Info Service on Health Issues (December 06/07)
Health: US gag rule killing women
policy denying access to sexual and reproductive health services over
issues around abortion has contributed to high death and disability
rates in developing countries public health experts say.
could change if the US reverses its policy according to a series of
reports published in the Lancet. The article below details the
impact of this policy so far.
is reproduced with the permission of South-North Development Monitor
(SUNS) # 6159, 11 December 2006.
Health: US gag rule killing
women, say experts
By Stephen Leahy, IPS, Brooklin,
Canada, 7 December 2006
While world attention has
focused on the HIV/AIDS pandemic, public health experts say that US
political interference and declining financial support for family planning,
abortion and prevention of other sexually transmitted infections has
contributed to shockingly high death and disability rates in developing
Approximately 500,000 women die each year of causes related to pregnancy,
abortion and childbirth, 99% of them in developing countries, according
to the World Health Organisation.
"These deaths would not be tolerated in other circumstances,"
says Dorothy Shaw, senior associate dean of the Faculty of Medicine
at the University of British Columbia in Canada.
Countries are failing in their responsibilities and promises to fund
sexual and reproductive health programmes, including supporting universal
access to contraception, Shaw said.
Contraception alone would dramatically reduce abortion rates, she said.
"More than 68,000 women die every year from back-alley or self-induced
abortions," noted Janie Benson, vice president of research and
evaluation at Ipas, an NGO focused on increasing women's ability to
exercise their sexual and reproductive rights and preventing unsafe
Many of the 20 million women who have unsafe abortions each year suffer
from medical complications - some for the rest of their lives, Benson
"This is a preventable pandemic," she emphasised.
Legal abortions are extremely safe. And when abortion is made legal,
it does not increase the number of abortions, she said, citing the South
African experience as an example.
However, by making abortion legal, South Africa is no longer eligible
for USAID (US Agency for International Development) funding for sexual
and reproductive health programmes, including some HIV/AIDS programmes.
"We need governments to decide that women's lives are worth saving,"
Changes in US policy could make a substantial contribution to improving
the sexual and reproductive lives of people worldwide, according to
a series of six reports coordinated by the World Health Organisation
and being published in the British medical journal Lancet this week.
Officially termed the Mexico City Policy, the George W. Bush administration
mandates that no US family planning assistance can be provided to foreign
NGOs that use funding from any other source to perform, recommend or
refer women for abortions.
The destructiveness of US policy is hard to understate, says Steven
Sinding, former director-general of the International Planned Parenthood
IPPF lost $15 million in funding because of this policy, known as the
"gag rule" because it stifles free speech and public debate
on abortion-related issues.
"Three of the five family planning facilities supported by IPPF
in Kenya were forced to close as a result," Sinding told IPS.
The direct consequences of those closures was "a dramatic rise
in unsafe abortions and substantial increase in unwanted pregnancies",
"The US stands embarrassingly alone on this," agreed Stan
Bernstein, senior policy advisor at the UN Millennium Project.
"No other country supports denying access to sexual and reproductive
health services over issues around abortion," Bernstein said in
But because it is the world's wealthiest nation and donor, US policy
has a major impact on the delivery of those services.
What is often forgotten in debates over policy and ideology is the fact
that unwanted births and the subsequent health consequences are a major
impediment to development. Low-income countries cannot keep pace with
the present health needs of their young and cannot improve without family
planning, Bernstein said.
Between 1960 and 2000, the percentage of women using modern contraception
globally increased from less than 10% to 60%, and the average number
of births per woman fell from six to about three.
However, in half of the low- and lower-middle income countries, fertility,
population growth and unmet family planning needs remain high while
contraceptive use continues to be low. As a result, more than 120 million
couples have an unmet need for modern contraception and an estimated
80 million women have unintended or unwanted pregnancies, with 45 million
ending in abortion annually, the Lancet Sexual and Reproductive Health
Pregnancy-related complications kill more than half a million women
every year, and leave approximately 210 million women with disabilities.
In Africa, less than 10% of the population has access to contraceptives,
said Bernstein. "Only the wealthy in Africa have the family size
they want," he said.
As for the White House's preferential strategy of promoting abstinence,
most women have no control over their lives and cannot refuse to have
sex, says Shaw.
"Fifty percent of sexual assaults are on girls under the age of
15. That is the reality in many low-income countries," she said.
Family planning is a powerful tool for boosting development, but funding
has dropped by 30% in recent years and is "desperately underfunded",
Current funding levels are less than half what the 179 countries committed
to at the 1994 Cairo conference on Population and Development. As a
result there has been no progress in 20 years, he said: "It's still
500,000 women dying every year just as it was in 1994."
Between 1995 and 2003, donor support for family planning commodities
and service delivery fell from $560 million to $460 million. Family
planning programmes in Africa alone are projected to cost more than
$270 million in 2006 and nearly $500 million in 2015. And the available
funding for 2006 will be at least $70 million less than needed.
"Without major increases in funding, there is no hope of improvement,"
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