Commentary Law and Policy

Dr. Leana Wen: It’s Time to End the Global Gag Rule

Dr. Leana Wen

The global gag rule doesn’t just drastically limit access to safe and legal abortion. It jeopardizes access to all health care offered by the same providers.

When we invest in global health, we save lives, transform communities, and change the trajectory for generations to come.

As a medical student, I saw the impact of U.S. foreign assistance firsthand when I worked with an NGO that provided care for women living with HIV and AIDS in Rwanda. Medical care with antiretroviral medications and wrap-around social and emotional support empowered women to better care for their families. As a physician and researcher, I have studied health systems in China, Slovenia, Nigeria, Colombia, and South Africa, among others, and I have seen the life-changing impact of global health investments. Now, as president of Planned Parenthood, I lead an organization that provides reproductive health care in the United States and partners with over 100 local organizations in 12 countries in Latin America and in Africa to provide health care and education. There is no question that access to health care, including reproductive health care, is critical to all people having control over our bodies, our rights, our lives and our futures.

For years, there has been a positive global trend toward patient-centered, comprehensive, and evidence-based health care, both in the United States and internationally. But now, President Trump’s global gag rule is systematically wiping out not only access to information and services related to abortion, but health care that people around the world count on. This policy is rolling back decades of progress—and we now have the best opportunity to stop it.

When asked, most people said health care was an important issue in determining their vote in the midterm election. The new U.S. Congress, gaveled in just weeks ago, is taking action in both the Senate and House of Representatives. By introducing the Global Health, Empowerment and Rights (HER) Act, U.S. Sen. Jeanne Shaheen (D-NH) and U.S. Rep. Nita Lowey (D-NY) aim to permanently repeal the global gag rule, which blocks health-care providers from offering lifesaving services and information, silences advocates, and creates fear and confusion for millions of women around the globe. They continue their long-standing leadership today to ensure that health-care providers across the world can do their jobs. Together with over 100 diverse organizations, a pro-reproductive health majority in the House, and bipartisan support in the Senate, we must use the energy of this moment to advance the Global HER Act and stop a policy that threatens health and lives around the world.

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Also known as the “Mexico City Policy,” the global gag rule was first introduced by President Ronald Reagan. It barred international organizations from receiving U.S. family planning funding if they provided, referred, or advocated for abortion services. After years of the policy going in and out of effect, President Donald Trump issued an executive order in January 2017, on his first full day in office, reinstating the gag rule—and going much further. He announced that these funding restrictions would be radically expanded to apply to all U.S. global health programs, including the President’s Emergency Plan for AIDS Relief. Now, if an organization wants to partner with the U.S. to fight HIV or improve maternal health, they have to give up their right to provide legal abortion services, counseling or referrals, or engage in advocacy on abortion—even with their own, non-U.S. funds. This policy is unethical, dangerous, and unacceptable.

For proof, look no further than the Family Life Association of Swaziland, which lost nearly $1 million in U.S. funding under this expanded global gag rule, forcing them to lay off a total of 56 staff members. That meant shutting down programs that provided cancer screenings, HIV services, pregnancy care, and diagnosis and treatment for sexually transmitted infections to young people and other groups who already face disproportionately difficult barriers to care. Fewer patients in need are getting critical, life-saving health care because of this policy.

In Kenya, Family Health Options was forced to close a clinic outside of Nairobi that once provided free HIV testing, antiretroviral medication, family planning, and cancer screening. The entire facility closed, all staff were terminated, and the people in the community who relied on it were left without alternatives.

Two years into the sweeping expansion of the global gag rule, there are countless examples around the world of patients losing access to health care, especially in places where maternal deaths, HIV rates, and unmet need for contraception are unacceptably high. Planned Parenthood’s recent report builds on a growing body of evidence from global health advocates around the world, and confirms that communities are losing access to vital health services and information—from antiretrovirals for people with HIV, to nutritional support for children, to contraceptive information for women.

The global gag rule is playing politics with women’s lives around the world, and now the Trump-Pence administration is also trying to gag providers in the U.S. by preparing a similar domestic gag rule. Whether at home or abroad, the administration is pushing policies that would ask physicians like me to make an impossible choice: either be censored from providing patients with accurate, comprehensive information, or stop providing potentially lifesaving care to some of the most vulnerable patients in need. These gag rules have nothing to do with medicine and everything to do with politics. As a physician, I find it unethical and unconscionable that people could be blocked from accessing vital health care and services that are legal in their countries and in the U.S.

The global gag rule doesn’t just drastically limit access to safe and legal abortion, it jeopardizes access to all health care offered by the same providers, who are often the most qualified experts in their respective region. The policy hits hardest those populations that already face barriers to care—including people of color, families with low incomes, youth, and the LGBTQ community. It places the trust of the physician-patient relationship in jeopardy, gags advocates, violates free speech, and bucks global trends recognizing that reproductive health care is health care and health care is a human right. How can we move health care forward when physicians like me can’t even talk about it to our patients?

We will not be gagged, and we will not be silenced. This is our moment. It is time for Congress to pass the Global HER Act and end the global gag rule once and for all.

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