(Brussels) – Governments should pledge political and financial support for sexual and reproductive health to counter the United States’ “Global Gag Rule,” Human Rights Watch said today. The Netherlands, Belgium, Denmark, and Sweden are hosting a summit in Brussels on March 2, 2017, to strengthen support for the “She Decides” funding initiative, which will support organizations affected by US restrictions and resulting cuts.

Women and girls wait with their children outside a doctor’s office in Chitwan, Nepal. Child marriage and adolescent pregnancy is widespread in Nepal, and access to comprehensive reproductive health services and information is crucial. April 12, 2016.

© 2016 Smita Sharma for Human Rights Watch

On his first full day in office, US President Donald Trump issued an expanded “Global Gag Rule,” or “Mexico City Policy,” which strips foreign nongovernmental organizations of all US health funding if they use funds from any source to offer information about abortions, provide abortions, or advocate liberalizing abortion laws. US law already prohibits using US funds for abortion in foreign family planning assistance.

“Governments, nongovernmental groups, and the private sector should stand with women and girls to protect their right to health,” said Nisha Varia, women’s rights advocacy director at Human Rights Watch. “The Trump administration’s damaging policy restricts women’s choices, pushes censorship of information about critical health options, and will reduce a wide range of health services in many countries that desperately need them.”

On his first full day in office, US President Donald Trump issued an expanded “Global Gag Rule,” or “Mexico City Policy,” which strips foreign nongovernmental organizations of all US health funding if they use funds from any source to offer information about abortions, provide abortions, or advocate liberalizing abortion laws.

The US is the largest donor to health initiatives globally. 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 of the current US global health funding. The Trump administration’s version has dramatically expanded its restrictions to include all US global health assistance. These funds, up to US$9.5 billion, support not only family planning, but also maternal and child health, nutrition, and the treatment and prevention of HIV/AIDS, infectious diseases, malaria, tuberculosis, and neglected tropical diseases.

Governments, nongovernmental groups, and the private sector should stand with women and girls to protect their right to health. The Trump administration’s damaging policy restricts women’s choices, pushes censorship of information about critical health options, and will reduce a wide range of health services in many countries that desperately need them.

Nisha Varia

Women’s rights advocacy director

Foreign organizations that receive US health funds will have to choose between losing their US funding or complying with the rule’s restrictions, which prevent healthcare providers from sharing full and accurate health information with their patients or providing them with potentially lifesaving care. The last time the Global Gag Rule was in effect – affecting a far smaller amount of funding – healthcare providers that often provide a wide range of health services in under-resourced areas had to close clinics and cut staff.

Human Rights Watch has documented the harm caused by a lack of comprehensive health care for women and girls. For example, unintended pregnancies contribute to child marriage in Nepal, Tanzania, and Malawi and often lead to ending a girl’s education. In Kenya, Human Rights Watch documented that girls who give birth before they are physically mature may get obstetric fistulas, resulting in lifelong health problems and stigma. In countries where abortion is highly restricted, such as Brazil, Colombia, Ecuador, and Haiti, Human Rights Watch has documented that women risk their lives with unsafe abortions and that doctors feel helpless as the restrictive laws drive higher maternal morbidity and deaths.

“Access to comprehensive health care, including contraception, and to safe and legal abortion, results in fewer unintended pregnancies, fewer abortions, and fewer women and girls dying from pregnancy and childbirth,” Varia said. “While it’s too early to determine how much US funding will be cut, a large gap could have devastating consequences for women’s health and lives if other donors don’t step up their funding.”

The Dutch government established the “She Decides” international fundraising initiative to support organizations providing comprehensive sexual and reproductive health care. Governments that increase their bilateral assistance on sexual and reproductive health care can announce this as support for the “She Decides” initiative. Private donors can contribute to a “She Decides” fund that crowd-sources donations from individuals, foundations, and corporations.

Belgium, Canada, Cape Verde, Denmark, Finland, Luxembourg, the Netherlands, Norway, and Sweden have already announced their support for the “She Decides” initiative, and several other governments have indicated they will announce their support at the March 2 multi-stakeholder summit in Brussels.

A European parliament resolution, adopted on February 14, called on the European Union and its member states to “counter the impact of the gag rule by significantly increasing sexual and reproductive health and rights funding…using both national as well as EU development funding.” Several countries that have a strong record of supporting women’s health in their foreign assistance have yet to announce their plans, including Australia, France, Japan, and the United Kingdom.

Almost 225 million women and girls have an unmet need for contraception. While maternal mortality dropped 44 percent between 1990 and 2015, it remains a serious problem. The World Health Organization estimates that every day, approximately 830 women and girls die from preventable causes related to pregnancy or childbirth. It also estimates that nearly 7 million women in developing countries are treated for complications from unsafe abortions annually, and at least 22,000 die from abortion-related complications every year.

Comprehensive sexuality education, access to contraception, and access to safe abortion is particularly important for girls, as complications due to pregnancy and childbirth are a leading cause of death for girls ages 15-19 globally. With less funding for sexual and reproductive health information, services, and supplies, the death toll could climb higher.

Draft legislation introduced in the US Congress – the Global Health, Empowerment, and Rights (HER) Act – would permanently repeal the Global Gag Rule. While there is no reason to expect the legislation would be adopted under the current administration, it has gathered increased support as a long-term strategy.

“President Trump’s expanded Global Gag Rule is anti-woman, anti-family, anti-health, and anti-free speech and threatens to roll back hard-fought health gains around the world,” Varia said. “Donors should protect the investments they have been making in global health by pledging new funds to help fill the gap.”