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Japan’s longtime focus on providing foreign assistance for maternal and child health has contributed to fewer mothers around the world dying during pregnancy and childbirth. This is a fact worth celebrating prior to International Women’s Day, March 8.

Between 1990 and 2015, the number of maternal deaths globally dropped by 44 percent.Yet those gains risk being undone by new US restrictions that will lead to huge cuts in funds from the United States, the biggest global donor on women’s health.

As a result, women’s health and lives may depend on whether countries like Japan ramp up their support. On March 2, governments, businesses, and nongovernmental organizations will gather in Brussels to build political and financial support for the international She Decides funding initiative, established by the Dutch government to help fill the massive funding gap created by a new Trump administration policy.

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 organizations of all US health funding if they use funds from any source to offer information about abortions, provide abortions, or advocate for liberalizing abortion laws. 

For example, if a health clinic in Cambodia offered vaccinations and treatment for TB and HIV infections with US funding and family planning assistance with Japanese funds--including information about abortion—it would lose all its US funding. In short, 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 wide 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 this 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 more maternal deaths. The World Health Organization estimates that each day 830 women and girls die from preventable causes related to pregnancy and childbirth. 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 ages 15-19 in developing countries.

To its credit, Japan has shown a strong commitment to maternal and child health and comprehensive reproductive health care is an essential component. To protect the gains that have been made, support for the She Decides funding initiative is critical and urgent.

The expanded global gag rule is anti-woman, anti-health, and anti-free speech, and threatens to roll back hardfought health gains around the world. The Japanese government should stand with women and girls and protect the investments it has been making in global health through its foreign assistance.

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