The foreign-aid restricting policy known as the Global Gag Rule for its intended impact on medical services offered to women in resource-limited countries, re-emerged this week in its new, sweeping form with restrictions to funding and activities of a greatly expanded range of health, and health-related service providers spelled out in detail in USAID’s Standard Provisions for Non-U.S. Nongovernment Organizations.
Posted a day before the release of the Trump administration’s “Foundation for American Greatness” 2018 budget plan, which proposed broad and deep cuts across the spectrum of medical innovation, health provision and protection both domestically and internationally, the expanded policy has a similarly arguable new name, “Protecting Life in Global Health Assistance.” Like previous iterations of the policy, it aims to prevent health providers from offering women information or services to terminate a pregnancy, even when their physical or mental health is endangered. But now, instead of restricting information and services offered by reproductive health and family planning providers, it now limits and silences providers and services across the spectrum of overseas programs providing health care, or services that might help people to stay healthy
That includes programs that provide services to prevent, treat and control HIV, tuberculosis, Zika, pandemic influenza and more, and it even includes foreign-aid programs that address community-level water, sanitation, and hygiene, a bulletin from Population Action International notes. The organization has provided a side-by-side comparison of the impacts of the previous version of the policy (also known as the “Mexico City Policy” for where it was launched) and the current version, which can be downloaded here.
But a full reading of the 10 pages that reintroduces the concept of limiting medical services that health providers can make available, and of limiting the activities undertaken by nonprofit organizations with their own resources if they receive funding from the U.S., is essential to measuring the extent to which the new policy will reduce and confine the benefits of foreign aid. Like the previous policy, the new version turns overseas recipients of American aid into enforcers of the policy, tasking them with not just with adhering to the policy but ensuring that no sub-recipient (or organization carrying out any of the funded work) violates the policy as well.The guidelines give a glimpse of the additional demands that might put on USAID staff making “independent inquiries in the community served by the recipient or sub-recipient under this award regarding whether it performs or actively promotes abortion as a method of family planning.” That aspect of the previous global gag rule policy brought its own costs, diluting the potential health benefits of $600 million in U.S. overseas funding. Now the demand that health providers play a role as enforcers of the policy, with the diversion of resources that entails is multiplied across a budget delivering $8.8 billion. Further, while the provisions in which the policy is included are titled “for Non-U.S. Nongovernment Organizations,” the enforcement role affects American nonprofits carrying out U.S.-funded programs as well, tasking them with policing their sub-recipients for violations.
And that policing cannot be easy. It means ensuring that a local service provider did not ever take a stance on the benefits of legalized abortion. It also means making sure a local health provider did not provide information or services to terminate a pregnancy “for the physical or mental health of the mother or . . .[because of] fetal abnormalities.” But while these services are allowed “if the life of the mother would be endangered,” who makes that evaluation — determining if information or services are provided to save a woman’s life, or simply to preserve her health, is not spelled out in the policy. What is Included is an acknowledgement that injuries or illnesses can be caused by “legal or illegal” abortions — although that guideline does not acknowledge that injuries are more likely in illegal settings. It also, then, makes an exception to its restriction on services for women — in the case of injury or illness, a woman can receive “post-abortion care.”