The Care Denied report is part of IWHC’s ongoing commitment to document the harmful impacts of the expanded Global Gag Rule and advocate with US policymakers to permanently end this dangerous policy. IWHC works in partnership with grantee partners in Kenya, Nepal, Nigeria, and South Africa to provide a comprehensive look at the impact of the policy on women, marginalized communities, health care providers, and civil society. In addition to this full report, IWHC’s grantee partners have also produced country-specific reports on Nepal and South Africa. You can view previous reports in this series for the year one and year two impacts of the policy. Read the executive summary of the report below and download the full report to learn more.

Executive Summary

In its third year, the expanded Mexico City Policy, also known as the Global Gag Rule, continued to cause immense harm around the world. Issued on January 23, 2017, US President Donald Trump’s presidential memorandum reinstated and expanded the policy. The implementation plan for the expanded policy, called “Protecting Life in Global Health Assistance,” (“the policy” or “the Global Gag Rule”) was announced in May 2017. Under the terms of the policy, any foreign nongovernmental organization that accepts US global health funds must certify that it does not provide abortion services, information, counseling, and referrals, nor does it advocate to expand access to safe abortion services. The Global Gag Rule applies to what organizations do with their own, non-US government funds, in many cases forcing health care providers to choose between providing a comprehensive spectrum of reproductive health care and receiving critical US funding.

Since the enactment of the policy, the International Women’s Health Coalition (IWHC) has sought to document its profound impacts across communities, including its effects on health care, access to services, civil society activity, and the political climate. Throughout the application of the policy, IWHC has worked alongside grantee partners in Kenya, Nepal, Nigeria, and South Africa to investigate and document the policy’s effects through interviews with civil society organizations, health service providers, anti-abortion groups, and government agencies across the four documentation project countries. The previous two phases of the project, which included over 160 interviews, found widespread misinterpretation and began to show how the policy was limiting access to critical health services and causing the fragmentation of health systems.

In this third phase of the project, 104 interviews from stakeholders revealed the following impacts:

• The policy continues to exacerbate existing barriers to health care access. Services including comprehensive abortion care, contraceptive services, and HIV/AIDS testing and treatment have become less accessible. The Global Gag Rule continues to be harmful to the health and well-being of women and marginalized groups such as young people, people living in rural areas, and poor communities.
• The policy creates funding gaps, and continues to fragment health services, and halt critical health programs, including those supporting government health services. The policy leaves gaps in nongovernmental organizations’ work in strengthening health systems through direct health service provision, technical and financial assistance to governments, as well as capacity-building of health workers. These gaps can be difficult, time-intensive, and sometimes impossible to fill.
• The policy is shrinking civil society spaces, silencing voices, and creating distrust amongst collaborators and partners. Partnerships and coalitions are becoming fractured due to the policy, thereby limiting civil society’s ability to work effectively and hold their governments accountable.
• Implementing and monitoring the requirements of the policy burdens organizations who have to reduce or shut down programs, restructure, retrench staff, and closely monitor compliance.
• Lack of clarity about the policy is still common among key stakeholders, including leaders of organizations receiving US global health funding. This confusion often resulted in over-interpretation of the policy. In particular, key stakeholders did not know that the policy exempted the provision of postabortion care or referrals for services in cases of rape and incest.
• The policy continues to embolden regressive actors and is creating new opportunities for such players to expand their influence. It has also been providing an excuse to hinder progress on sexual and reproductive health for individuals who do not support comprehensive sexual and reproductive health and rights within their professional capacities. Governments of countries receiving large amounts of US global health funds have remained largely silent regarding the consequences of the policy on the health of their own people and have failed to take significant steps to mitigate its effects.

Based on the findings of this research, IWHC strongly urges the US government to prioritize legislative action to permanently end the Global Gag Rule, and to prevent future presidential administrations from unilaterally reinstating it. The research conclusively shows that the policy has implications even when it is not in place and, while Presidential action to end it is important, congressional action remains critical. IWHC urges the US Congress to pass the Global HER Act and to finally end this policy permanently.

IWHC further urges congressional action to repeal other abortion restrictions in US law, including the Helms Amendment and similar restrictions on the use of US foreign assistance funds. These policies, similar to the Global Gag Rule, erect needless barriers to abortion care around the world and increase stigma around abortion services.

Finally, IWHC urges donors and national governments to continue to act to mitigate the impacts of the Global Gag Rule, including by increasing funding commitments for sexual and reproductive health, filling the gaps left by US policy, and by supporting organizations and communities most impacted by the policy.