Gagged Up

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Reinstatement of the Global Gag Rule causes wide-spread fear that progress of maternal health in developing countries would be severely hit

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Alok Vajpeyi

The Global Gag Rule (GGR), reinstated by the US President, Donald Trump, will severely hamper access to legal abortion and the repercussions would be felt on Family Planning and Reproductive Health in developing countries. Alok Vajpeyi, Director Programmes, Population Foundation of India (PFI)  points out, “As it would cause cuts in services, increase in fees and closures of clinics; the result will be increase in unintended pregnancies, unsafe abortions, maternal deaths and newborn deaths. Nearly 225 million women in developing countries who want to avoid pregnancy but have no access to modern contraception will be affected by GGR, as it will put birth control even farther from their reach.”

According to the World Health Organization (WHO), every eight minutes a woman in a developing nation will die of complications arising from an unsafe abortion. For every woman who dies of pregnancy- related causes, an estimated 20 women experience acute or chronic morbidity, often with tragic consequences. Family planning prevents 272,000 maternal deaths worldwide.

Experts highlight that GGR broadens the gap between women and access to safe abortion. It hampers important efforts by governments and NGOs around the world to deliver needed services, to engage in advocacy and free speech on safe abortion. The progress made so far toward s providing women with the right to abortion would be slowed by the GGR, inform global NGOs.

An injury to global reproductive health

Access to contraception gets severely compromised under the GGR will have terrible consequences for women’s health, the incidence of unintended pregnancies, unsafe abortions and ultimately maternal deaths will rise. Maternal morbidities such as obstetric fistula cases would escalate.

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Ulla Müller

Highlighting the impact of GGR on women’s health globally, Ulla Müller, President and CEO, EngenderHealth, of a leading global women’s health organisation says, “While GGR was in effect between 2001 and 2009, the policy forced clinics to reallocate their funds and cut back on a range of critical health services that have nothing to do with abortion, such as family planning, obstetric care, HIV testing, and malaria treatment. 20 developing countries in Africa, Asia, and the Middle East lost US-donated contraceptives, and many organisations and clinics were forced to reduce services, lay off staff, or shut down entirely.”

More than 22 million women every year—almost in all developing countries—will have an unsafe abortion because they lack access to safe, high-quality abortion care.

Stating that Trump’s GGR will overall have a more insidious and damaging affect on women’s health, Vajpeyi states, “GGR is a violation of women’s rights and, by making essential services out of reach. It will also increase unintended pregnancies and unsafe abortions at the cost of women’s health and lives, especially in the poorest countries of the world.”

As per experts, GGR denies women the fundamental right to make informed decisions about their bodies and their health. It also denies women access to sexual and reproductive healthcare that includes comprehensive abortion care and contraceptive care.

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Vinoj Manning

Citing an example on the impact of GGR in developing countries, Vinoj Manning, Head of global reproductive rights charity, Ipas in India said, “In 2003, the Planned Parenthood Association of Ghana lost $200,000 in USAID funding when they refused to sign onto the Gag Rule. The impact was devastating — the organisation was forced to lay off key staff and to reduce its nursing staff by 44 percent. This leads to a 40 percent reduction in family planning use by clients served by the organisation. In total, more than 1,327 communities in Ghana were affected by the cuts.”

When it comes to India, though the country’s stand on abortion has been clear, unsafe abortions continue to be the third largest reason for  maternal deaths. In this scenario, GGR can adversely affect family planning and reproductive health system of India as well.

Collateral damage to India?

Ipas, a global non-profit that works to enable women’s  to exercise their sexual and reproductive rights, informs that nearly five million women in India this year will have an unsafe abortion because they lack access to safe, high-quality abortion care. These are women who want to avoid pregnancy but lack knowledge and awareness on modern contraception methods.

“If affordable contraceptives are not provided to Indians, we will see an increase in the unmet need for family planning. This would mean that there would be more unplanned and unwanted pregnancies, resulting in more abortions, including unsafe abortions, increased maternal and child morbidity and mortality,” points out Müller.

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According to EngenderHealth, India has an estimated modern contraceptive prevalence rate (mCPR) of 52.4 per cent and unmet need of 31.1 per cent as of 2015. This translates into 30,100,000 women who have an unmet need for family planning services.

The consequences of GGR on rural women is likely to be more as the US agencies provides considerable aid to India. In 2006, 69.1 per cent of women reported satisfaction in terms of using modern contraceptives to avoid pregnancy and these contraceptives were provided by the United States Agency for International Development (USAID). In 2015, USAID reportedly spent $21 million dollars on Family Planning and Reproductive Health in India, and a year prior to that, it spent $13.9 million.

Manning gives a detailed overview of the scenario and states, “India’s stand on abortion has been bold and clear since 1971 with the passage of the Medical Termination of Pregnancy (MTP) Act. The Act permits termination of pregnancy for a broad range of conditions. Abortion care as such in the public sector in India may not be affected by this decision since comprehensive abortion care is an integral component of the interventions under the National Health Mission.”

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He further elucidated, “However, it may impact NGOs that receive US funds for family planning services if their work includes counselling on abortion services or safe abortion service delivery.  Some women may not be referred to a public health facility for abortion and instead turn to unsafe methods of ending their pregnancy. Cuts to their funding would have an associated impact on women’s access to information and services because of fragmented information on maternal health and family planning without abortion,” he added.

However, Vajpeyi feels that restricting universal access to family planning and reproductive health services will not adversely affect health and family planning services in India. Explaining his rationale he says, “Very few NGOs receive funds from international donors or the US. In India, family planning and reproductive health services are mainly provided by the government. Organisations which were giving valuable technical assistance and US-donated contraceptives, including condoms would be lacked.”

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Besides, PFI also informed that India has a robust network which supplies contraceptives, including condoms, oral pills, IUDs, tubal rings, ECPs and pregnancy test kits.

“Our public health centres are also equipped to provide sterilisations under certain mandated guidelines. Between 2014 and 2015, nearly 176 million condoms were provided, along with 102.84 million oral pills and 102.38 pregnancy test kits. The annual report from the Ministry of Health and Family Welfare says that a total of 40,36,683 women were sterilised and 51,28,893 women opted for IUCD insertions,” Vajpyei asserts.

He further informed that the Indian government has estimated that the current unmet need for family planning can be fulfilled within the next five years, which would help the country to avert 35,000 maternal deaths and 12 lakh infant deaths.

“But family planning is directly linked to the health of women and children, GGR will result in wide-ranging collateral damage – most organisations that offer abortions also offer integrated services in the realm of sexual and reproductive health and rights like HIV testing and cervical scans to check for cancer,” he added.

Most NGOs and organisations which deal with family planning and reproductive health offer integrated services, which means people who seek information on abortions and family planning may also require auxiliary services like HIV testing and cervical scans to check for cancer.

“As a result of the reinstatement of the GGR, Indian NGOs such as Marie Stopes (MSI), PSS (an offshoot of MSI) and Family Planning Association of India, to name a few will have to choose between continuing to provide information, counselling, services or referrals for abortion and stopping abortion-related activities to become eligible to receive funding from USAID.

At that point, NGOs choosing to be eligible for USAID funding will have to give up life-saving abortion care services, thus leading to an increase in the prevalence of unsafe abortions and maternal mortality in the country,” Uller highlighted.

She also informed that EngenderHealth, being a US-based NGO, is not directly subject to the restrictions of the GGR.  However, they run projects in India through other NGOs that are subject to GGR. Likewise, they collaborate with international NGOs like International Planned parenthood (IPPF) and MSI in their global projects.

“We may no longer be able to work with those local and international NGOs, if they decide or continue to be involved in abortion care. Though EngenderHealth’s projects in India are funded by private donors, this restriction on NGOs may have a bearing on the amount of funds we can spend in India,” she added.

Thus, experts caution that the far reaching effects of GGR would range from loss of thousands of jobs, cutting access to healthcare in hard-to-reach areas, and increased vulnerability of girls and women in these areas to unsafe abortions and other desperate and harmful measures to access care.

“The GGR will have a devastating economic effect in developing countries. When a woman or girl can’t access family planning and safe abortion, she risks discontinuing her education due to unintended pregnancy, financial hardship, and the inability to contribute to the well-being of her family and her community,” Manning warns.

Need for a responsible policy

Thus, experts unanimously agree that GGR will have terrible consequences on the health and lives of poor women and their families in ways that have nothing to do with abortion. From 2001 to 2009, when the then US President George W Bush reinstated GGR, 20 developing countries in Africa, Asia, and the Middle East lost US-donated contraceptives, and many organisations and clinics were forced to reduce services, lay off staff, or shut down entirely.

Meanwhile, data provided by the Guttmacher Institute, a  research and policy organisation committed to advancing sexual and reproductive health and rights in the US, stated that in 2016, $607.5 million aid has been used for family planning, which has granted 27 million women access to the basket of contraceptive choices, averted six million unintended pregnancies, and prevented 2.3 million abortions.

Loss of US funding will burden more than 225 million women globally. In the absence of the GGR and full access to the US funding, healthcare providers would have been better equipped to help women in developing nations have safe pregnancies, avoid unsafe abortions, and have access to modern contraceptives.

prathiba.raju@expressindia.com

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