U.S. Policies and the Global South
Women's Reproductive Health and Rights
Prepared by the Women's Edge Coalition
June 2006

I. Global Gag Rule (GGR)

The policy:

• Officially known as the Mexico City Policy
• First passed by President Reagan in 1984; rescinded by President Clinton; President Bush reinstated the measure on his first day in office in January 2001
• Restrictions mandate that no U.S. family planning assistance can be provided to foreign NGO's that use funding from any source to:
  • Perform abortions in cases other those that threaten life of mother and/or results from rape or incest
  • Provide counseling, referral for abortion
  • Lobby or make abortion legal or more available in their country

How it hurts women:

• Restricts free speech
• If an organization accepts the measures, they can not fully serve the needy population
• If an organization rejects the measures, they lose funding, and can not fully serve the needy population
• The loss of funding leads organizations to lay off senior staff first, which means doctors and nurses
• Negatively impacts HIV/AIDS prevention efforts because the family planning organizations are also so involved with HIV/AIDS education, so when they close down, can no longer educate the population and HIV/AIDS thus continues to spread

Specific examples/quotes:

• Since Bush signed the Global Gag Rule, Nepal's leading family planning organizations have lost $100K, leading them to lay off 60 doctors and nurses
• In Kenya, 6 of 12 clinics run by the leading family planning organization have closed since January 2001. They provided poor women with a range of services, including HIV/AIDS education. As a Kenyan Governmental Agency Staff Member says, "If a woman used to go to one of their clinics that closed, there is a good chance that there will be no other clinic to go to in that area."
• Globally, almost 20 million unsafe abortions annually, 95% of which take place in developing nations; nearly 70,000 women die from abortion complications each year, which does not even count the millions that then suffer from injuries and disabilities

Important points:

• There is no evidence that this measure has reduced the number of abortions occur globally (the number of annual abortions globally did not drop from 1984-1992 (Reagan/Bush I) - there is no reason why it would work now)
• Anti-choice groups within these countries are not held under the same constraints under the Global Gag Rule, as they are free to advocate for greater restrictions on abortions
• The GGR undermines U.S. efforts to encourage democracy around the world, as this order limits free speech and makes actions that are legal in the U.S., and often within countries, illegal
• The GGR negatively impacts the prevention of HIV/AIDS because of the severe limits it places on organizations
• The GGR directly impacts women's health in a purely negative way, i.e. when a clinic is forced to close because it loses funding, it is not replaced by another clinic
• The Global Gag Rule puts ideology before sound health care judgments that directly affect women's lives
• By reducing funding to reproductive health care providers in developing nations, the Gag Rule decreases women's ability to access pregnancy related care, family planning, HIV/AIDS education, protection against STD's and overall, leads to higher rates of unintended pregnancy, which in turn leads to more abortions, including abortions that are performed under extremely unsafe condition

II. "Abstinence, Be Faithful, Use Condoms" (ABC)

The policy:

• U.S. policy created as a comprehensive approach to slowing the sexual transmission of HIV/AIDS; Administration's global HIV/AIDS prevention strategy
• Strategies are "balanced, combined, targeted and implemented as appropriate in each country to effectively slow the spread of HIV/AIDS"

How it hurts women:

• Women do not have the bargaining power to negotiate the use of condoms with their partners
• Men often have multiple partners, so even if the wife is faithful, she is still at great risk for infection
• The Bush Administration has placed the greatest emphasis, and the greatest amount of money, promoting the "A" and "B" of this strategy, but abstinence and faithfulness do not give women concrete strategies to stay safe and protect themselves; they also do not protect those females coerced into sex
• Women do not always have the ability to abstain

Specific examples/quotes:

• "I had no voice to tell him to use a condom. He asked me why I wanted to use a condom, whether I did not trust him." - Chompoo Yokhee, married mother of 2 young children who was infected with HIV by her husband because he would not use a condom
• In Uganda, the pressure from the U.S. government to promote the abstinence prong is so great that the curriculum in primary school education is devoid of education on condom use, safe sex practices; there have also been instances of false statements of the failure of condoms in secondary school education curricula.

Important points:

• Married women are at great risk of infection, despite the ABC outline because:
  • They have little or no negotiating power in condom use
  • Their husbands are often unfaithful or practice polygamy (culturally acceptable)
  • Of the prevalence of abuse - domestic violence, rape, wife inheritance
  • They lack economic independence, they are often unable to leave the marriage
• This policy focuses on abstinence, which is a socially conservative voice in the debate that fails to acknowledge other important factors, like infidelity

III. Anti-Prostitution Loyalty Oath

The policy:

• This is the U.S. policy that requires organizations receiving U.S. HIV/AIDS assistance to formally pledge their opposition to prostitution and sex trafficking; it prohibits activities that "promote or support the legalization or practice of prostitution"
• The law is not clear on private vs. public funded programs, so the U.S. government has interpreted the law to restrict organization's speech and activities, regardless of the funding source
• The law is so broadly interpreted that its blanket covers any organization that is doing any work related to prostitution; organizations have become so afraid to be seen as pro-prostitution and therefore lose their funding, that so many programs have stopped

How it hurts women:

• Sex workers, the vast majority of whom are female, lose access to HIV/AIDS prevention measures; sex workers are at the highest risk of HIV/AIDS infection
• The policy damages trust between health workers and those they are trying to serve because it creates or exacerbates the stigma
• Many organizations, so as not to lose funding, are forced to discontinue their effective programming
• The criminalization of prostitution has negative effects: pushes the trade further underground, leading to more abuse and pushing workers further away from health services, and therefore the access to remain safe or find a way to escape

Specific examples/quotes:

• Brazil, in May 2005, refused funding from the U.S. because of this oath and, in effect, gave up $40 million that would have gone to the prevention of HIV/AIDS
• Pedro Chequer, director of Brazil's AIDS program views U.S. demands as "interference that harms the Brazilian policy regarding diversity, ethical principles and human rights."
• Brazil's approach to the AIDS epidemic is considered a model by some scientists and public health specialists: in 1992 experts feared 1.2 million Brazilians would be infected by 2002, but due to Brazil's programs, the number reached 600,000 infections, significantly less than forecasted; rates of infection are dropping in Brazil
• This decision, reported the Wall Street Journal, "escalates a global fight over the moral strings President Bush and his conservative allies in Congress attach to foreign assistance, especially when it comes to sex, drugs and AIDS prevention in developing nations."

Important points:

• Any work with sex workers, whether it be prevention, health care, or assistance helping them leave prostitution, can be viewed as pro-prostitution and funding can be taken away
• This anti-democratic policy of the U.S. is especially hypocritical as the U.S. works to spread democracy to other nations
• Because the law is so vague, it can be interpreted narrowly or loosely, leading to arbitrary application
• The policy forces the U.S. government's point of view on private U.S. organizations, which is another erosion of freedom
• NGO's around the world are becoming increasingly critical and skeptical of U.S. policies because they are viewed as based on ideology instead of pragmatism

Other information:

• There are two lawsuits against the policy: DKT International vs. United States Agency for International Development, in Washington, D.C. And Alliance for Open Society vs. United States Agency for International Development, in New York
• Two federal judges have ruled unconstitutional the government's policy of forcing U.S. health groups to denounce prostitution as a condition for receiving funds for international AIDS work
• The policy violates the First Amendment right to free speech
• It important to note that these rulings apply to the plaintiffs only, but do set an extremely important precedent

IV. United Nations Population Fund (UNFPA) Funding

The policy:

• UNFPA mission statement: "UNFPA, the United Nations Population Fund, is an international development agency that promotes the right of every woman, man and child to enjoy a life of health and equal opportunity. UNFPA supports countries in using population data for policies and programs to reduce poverty and to ensure that every pregnancy is wanted, every birth is safe, every young person is free of HIV/AIDS, and every girl and woman is treated with dignity and respect."
• The Bush Administration has withheld funding to the UNFPA (the United Nations Population Fund) each year in office
• In 2005, Congress approved $34 million in funding, which the Bush Administration did not approve. Their rationale: the Bush Administration alleges that UNFPA's family planning efforts in China violate "Kemp-Kasten," a vaguely-worded law that prohibits U.S. funding of coercive abortion and forced sterilization. However, in reality, the UNFPA does just the opposite, as it works with the Chinese government to eliminate coercive practices and to promote voluntary family planning and birth control methods
• The activities of UNFPA have been confirmed by several groups sent to monitor the situation, including a fact-finding team handpicked by the Bush administration

How it hurts women:

• Those who are "punished" are women in the 140 other countries where UNFPA works because the withdrawal of America's contribution to UNFPA does not impact activities in China and prevents UNFPA from carrying out its vital work to millions of others

Specific examples/quotes:

• Experts estimate that the U.S. contribution to UNFPA would prevent two million unintended pregnancies, nearly 800,000 abortions, 4,700 maternal deaths, and 77,000 infant and child deaths each year

Important points:

• UNFPA operates in over 150 poor countries around the world, but does not provide or pay for abortion services anywhere in the world. UNFPA works to reduce the need for abortion by promoting voluntary family planning

V. Other Resources

Global Gad Rule - www.globalgagrule.org

Center for Reproductive Law and Policy - www.crlp.org

Population Action International - www.populationaction.org

Women's eNews - www.womensenews.org

CHANGE - www.genderhealth.org

Global AIDS Alliance - www.globalaidsalliance.org

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