Beyond abortion: impacts of the expanded global gag rule in Kenya, Madagascar and Nepal

Abstract

Since 1984, Republican administrations in the US have enacted the global gag rule (GGR), which prohibits non-US-based non-governmental organisations (NGOs) from providing, referring for, or counselling on abortion as a method of family planning, or advocating for the liberalisation of abortion laws, as a condition for receiving certain categories of US Global Health Assistance. Versions of the GGR implemented before 2017 applied to US Family Planning Assistance only, but the Trump administration expanded the policy’s reach by applying it to nearly all types of Global Health Assistance. Documentation of the policy’s harms in the peer-reviewed and grey literature has grown considerably in recent years, however few cross-country analyses exist. This paper presents a qualitative analysis of the GGR’s impacts across three countries with distinct abortion laws: Kenya, Madagascar and Nepal. We conducted 479 in-depth qualitative interviews between August 2018 and March 2020. Participants included representatives of Ministries of Health and NGOs that did and did not certify the GGR, providers of sexual and reproductive health (SRH) services at public and private facilities, community health workers, and contraceptive clients. We observed greater breakdown of NGO coordination and chilling effects in countries where abortion is legal and there is a sizeable community of non-US-based NGOs working on SRH. However, we found that the GGR fractured SRH service delivery in all countries, irrespective of the legal status of abortion. Contraceptive service availability, accessibility and training for providers were particularly damaged. Further, this analysis makes clear that the GGR has substantial and deleterious effects on public sector infrastructure for SRH in addition to NGOs.

Striving toward safe abortion services in Nepal: A review of barriers and facilitators

“…The global gag rule (GGR) prohibits non‐US‐based nongovernmental organizations (NGOs) from providing, referring, or counseling abortion services that receive US global health assistance. It also prohibits advocating for abortion law reforms 20 . GGR has fragmented sexual and reproductive health (SRH) service delivery in many countries, including Nepal 20 .…”

“…It also prohibits advocating for abortion law reforms. 20 GGR has fragmented sexual and reproductive health (SRH) service delivery in many countries, including Nepal. 20 The broad scope of this policy affects funding allocation, posing challenges even for NGOs without direct US government funding.…”

“… 20 GGR has fragmented sexual and reproductive health (SRH) service delivery in many countries, including Nepal. 20 The broad scope of this policy affects funding allocation, posing challenges even for NGOs without direct US government funding. This disruption is consistent with pre‐existing barriers to legal abortion, such as limited knowledge, stigma, cost, and limited access to services.…”

Two decades of research capacity strengthening and reciprocal learning on sexual and reproductive health in East Africa – a point of (no) return

“…Abortion care is included on the WHO’s list of essential healthcare since 2020 [ 2 ], and while there has been advances in SRHR in recent years, the world has also experienced a significant backlash leading to restrictions on access to abortion care [ 3 ]. For instance, the reinstatement of the Mexico City Policy in the US in 2017 prohibited foreign non-governmental organisations from providing, referring, and advocating for or counselling on abortion as a method of family planning which resulted in decreased access to SRHR services in many low- and middle-income countries [ 4 ]. This was followed by the upheaval of Roe vs Wade in 2022, ending the constitutional right to abortion in the US, giving anti-choice movements, increasing ground to target countries outside of the US including East Africa.…”