Bush and the Global gag Rule

On 22 January 2001, as one of his first actions in office,
United States President, George W Bush reinstated the Mexico City Policy
 more commonly known as the Global Gag Rule.
ELIZABETH DOGGETT explains how this could affect HIV/AIDS services in South Africa


The Global Gag Rule stipulates that no foreign non-governmental organisation (NGO) which performs abortions, provides information or referrals to abortion services, or lobbies to make abortions legal or more easily accessible (except in cases of rape, incest, or threat to the life of the woman), may receive family planning funding from the United States Agency for International Development (USAID).

As a result, international reproductive health care providers and educators such as Marie Stopes, the International Planned Parenthood Federation (IPPF), and the United Nations Population Fund (UNFPA) lost large percentages of their funding. IPPF has lost an estimated $18 million a year, and UNFPA $34 million in the first 18 months after the Rule was reinstated.

The loss of funding for health services has serious implications, not only for reproductive health, but also for HIV/AIDS in South Africa and other countries straining under the impact of the pandemic. And women stand to suffer most, as they are most vulnerable to the virus because of social inequalities, sexual abuse, domestic violence, limited access to education and financial resources, and limited autonomy in reproductive and sexual decision-making.

It is unlikely that the funding cuts do much to prevent abortions. UNFPA estimates that the loss of its US funding will result in two million unwanted pregnancies, 800 000 abortions, and more than 81 000 deaths.

Even though the Bush administration backed down from extending the restrictions to HIV/AIDS programmes under the President?s Emergency Plan for AIDS Relief (PEPFAR), no measures were taken to ensure that this does not happen in the future.

The PEPFAR funds were introduced in President Bush?s 2003 State of the Union Address. It entailed a plan to authorise $15 billion over five years to be spent fighting AIDS in 14 developing countries, including South Africa. But this seemingly generous gesture, the ?largest international health initiative ever to target a single disease?, carries restrictions which may bring about more damage than relief.

Although the Bush administration explicitly stated that groups receiving HIV/AIDS funds were not subject to the restrictions, the indistinct (and sometimes nonexistent) boundaries between family planning and HIV/AIDS interventions make it impossible to separate the two. The Mexico City Policy diminishes the effectiveness of the PEPFAR funds in ways that should have been anticipated.

Firstly, there are probably NGOs that qualify for PEPFAR funding but are unaware of the fact that the Gag Rule applies only to family planning funds. Secondly, the most easily visible NGOs that lost funding for refusing the terms of the Policy (such as IPPF, Marie Stopes, and UNFPA) use comprehensive approaches to provide health care, family planning services and information, as well as sexually transmitted (STI) and HIV education, testing, and treatment.

It makes sense to integrate family planning and HIV in South Africa for many reasons. The most obvious of these are to provide those women who have limited resources and access to clinics, with family planning and HIV support services in the same settings.

The daily, intimate contact NGOs have with the communities they serve, also make them better equipped to identify the multiple experiences of their clients. An NGO serving abused women and children must focus not only on abuse, but also on poverty, lack of access to health care, discrimination, and the lack of education clients may experience. Similarly, many NGOs that provide education on women?s health care, STI and HIV, and other family planning services, cannot afford to refuse women information on and access to safe abortion services.

The effectiveness of the NGOs? work is usually limited by a lack of adequate funding in South Africa. During the last year, both the Women?s Health Project and the Reproductive and Sexual Health divisionof the Gender Advocacy Programme ? and presumably other NGOs ? were forced to dissolve because of severe funding restrictions.

Countless others inevitably limit the extent to which their programmes operate because of a lack of adequate staff and resources. It is important for the government and international community to recognise the role that NGOs play ? as ?bridges to at-risk communities? and as agents capable of addressing the specific needs of communities ? and for them to help NGOs work to their fullest capacities.

The Mexico City Policy poses misguided and counterproductive restrictions on the groups that need the most support. As the Bush administration enters a second term, it is important to recognise the negative impact of policies based on partisan ideals and not on facts.

Ms Elizabeth Doggett did an internship programme in the Democracy and Governance Research Programme in 2004, and is now working in Washington, DC, USA.