Time to cut the string on the global reproductive health yo-yo

Global advocates for sexual and reproductive health and rights had a lot to celebrate during the first 100 days of the Biden-Harris administration. The list includes repeal of the global gag rule, disavowal of the Trump administration’s anti-abortion and anti-LGBTQ+ Geneva Consensus Declaration, and restoration of funding to the United Nations Population Fund (UNFPA).

Our movement has been here before, however. You don’t have to look far into the past to understand just how precarious these early wins can be. Depending on the administration in the White House, every four to eight years there is a yo-yo effect on global reproductive health and rights — a yo-yo that has long-lasting and devastating consequences for people across the world whose health can and should be improved with U.S. support.

Nowhere is this more evident than with a policy commonly known as the global gag rule, which prohibits the U.S. from funding organizations that provide (or even just counsel patients about, refer patients to, or advocate for) legal abortion services. The rule, first implemented by executive order in 1984, has been repealed by each Democratic administration and then predictably reinstated by each Republican. 

The rule is devastating because it forces health care providers to choose between critical funding and the freedom to provide clients with an accurate, full range of safe and legal reproductive health options — a lose-lose decision that ultimately means people with already-limited access to critical services, including reproductive and maternal health care, and HIV treatment, end up with none at all. Marie Stopes International estimated the loss of services during four years of former President Trump’s global gag rule would lead to up to 2.1 million unintended pregnancies, 720,000 unsafe abortions, and 5,600 avoidable maternal deaths. On top of that, the International Planned Parenthood Federation estimated 275,000 pregnant women living with HIV would lose access to antiretroviral treatment.

The global gag rule also creates a chilling effect problematic in itself, driving a wedge between individuals and organizations depending on whether they sign on to the policy. And as highlighted in research from Columbia University, organizations in Kenya have self-censored themselves beyond what the policy mandates, due to confusion about the policy and fear of scrutiny from the U.S. government. And because of the temporary nature of repeal, these effects remain whether the policy is currently being implemented or not. 

Planned Parenthood’s global partners have seen the global gag rule’s devastating effects firsthand — the difficult trade-offs, the lives upended and lost, and the fissures opened between civil society groups that should be working together.

While the global gag rule’s repeal is absolutely a cause for celebration, the back and forth has to stop.

That is why we’re fighting for Congress to permanently repeal the global gag rule by passing the Global HER Act. By doing so, they will tell the world the United States is truly committed to sexual and reproductive health and rights. And, it will make room to rebuild systems and movements to advance these rights in countries where the gag rule has been a tremendous barrier.

Without the threat of reinstatement, U.S.-funded global health programs could stop worrying about the yo-yo, reach their full potential and ensure their communities have full access to sexual and reproductive health care. 

There are, of course, other actions the administration can and should take to undo the global gag rule’s harms and support lasting global progress on sexual and reproductive rights, including working with Congress to make robust investments in international family planning and reproductive health programs like UNFPA, and striking other harmful policies like the Helms Amendment. 

It is also impossible to forget about COVID-19 — the combined effects of stagnant investments in global health, policies like the global gag rule and inequitable access to care have snowballed during the crisis, and low-income countries continue to bear the brunt of these challenges. A recent UNFPA report found that as many as 23 million women experienced interrupted access to birth control and family planning services due to the pandemic, resulting in potentially 2.7 million unintended pregnancies. This is just another reason why permanently ending the global gag rule is a critical and urgent next step.

As the world gets reacquainted with a more engaged, collaborative United States, the Biden-Harris administration and Congress have the opportunity to be bold with policies, dollars, and leadership. Our hope is that in the next 100 days and beyond, they will be as brave as advocates all over the world who fight every day to provide essential health care to those in need. We must all work together to achieve transformational change for global health and human rights.

Dawn Laguens is the interim executive director of Planned Parenthood Global and senior adviser to Planned Parenthood Federation of America’s president and CEO Alexis McGill Johnson.