Bound and Gagged

Just two days after millions of people around the world marched to demand respect for women’s health, dignity and rights, President Donald Trump imposed a radically expanded “global gag rule.”

You could dismiss the expansion as the spiteful act of a small man, and if it were only about Mr. Trump, you might be right. It’s not so easy, however, to dismiss the support of nearly every antiabortion elected official and almost the entire antiabortion movement across the United States. For many religious conservatives, this is bigger than spite. And even less admirable.

What their support of this policy makes clear—if it wasn’t already—is a complete lack of interest in taking steps that actually reduce the need for abortion. Because the evidence speaks for itself: By extending the ban on family planning to all global health organizations, Mr. Trump’s version of the global gag rule will make unwanted pregnancy more widespread and threaten more women’s lives.

If Republicans in Congress and antiabortion activists were truly interested in reducing the need for abortion, they would cheer the fact that the Affordable Care Act has helped bring abortion in the United States to its lowest level in decades. Instead, they are committed to its repeal.

If participants at the so-called March for Life really cared about life, they would oppose the global gag rule and demand real investment in reproductive healthcare and family planning and access to birth control for women around the world. Instead they cheer its reimposition by Mr. Trump and demand elimination of the programs that work that prevent unintended pregnancies.

If conservatives were really interested in the effective use of taxpayer dollars, they would demand that Mr. Trump lift this appalling policy. Instead they’re pushing to write it into permanent law.

Few global investments bring as high a return as those made to reproductive health. And there are few policies as destructive and cruel as the global gag rule. Mr. Trump’s version of the policy will withhold any US global health aid unless providers pledge to refuse access to safe, legal abortion—either directly or through counseling or referral. As the United States is one of the largest funders of healthcare in the world, this ban will immediately disqualify the most effective, experienced and respected reproductive healthcare providers around the world from much-needed financing.

Consequently, Mr. Trump is forcing healthcare providers to make a devastating choice: either deny information about and access to the full range of reproductive health options that their patients deserve and need, or lose desperately needed support to provide a wide range of healthcare services—from contraceptives to HIV prevention and treatment to malaria care. Either choice hurts the people, especially vulnerable girls and women, who rely on these providers for healthcare.

The evidence speaks for itself: By extending the ban on family planning to all global health organizations, Mr. Trump’s version of the global gag rule will make unwanted pregnancy more widespread and threaten more women’s lives.

And make no mistake: the impact will be widespread. When a similar policy was in effect during the term of George W. Bush, it caused abortion rates in several African countries to double.

Yet the leaders of the antiabortion movement cheer its existence.

Today, about 47,000 women die from unsafe abortions every year. It is impossible to have a serious effort to reduce maternal mortality and improve women’s health without addressing the impact of unsafe abortion. Mr. Trump’s reinstatement and expansion of the global gag rule does nothing to help and much to hurt that effort.

It seems that there are two likely objectives of Trump’s policy imposition. First, to stifle any efforts to address the crisis of unsafe abortion in the developing world. And second, to turn the entire US global health budget into a slush fund for ideologically conservative religious agencies.

Let’s look at South Africa as an example. The right to abortion is explicitly guaranteed in the South African Constitution, and the country continues to face a significant HIV problem. Reproductive health providers are on the front line of the fight against HIV, but are also likely to discuss abortion as an option with women facing unintended pregnancy. That will cost them US support for their HIV programming. Who will take US funding in South Africa when they have to pledge to avoid any discussion of safe abortion options? It will be organizations that are not only antiabortion, but also likely to refuse to provide access to condoms and other contraceptives and promote abstinence as the only effective means to avoid infection.

The consequences of such an approach are already known. When Mike Pence was governor of Indiana, he eliminated critical funding for healthcare clinics that provide abortion care, causing a Planned Parenthood clinic in Scott County to close. But this was also the only clinic that provided HIV testing and prevention services in the county. Within a short time, Scott County saw a brand-new outbreak of HIV. So, in addition to the evidence of direct harm in the developing world, we know—and the Vice President knows—that putting ideology over evidence is a healthcare and humanitarian disaster waiting to happen.

It’s time for Republicans in Congress and their allies in the antiabortion movement to ’fess up. They aren’t interested in effective use of tax dollars. They aren’t interested in ethical aid policies. And they aren’t interested in protecting life.

They are interested in punishing and shaming women who face the outcomes of a lack of access to reproductive healthcare, from unintended pregnancy to STIs. The increase in unsafe abortion and the threat to women’s health and lives is a feature, not a bug, of this policy. And they are interested in using taxpayer dollars to prop up their ideological fellow travelers.

So the next time you hear Mike Pence or the US Conference of Catholic Bishops pontificate about a culture of life, remember this: They are knowingly promoting policies that kill women, increase the need for abortion and destroy families.

Make them answer for it.