The political discourse surrounding abortion and health care has dominated election cycles and governance in the United States for quite some time, but its impact doesn’t end at the border. In some fragile communities throughout the world, the politicization of access to abortions in the United States could lead them into conflict.
Just three days after his inauguration in 2017, President Trump signed an extremely restrictive anti-choice policy that will likely have wide-reaching negative impacts on global peace and security and US influence abroad.
This policy is actually an updated version of the “Mexico City Policy,” the Reagan-era act that prohibited non-governmental organizations that provide abortion-related services from receiving any US federal funding related to family planning and reproductive health.
The Trump Administration’s version of the Mexico City Policy has gone a step further. It prohibits foreign non-governmental organizations that provide abortion-related services from receiving any form of US global health assistance.
Beyond family planning and reproductive health, US global health assistance also includes funding for organizations doing work related to maternal and child health; nutrition; HIV under the US President’s Emergency Plan for AIDS Relief (PEPFAR); prevention and treatment of malaria, tuberculosis and other diseases; and hygiene programs. Many of the organizations that receive US global health assistance also receive aid from non-US sources, and use those alternative sources of funding to pay for reproductive health programs and abortion-related services. The Trump Administration’s policy would take that option off the table, should an organization want to continue receiving US funds.
Opponents of the policy have dubbed it the “Global Gag Rule,” because of the way it prevents local-level health care providers from not only providing abortions, but also from advocating for the legalization of abortion and educating about abortion as an option. Originally reported by Casey Quackenbush in TIME, some critics say the policy “holds life-saving aid hostage to ideology.”
Throughout the last 33 years, the Mexico City Policy has been a political football between Administrations: repealed by Democrats and dutifully reinstated by Republicans. This process forces a domestically politicized issue onto the international stage and in practice, this policy can actually have dangerous effects on US security.
In communities in which conflict already exists or tensions are high, inadequate access to health care can exacerbate the prevailing issues.
In communities in which conflict already exists or tensions are high, inadequate access to health care can exacerbate the prevailing issues. The reverse is also true. During an outbreak of violence, health issues, such as communicable disease outbreaks and maternal mortality all rise.
According to the World Health Organization, “Investing in health is investing in peace. Health needs and contributes to physical, psychological, social and economic security. Investing in health can reduce the risk of conflict as well as mitigate its impact… Placing social services high on the political agenda helps maintain social stability, and reduce militarization in situations where the risk of violent conflict is high.”
Recent publications by the United States Institute of Peace, the World Health Organization, and the journal on Health Research Policy and Systems, have reported about the positive impact that effective health systems and equitable access to those systems has on reducing drivers of fragility, such as conflict or overall mortality rates. That is why development experts and global advocates for women’s rights believe that the newly expanded Mexico City Policy will affect the world’s most vulnerable individuals in the world’s most fragile communities.
Advocates of this policy contend that the effects of it will only be felt by abortion providers. In reality, it isn’t quite so simple.
In states such as Madagascar, Kenya, and Colombia, those living in rural communities often depend on non-governmental organizations for their healthcare. These services are provided by clinics that provide a multitude of services, including those related to sexual and reproductive health, tuberculosis, HIV/AIDs, and malaria. Because the aid they receive is intermingled, it can be difficult for these organizations to completely change their service model in order to sign and comply with the US Mexico City Policy. When organizations either cannot or choose not to sign on to the policy, clinics end up closing. This severely limits already at-risk individuals from access to even the most basic of health needs.
Ironically, since the Mexico City Policy is cutting off access to family planning services, including contraception, it might actually be increasing demand for abortions. Since its most recent implementation, the Mexico City Policy has already resulted in tens of millions of dollars in funding cuts. At the same time, there has been a 40% increase in abortions in some African countries. Looking ahead, some experts are estimating this policy could lead to 15,000 maternal deaths, 8 million unwanted pregnancies, and up to 26 million fewer women and families with access to contraception and family planning services.
While the Mexico City Policy does not change the total amount of health-related aid appropriated by Congress, the policy considerably weakens the ability that local health providers have to effectively serve their communities. The on-again/off-again nature of the policy causes extreme instability among local healthcare providers, many of which are the sole location for such services in a region. This instability leads to staff layoffs, higher transaction costs, and confusion about access to care. It also prevents healthcare providers from conducting any long-term planning to better meet the needs of a community.
No matter the intention of its supporters, the Mexico City Policy damages the health care infrastructure in the countries that rely on American aid the most. This, in turn, increases the likelihood of conflict in these communities and severely undermines American soft power.
Soft power efforts — like the promotion of freedom, democracy, and human rights — have been a hallmark of the US foreign policy strategy for the last 70 years.
One of the primary ways the United States has historically strengthened national security, promoted US values abroad, and improved its global influence is through investments in global development, including public health. In Fiscal Year 2019, the US contributed $11 billion to global health funding through the US Agency for International Development (USAID) — more than any other contributor in the world. That funding is now entangled with the Mexico City Policy, directly undermining the goals of USAID. Further, in the developing world, the United States is now in constant competition with growing Chinese influence. By enacting policies that negate the reach of US soft power, the Trump Administration is actually weakening US security.
The US House of Representatives has made a move to end this dangerous policy. In the FY20 funding bill for the Department of State, Foreign Operations, and Related Programs (SFOPS), the House Appropriations Committee included a permanent repeal of the Mexico City Policy, which was ultimately passed by the entire chamber. This repeal is sure to be a point of contention between the House and the Senate when coming to an agreement on a final funding package.
No matter what happens in Congress, the most heavily affected health care providers stay optimistic that they will eventually find the funding they need to operate in the interest of their communities. Even if they do, the damage to US influence is likely to last.
Advocates of the Mexico City Policy have clearly not thought through the implications of their policies or are not interested in the instability the policy has unleashed. Personal ideologies that are not even the law of the land in the United States should not take precedence over American security. There is no room for debate — comprehensive global health assistance is a fundamental factor in conflict prevention and stability. It is in the security interest of the US government to empower local health providers, allowing them to decide how best to serve their fragile communities. It’s time for the Mexico City Policy to be repealed and never replaced.
Rachel Emond is a Scoville Fellow at the Center for Arms Control and Non-Proliferation, focusing on the intersection between women’s issues and national security policy.