Repealing the Global Gag Rule Is Only the First Step
After eight years of a policy that denied funding for crucial health services, stifled democratic debate, contributed to deaths from unsafe abortion, and stood in the way of global progress toward access to safe abortion, the Global Gag Rule should soon be history. The impact will be certainly be significant -- clinics refunded, organizations again able to speak out on abortion issues -- however, repealing the Gag Rule will not actually end the longstanding ban on foreign aid for safe abortion care.
The ban on foreign aid for abortion is based on the government's interpretation of the Helms Amendment, adopted in 1973. The Helms Amendment states "No foreign assistance funds may be used to pay for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortions."
The language of the ban is as peculiar as its implementation. One might wonder, under what circumstances is abortion used as a "method of family planning?" Abortion certainly isn't family planning when a pregnancy threatens a woman's physical or mental health or where the woman is a victim of sexual violence. Under Helms, could USAID have a role in ensuring women's access to safe, legal abortion under these circumstances?
In countries where abortion is legal under a broad set of conditions, the ban has meant that no U.S. assistance can help the government make services safer (for example, through training or equipment), or indeed to make safe abortion care available at all. In Nepal, where the government is working to implement the 2002 abortion law, USAID-funded training facilities and clinics dedicated to treating complications of unsafe abortion may not be used for safe abortion care. The government instead had to build new facilities or compromise quality of care by using less appropriate facilities.
U.S. administrations have applied the Helms language to effectively prohibit any use of foreign assistance funds for safe abortion care, but also to prevent dissemination of information about abortion or the purchase of equipment to treat abortion complications. The prohibitions are applied equally to non-governmental organizations (NGOs), foreign governments and multi-lateral organizations (by contrast, the Global Gag Rule only applies to NGOs and dictates what they do with their own, non-USAID funding).
This includes the purchase and distribution of manual vacuum aspiration instruments, life-saving equipment that can be used to both provide safe induced abortion as well as to treat complications from unsafe abortion and miscarriage, particularly in low-resource settings. Though USAID funds train providers to treat complications from unsafe abortion, funding for the equipment to put this training into practice must be acquired elsewhere.
The Helms Amendment has even led to the control of information about the scientific, public health, and human rights aspects of abortion -- far beyond any reasonable interpretation of the language of the law. USAID-funded journals and databases have been censored systematically and through outlandish intrusions. In April 2008, administrators of the U.S.-funded Popline database made the word abortion an unsearchable stop word, all because of a phone conversation over USAID's concerns that Popline may be violating the abortion ban by including what they thought were abortion advocacy materials. The items in question were articles in A: the abortion magazine, published by Ipas, in an issue on the growing recognition of the linkages between abortion and human rights. Abortion was shortly reinstated as a search term but the offending articles remain banned from the "world's largest bibliographic database" on reproductive health literature.
It does not have to be this way. A 1994 policy interpretation by USAID stated that the Helms Amendment permits funding for abortion in cases of rape, incest, and danger to the life of the woman. But USAID has yet to fund any programs or services that meet these conditions. Annual foreign aid appropriations bills specify that the Helms Amendment should not prohibit providing information or counseling about all pregnancy options, and this also has never been implemented -- indeed the Global Gag Rule has undermined this condition.
Only Congress can repeal the abortion ban, although President-elect Obama certainly has signaled his opposition to bans on public funds for safe abortion care. The wording of the Helms Amendment does give the next president the opportunity to request USAID to issue guidance on what activities are permissible under the Helms Amendment. Such activities would include but are not limited to: creating awareness of unsafe abortion as a public health problem, equipping providers with appropriate technology, training providers to provide legal abortion under certain circumstances and providing abortion information, counseling, and referrals.
Millions of women have died of unsafe abortions in the 35 years since the Helms Amendment was enacted, and tens of millions more have suffered injuries and disabilities due to complications. The end of the Global Gag Rule will begin a new era of U.S. foreign policy that will improve women's health and lives. But the Helms Amendment will remain a major impediment to efforts by governments, advocates and organizations to ensure that the world's poorest do not have to face unsafe abortion. Even with Helms in place, through new and clarifying guidance, the administration can lessen its harm, comply with U.S. international commitments, and save lives of the world's poorest women.