Donald Trump has been in office for but two weeks and already he is dramatically changing the face of the World as we know it. One of Trump's first actions was to reinstate the global gag rule, a rule initially devised in 1984 by Ronald Reagan. When initiating this, Reagan drew heavily on the morality of US citizens, suggesting the rule was about removing financial support for abortions around the world. Similarly, the conversation about the gag rule has mostly focused around the subject of abortion. Yet, what the gag rule actually does is reduce funding for organisations that educate and counsel on a whole range of issues, including family planning, maternal health, HIV prevention and testing, contraception and sex education for young people.
In order to better understand how this might affect women in the countries that may see a dramatic reduction in financial aid supporting family planning, I interviewed Dr Bianca Stumbitz, who has extensive experience researching issues related to maternity protection including in both Ghana and Malaysia. Bianca draws primarily on her experiences in Ghana, working on an ILO funded study concerning maternity protection in the workplace, looking especially at informal workers in impoverished areas, where access to health care is a key challenge.
I asked Bianca how she thought the gag rule might impact women around the world, to which she replied:
'US aid money is used to provide support to areas where otherwise without that money the support would simply be non-existent. Women will be affected around the world, but the most affected will be the most vulnerable and marginalised from the poorest regions. In these regions women and girls often face pressure to marry young, they may have little or no access to education about sexual health and reproduction. Women who do become pregnant out of wedlock may face serious social stigmatisation and these situations can often mean women turn to abortion as a last resort.'
We began to discuss abortion in more depth...
'There are many issues as to why unwanted pregnancies occur, there is a lack of education, women often feel incapable of saying no, especially in cases of rape and abuse, contraception might not be available, there may be resistance to using contraception, it is complex and begs the question where do you start tidying this up? In these contexts, women will keep finding ways to have abortions, if they do not see another way out. For example, abortion in Ghana was made legal in the 80s but only under certain circumstances. While that may be true many doctors will not perform abortions due to religious beliefs and moral positions. In Malaysia, women face similar barriers to safe abortions as we heard at a previous workshop .
'During my research in Ghana one NGO working in Ghana commented on the common practice of drinking water laced with broken glass, as many women believe that this will induce an abortion.
This obviously ends in death quite frequently. This really does highlight the desperation of the women, but also where the level of reproductive education is at.'
'The same NGO also gave us examples of doctors who agree to perform an abortion informally and at little or no cost, on the condition that the woman will have sex with them beforehand.
For women who do manage to receive a safe abortion, there is little information available to them, about how to prevent it from happening again.'
Considering the lengths that women are willing to go to end unwanted pregnancies it is perhaps unsurprising that:
'Maternal mortality is the second most frequent killer of women in Ghana, unsafe abortion is the second most frequent cause of maternal death - it is a big problem. Globally it is estimated that 21.6 million women suffer an unsafe abortion each year.'
It's ironic that abortion was the moral argument used to introduce the gag rule, given that after Bush reinstated it when he took office in 2001, it resulted in an increase in abortions due to the fact that reduced access to contraception and family planning services led to more unwanted pregnancies. Yet, as Bianca points out this isn't the only irony:
'There is a massive contradiction here, between this particular policy, and the United Nations Sustainable Development Goals which demand we come together to leave nobody behind in achieving good health and well-being, aim to reduce maternal mortality drastically by 2030, empower all women and girls and achieve gender equality.'
When I asked Bianca about the wider political ramifications, she suggested that we can't really predict the future:
'but the messages that have been sent by the US over the last couple of weeks are shocking. It is about the status of women all over the world, it is about the status of the marginalised, this is about social justice, global socio-economic development and sustainable development, it is not only about women, it is the livelihood of families and society.'