The months following Donald Trump's election win were filled with uncertainty and speculation about whether he would follow through on the controversial and problematic promises of his campaign. On January 21, the day after his inauguration, hundreds of thousands of women protested in cities around the world to "defend women's rights and those of others in response to the rising rhetoric of far-right populism around the world". Two days later, Trump signed an anti-abortion executive order with far-reaching implications, sparking a global outcry. The Mexico City policy — also known as the Global Gag Rule — "forbids the U.S. from funding any group that provides or promotes abortion" around the world.
While the policy refers to abortion, organisations that offer holistic sexual and reproductive healthcare risk losing funding too. This could have a greater impact — including the loss of access to safe and affordable contraceptives, maternal and child health, HIV treatment and support and, in some cases, malaria treatment.
In a statement, Doctors Without Borders (MSF) expressed concern about the impact the policy will have on women's health and progress in global health efforts, particularly efforts geared towards reducing maternal mortality related to unsafe abortions. According to the World Health Organisation, unsafe abortions account for approximately 13 percent of maternal deaths internationally.
"No matter what the risk or barrier, women will continue to seek ways to end pregnancies and they will continue to needlessly die if safe abortion care is not accessible. The Trump Administration needs to face these facts and end policies that endanger the lives of women and girls," says Jason Cone executive director of MSF-USA.
In a statement, public interest law centre Section 27 told the Huffington Post South Africa that the gag rule is "calamitous" for sexual and reproductive health rights and would have far-reaching implications across the health sector.
"More importantly the Gag Rule challenges sections of our constitution in which reproductive health rights are enshrined," the organisation said. The South African Constitution, it points out, outlines every person's right to healthcare — including reproductive healthcare, which includes safe and legal abortion services provided by the state.
The Department of Health has a more cut-and-dried reaction to the signing of the policy. "Abortion is legal in South Africa under the Choice on Termination of Pregnancy Act," says Department of Health deputy director general Dr. Yogan Pillay.
Pillay however believes that South African women should be unaffected by the gag rule, as public healthcare services are not funded by the United States government.
But for Whitney Chinogwenya, a spokesperson for Marie Stopes South Africa's Bryanston branch in Johannesburg, it's not that simple. Chinogwenya believes it's unlikely that the public healthcare system will be able to handle the overflow of women looking for safe abortion options who will no longer be able to rely on NGOs for them.
Her concern is that it will "erode women's rights over time" regardless of what their current sexual and reproductive healthcare needs are. "The effects are all integrated," she says. "If you aren't able to practice modern contraception and have an unwanted or unsupportable pregnancy, you may be forced to have an unsafe abortion. It pushes women into a corner and leaves them with very few options," she added.
Marie Stopes South Africa's clients pay for their services and the organisation is not donor funded, so the organisation will not be directly affected by the gag order. But Chinogwenya says the public use of their services is a good indication of what South African women need.
"Safe abortion care is our most used service," she says. "Contraception is more widely available in state services, but safe abortion care is not".
Chinogwenya believes that the state system is ill-equipped to provide the services that South African women require. She points out that even though abortions can be performed legally until the 20th week of pregnancy, few public healthcare facilities are willing to perform them in the second trimester. Chris Hani Baragwanath Hospital in Soweto and Leratong Hospital in Mogale City are the only two government facilities providing second trimester abortion services in Joburg, she says.
Ambika Samarthya-Howard, head of communications at the Praekelt Foundation, believes the policy could affect health service providers in an even broader sense. The foundation uses mobile and open source technology to deliver information and services to more than 10 million people in over 40 countries. The Global Gag Rule, she says, could curtail what information they are able to disseminate.
"It is a larger issue than just abortion: the ethical question of whether to censor the information we give to people in order to be able to provide at least some information, or to stand our ground on certain issues and then risk losing the project altogether is one that we face often," Samarthya-Howard says.
It is a trade-off that service providers must make carefully if they are to ensure the least impact on the communities they support: work within the tight boundaries of the policy to try to provide some healthcare to women and girls; or don't and cut them off from that healthcare completely.
"Each time we have to censor information, we are very aware that it reduces the efficacy of our programmes," she adds.
The U.S. Embassy in Pretoria says it's too soon yet to tell what the effect of the policy will be. Embassy spokesperson Cynthia Harvey says: "U.S. Mission in South Africa has not yet received guidance from the new administration with respect to these new policies, and any discussion of implications of such policies at this state would be premature".
Harvey says that, through various agencies, "the U.S. government funds South African organisations that engage to improve HIV and TB services," but added that no U.S. agency is currently funding abortion abroad, including in South Africa.
While it is too early to say yet with any degree of specificity what the impact of the policy will be in practice, history has shown that restricting funding for clinics that provide abortion services can lead to a rise in unsafe abortions. A 2011 Stanford University study also found that in countries that had a greater reliance on U.S. funding, there was a drop in contraception use and a rise in the number of abortions when the policy was instituted.