficking.
Women's health and HIV/AIDS organizations felt, justifiably, that the global gag rule made it impossible to engage in family planning and HIV prevention efforts, and many American groups that accepted US government funds after acceding to the rules were denied access to international meetings, shunned by counterpart non-American groups.
In 2006, the Congressional General Accountability Office concluded that the global gag rule, coupled with abstinence promotion, was impeding the global fight against HIV. A series of legal challenges arguing the rule violated the First Amendment right to free speech made their way through federal courts.
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Three days after his inauguration in 2009, President Barack Obama rescinded the global gag rule. And in 2011, researchers from Stanford University published striking evidence that the global gag rule had, perversely, increased abortion rates. In a survey of 20 poor countries receiving foreign assistance from the United States during the 1994 to 2008 time frame, the researchers, "found robust empirical patterns suggesting that the Mexico City Policy is associated with increases in abortion rates in sub-Saharan African countries."
Where the Mexico City Policy was "high exposure" and enforced by US agencies, and adopted by the local government and NGOs, birth control use was low, particularly compared to use rates in countries that hadn't been saturated with anti-abortion, pro-abstinence messaging.
And in those same "high exposure" countries saturated with abstinence messaging, and gagged under the Mexico City Policy, abortion rates soared. Now President Trump wants to turn back the clock to the 1980s, when televangelist Billy Graham declared, "AIDS is a judgment of God."
White House press secretary Sean Spicer told reporters in a press conference on Monday that, "It's no secret," that Trump "is a pro-life president." Trump "wants to stand up for all Americans, including the unborn," Spicer continued.
But this isn't 1984, and Donald Trump is no Ronald Reagan. In the United States, abortion rates last year were the lowest seen since the CDC started tracking the numbers. The procedure is less frequently used today because women and teenagers have access to birth control, sex education and the right to make choices about reproduction. Contraceptive technology has improved since the 1980s, more women are in the labor force trying to balance work and family care duties and the global health community has become accustomed to incorporating family planning into general health and medical programs.
The world begrudgingly worked around the gag rule in the 1980s, fought it and the abstinence prevention strategy during the George W. Bush years and will likely do battle with reinstated gags in 2017. Limiting family sizes to slow population expansion and prevent maternal mortality is a matter of policy throughout the United Nations and most of the 194 nations today. All the failures, bureaucratic nightmares and -- yes -- increases in abortion rates will now follow the gag rule reinstatement. It is an irrational 2017 policy that will produce a backlash. I cannot imagine what effect Trump imagines, but reinstating the gag rule in 2017 will certainly fail to have the effect Reagan envisioned.