Donald Trump: A threat to women’s health in India?

Donald Trump’s stance on abortion could pose a challenge for women’s healthcare in India.

The 45th U.S. President revived the Mexico City policy within days of taking office in January. Also known as the “global gag rule”, the Mexico City Policy prevents the United States Agency for International Development (USAID) from funding international non-government organisations (NGOs) if they “perform or actively promote abortion as a method of family planning in other nations.”

This is no matter who funds those services, be it a private foundation or even the organisation’s own resources. U.S. funds being used to finance the performance of abortion procedures abroad has long been out of the question.

The 1973 Helms amendment prohibits U.S. foreign aid being used “for the performance of abortion as a method of family planning…[or to] motivate or coerce any person to practice abortions.” What the Mexico City policy does is control how NGOs spend their other funds, under penalty of losing what could be crucial U.S. funding.  

The policy is a favourite of Republicans, with every Republican U.S. President since Ronald Reagan implementing it (and every Democrat President, including Trump’s predecessor, Barack Obama, repealing it.) However, Trump is taking it a step further.

The rule only applied to family planning organisations – until now.

Trump goes a step further

Trump has expanded it to include all health-related NGOs. He also expands the rule to apply to any NGO which accepts global health assistance aid from U.S. agencies, not just the USAID. This includes funding from the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH). It even encompasses funding from specialised agencies, such as the President’s  Emergency Plan for AIDS Relief (PEPFAR).

The ramifications for India could be huge. The U.S. continues to be one of the top donors of foreign aid to India. The Times of India puts its present contribution at around $100 million, on top of $380 million through public-private partnerships (PPPs). In 2016, the U.S. provided $20.3 million to India in health aid, of which 22.9 percent was for maternal and child health and 16.7 percent for family planning and reproductive health.

Much of this assistance could be under threat because of Trump’s hardline stance against abortion, both at home and abroad. Already, Indian NGOs are being asked to sign a declaration that

“Organisation does not provide abortion services, counsel or refer for abortion, or advocate for the liberalization of abortion laws with US Govt. or non-US Govt. funds, including its own funds.”

“Millions of people who needed healthcare had to do without”

The effects of losing this funding are far reaching. As EngenderHealth points out

“Starting in 2001, health clinics around the world were denied funding and forced to close. This means pregnant women were robbed of prenatal care, children could not get immunizations for measles or medicine for malaria, and couples had no way of getting condoms…millions of people who needed healthcare had to do without.”

This leaves Indian NGOs caught between a rock and a hard place. Signing the declaration binds them to not recommend abortions to patients, nor can they participate in any campaign advocating for changes in Indian abortion laws (with some arguing reform is direly needed.) The potential effects of this on women’s health could be ruinous and, in some cases, lethal. It could leave them with no option other than to have the abortion performed in hazardous, unsanitary conditions by untrained ‘quack’ doctors, with nobody to counsel them otherwise.

Not signing the declaration, on the other hand, may leave NGOs drastically under-resourced and underfunded and forcing them to stop certain programmes and initiatives.

“Women will die because of this”

Many organisations condemn President Trump’s renewed enforcement of the global gag rule, saying it will obstruct women’s ability to access medical care worldwide. Women’s health advocacy group NARAL said in a Tweet that Trump “officially turns his anti-woman, anti-choice rhetoric into policy” by reinstating the rule. Planned Parenthood bluntly says that“women will die because of this.”

Underpinning the Global Gag Rule is a deep irony: by trying to prevent abortions, it will increase demand for them. Preventive health services tend to make up the vast majority of services provided by family planning services, with abortion services comprising a minute percentage. Planned Parenthood, for example, provides a full range of reproductive health services. About 97 percent of those services are preventive health services.”

Preventive health services often includes the provision of contraception. Limiting access to these services in developing countries will mean the number of unplanned pregnancies will increase – and, with them, unsafe abortions and maternal deaths.