Democratic Wings: What can Democrats do about the deadly effects of the Republican Global Gag Rule? Force Republicans into the public position of voting against providing contraception to developing nations

January 07, 2007

What can Democrats do about the deadly effects of the Republican Global Gag Rule? Force Republicans into the public position of voting against providing contraception to developing nations

From Bradford Plumer in The New Republic:

The World Health Organization estimates that nearly 500,000 women in developing countries die each year from causes related to pregnancy and childbirth. Of those, roughly 70,000 die from back-alley abortions. And aid restrictions have hurt those groups best positioned to help. In Kenya, for example, two health organizations have had to shut down eight clinics since 2001 after proving unable to abide by the gag rule and losing their USAID funding. Many of those clinics were the sole providers of health care for women and children in their respective regions, and most had offered post-abortion care--critical in a country where abortion is illegal, unsafe, and causes an estimated one-third of maternal deaths annually.

Increased access to birth control would, of course, prevent many of those pregnancies from occurring in the first place. Thanks to the gag rule, though, many NGOs can no longer receive donations of contraception from the United States, a primary supplier. As of 2002, at least 16 developing countries had lost their entire USAID supply of birth control, because an affiliate of International Planned Parenthood had been the only group distributing contraception in the country Among the things one never expects to see in the Des Moines Register is a six-part exposé on how Ethiopia is suffering at the hands of U.S. family-planning policies. But, in October, Rekha Basu, a columnist for the Register, traveled to Ethiopia and sent back a vivid portrait of a poor country that has seen its birthrate skyrocket, due in part to a paucity of birth control and family-planning clinics. One in seven women die from pregnancy-related causes. Many more opt for illegal "backyard" abortions--and often kill themselves trying.

One might assume that the United States, which sends more than $200 million in aid to Ethiopia each year, is in a position to help. Not so. Thanks to restrictions put in place by both the Bush administration and anti-abortion Republicans in Congress, most of that aid has been funneled away from family-planning organizations, forcing health clinics to shut down and birth-control supplies to dwindle. "We haven't counted the number of women who got pregnant as a result," one local advocate said.

Even though these restrictions have exacted a deadly toll on women in developing countries--and, ironically, may well increase the abortion rate--they garner relatively little attention, tracked mainly by advocacy groups and the occasional attentive columnist. But the debate over family-planning funds could become one of the major reproductive-rights battles over the next two years: Although pro-choice Democrats in Congress may lack the votes to improve abortion rights at home, the international arena is a different matter, and the first skirmish may come over one of the most notorious Bush-era policies--the so-called "global gag rule".

In 1984, at a U.N. population conference in Mexico City, Ronald Reagan first declared that not one cent of USAID money would go to any nongovernmental organization that promoted abortion as a method of family planning. If a health-care provider wanted to receive U.S. funds, it couldn't refer women to abortion clinics, or offer post-abortion counseling, or lobby to make the practice legal, or even so much as discuss abortion policy in public. Many groups agreed to the new rules. Others refused and immediately lost their funding--no small thing, given that the United States provides some 40 percent of the global aid budget for population programs.

The tug-of-war over the gag rule has never ceased. Bill Clinton repealed the policy on his first day in office. In 1999, Republicans in Congress forced Clinton to reinstate it in exchange for releasing nearly $1 billion in back dues to the United Nations. The rule was reversed again the following year, but George W. Bush, on his very first day in office, brought it back and, two years later, expanded the gag rule to cover other State Department family-planning grants. The religious right, suffice to say, rejoiced.

The destructiveness of the gag rule is hard to overstate. The World Health Organization estimates that nearly 500,000 women in developing countries die each year from causes related to pregnancy and childbirth. Of those, roughly 70,000 die from back-alley abortions. And aid restrictions have hurt those groups best positioned to help. In Kenya, for example, two health organizations have had to shut down eight clinics since 2001 after proving unable to abide by the gag rule and losing their USAID funding. Many of those clinics were the sole providers of health care for women and children in their respective regions, and most had offered post-abortion care--critical in a country where abortion is illegal, unsafe, and causes an estimated one-third of maternal deaths annually.

Increased access to birth control would, of course, prevent many of those pregnancies from occurring in the first place. Thanks to the gag rule, though, many NGOs can no longer receive donations of contraception from the United States, a primary supplier. As of 2002, at least 16 developing countries had lost their entire USAID supply of birth control, because an affiliate of International Planned Parenthood had been the only group distributing contraception in the country--and refused to accept the gag. A recent study in the Lancet found that 120 million couples in low-income countries don't get the contraception they need. Partly as a result, 80 million women have unwanted pregnancies each year, more than half of which end in abortion.

Anti-abortion groups tend to gloss over these points. Asked whether it seems plausible that the gag rule has actually increased the number of abortions in the developing world, Jim Sedlak, vice-president of the American Life League, simply retorts that abortion statistics are hard to come by. "The important thing is that we have hindered the efforts of organizations like Planned Parenthood to lobby for abortion, in countries where it's illegal, using U.S. taxpayer money."

He's right: Family-planning groups funded by USAID are forced to sit on the sidelines in local debates over reproductive choice, leaving abortion opponents free to dominate the discussion. In Peru, where abortion remains illegal, women's health organizations that want to preserve their funding can't even cite statistics on the 50,000 women hospitalized each year due to unsafe abortion. For many abortion foes in the United States, that's exactly as it should be. Indeed, conservatives who talk loudly about democracy-promotion in other contexts have little to say about a policy that effectively stifles public debate throughout the developing world.

All that could soon change. Last year, Democratic Senator Barbara Boxer sponsored an amendment to an appropriations bill that would have overturned the gag rule. It passed in the Senate, but Bush threatened a veto, and the provision was quietly stripped out by the House Republican leadership. With the GOP now consigned to the minority, nothing is stopping a showdown with the president over the issue. "I believe the support exists in Congress for correcting this policy," insists Representative Nita Lowey, a New York Democrat and prominent critic of the gag rule. On the anti-abortion side, Sedlak predicts "two years of intensive battles" over international family-planning legislation.

Abortion foes hope that the White House will veto any attempt to overturn the gag rule. But polls show that over 70 percent of Americans support USAID-funded family-planning efforts, and it's not clear that a weakened president will have the strength to beat back repeal efforts. Democrats could also craft a compromise bill that would allow groups blacklisted by USAID to receive, at the very least, supplies of contraception. That's an inadequate half-measure, but it would prove difficult for Republicans to oppose publicly. "If members had to vote against providing contraceptives to developing countries, I don't think a majority of them could," says one Democratic aide. "So far, the [GOP] leadership has protected its members from being put in this position."

Republicans could find themselves in a quandary, since a number of influential anti-abortion organizations flatly oppose any such compromise. Sedlak argues that sending even condoms to Planned Parenthood affiliates abroad would enable those affiliates to free up resources for promoting abortion rights. In any case, Sedlak claims that many contraceptives are "a kind of chemical abortion"--a view supported neither by science nor most voters, but gaining in popularity among anti-choice lobbying groups.

No such tension really exists among Democrats, even though they may be split on other abortion issues. "On the Democratic side, there is strong support across the abortion divide for restoring U.S. support for the prevention of unintended pregnancies," says Susan Cohen, director of government affairs for the pro-choice Guttmacher Institute. Even anti-abortion Democrats in the Senate such as Harry Reid and Ben Nelson voted for the Boxer amendment. In the House, Representatives James Oberstar and Tim Ryan, both normally opposed to abortion rights, recently introduced a bill to double the amount that USAID spends on contraceptives, exempting donations from the gag rule.

If Democrats can make headway on the gag rule, other foreign-aid issues may follow. The Bush administration has withheld hundreds of millions of dollars from the U.N. Population Fund (a major supporter of international family-planning efforts) over unsubstantiated charges that the agency supports forced abortions and sterilizations in China. Similarly, restrictions in how family-planning groups abroad can use funds in the Bush administration's HIV/AIDS initiative have, as Basu showed, sometimes hindered HIV-prevention efforts in countries like Ethiopia. These are all relatively obscure issues--but they're also matters of life and death, and deserve a major fight.

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