Cambodian mothers might not know it yet, but they are likely to be among those harmed by new Trump administration policies.
Access to health care for women in Cambodia has improved drastically in the last decade with the support of donor governments including the US and Australia. Maternal mortality rates have more than halved from 2005 to 2014. Yet those gains risk being undone by new restrictions that will lead to huge cuts in funds from the US, the biggest global donor on women's health.
As a result, women's health and lives may depend on whether countries like Australia ramp up their support. On March 2, governments, businesses, and non-governmental organisations will gather in Brussels to build political and financial support for the international She Decides Fund, established by the Dutch government to help fill the massive funding gap created by the US. Australia's Foreign Minister Julie Bishop has been invited to attend.
One of Donald Trump's first acts as president was signing into effect a dramatically expanded "Global Gag Rule". The rule strips foreign non-governmental organisations of all US health funding if they use funds from any source to offer information about abortions, provide abortions, or advocate for liberalising abortion laws. For example, a health clinic in Cambodia offering vaccinations and treatment for TB and HIV infections with US funding and family planning assistance with Australian funds – including information about abortion – would lose all its US funding. NGOs will have to cut comprehensive reproductive health services or face cuts to their broader services. This damaging policy restricts women's choices, promotes censorship of critical health options, and will reduce overall availability of a range of health services in many places.
When previous versions of the Global Gag Rule were imposed by past US Republican presidents, it applied only to US family planning funds, or roughly US$575 million. Trump's version has expanded to include all global health assistance, a staggering $9.5 billion that supports not only family planning but also maternal and child health, nutrition, HIV/AIDS, infectious diseases, malaria, tuberculosis, and neglected tropical diseases.
The consequences could be devastating. Women and girls in 60 low and middle income countries may lose access to contraception, HIV prevention, and maternal health care, resulting in more unintended pregnancies, more unsafe abortions, and maternal deaths. Studies estimate that globally between 8 and 18 percent of maternal mortality is due to unsafe abortion. Lack of access to contraception also contributes to early childbearing, which is a leading cause of death for girls aged 15-19 in developing countries.
In Cambodia, Australia has committed $20 million over six years in funding for sexual and reproductive health, with a specific emphasis on assisting young women working in garment factories. The US government's health funding to Cambodia was $41 million in 2015 alone. While it's too early to determine how much US funding will be cut, a large gap could have devastating consequences for many Cambodian women if other donors don't step up.
Australia has shown a commitment to sexual and reproductive health. Earlier this month Bishop announced a continuation of its funding to International Planned Parenthood for sexual and reproductive health services in crisis settings in the Asia-Pacific. Bishop acknowledged sexual and reproductive challenges are "leading causes of death and disability among women and girls in the world today". Bishop announced 80 percent of the aid budget would address "gender equality and women's issues and their empowerment."
Australia's commitment is there, but will there be sufficient commitment from Australia and other countries to make up the huge loss from Trump's expanded global gag rule?
Support for the She Decides fund is critical and urgent.
The expanded global gag rule is anti-women, anti-health, and anti-free speech and threatens to roll back hard fought health gains worldwide. The Australian government should protect the investments it has been making in global health through its foreign assistance. The Australian government should stand with women and girls and for evidence-based health care by pledging sustained political and financial support for comprehensive sexual and reproductive health care on March 2.
