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Donald Trump’s reinstatement of the anti-abortion global gag rule, which bars non-governmental organizations that provide abortions or even talk about abortions from receiving federal funding, has already led to devastating consequences. According to a new report in the Guardian, non-profits running clinics around the world have had to cut services and close clinics, leading to a rise in sexually transmitted infections and numerous cases of people being forced to seek out dangerous abortions.

Here’s how the global gag rule has impacted clinics run by the International Planned Parenthood Federation (IPPF), per the Guardian:

IPPF had 49 projects run by local member organisations in 31 countries in Latin America and the Caribbean, sub-Saharan Africa, and South Asia in January 2017 when the rule came in. Services in some areas shrunk by up to 42% within the year and the impact is already visible.

In Kibera, one of Nairobi’s biggest slums, volunteers report a rise in sexually transmitted infections, such as syphilis, and unsafe abortions. An outreach family planning clinic arrives once a month instead of three to four times. In some rural areas of Kenya, such clinics have stopped completely. Some HIV clinics have closed.

In Dakar, Senegal, volunteers report a rise in unsafe abortions, teenage pregnancies and sexually transmitted infections in an impoverished neighbourhood where three out of five clinics that had been funded by IPPF have closed.

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IPPF is not the only global health organization that has refused to abide by the global gag rule and as a result, seen its work dramatically curtailed. According to John Lotspeich, the director of external affairs for Marie Stopes International, some of the programs the group supports have been forced to end due to lack of funding. “It happened very quickly in 2017,” Lotspeich told the Guardian. “Most outreach services in Uganda had to stop.”

The reinstatement of the anti-abortion global gag rule, first introduced by Ronald Reagan, was one of Trump’s first actions in office. Since it was introduced in 1984, the policy has been rescinded by Democratic presidents and reinstated by Republicans, turning global abortion rights and reproductive health into a kind of partisan football. For global health organizations, it forces them to make a terrible choice: accept much-needed funding from the U.S. government but be barred from mentioning abortion to their clients, or scramble to find other sources of funding.

In March of this year, the Trump administration went one step further and extended the global gag rule, announcing that no federal funds would be given to non-governmental organizations that themselves provide funding to groups that provide abortion services, referrals, or information. Describing the Trump administration’s latest move as “quite outrageous,” Lotspeich of Marie Stopes International explained its practical implications to the Guardian: “What they are saying is, even if an organization’s money mainly comes from other organizations, say the Danish government, there is a ban on that money from being used to discuss abortion.”

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Shortly after Trump reinstated the global gag rule, Giselle Carino, the regional director of IPPF’s western hemisphere region, described the policy in an interview with Jezebel as “profoundly anti-democratic and unfair.” “You are telling organizations that with their own money, even in countries in which abortion is legal, they can’t work on the issue, advocate for the issue or counsel women,” Carino said.

She added: “We have seen this before and now we have evidence that it doesn’t work. It puts the poorest and most vulnerable women at risk, and the number of unsafe abortions increases. So it’s not a measure that is based on evidence. The evidence shows that if you actually want to reduce the number of abortions, you need to make it safe and legal.”