Five reasons to keep speaking out against the global gag rule

Two women sitting crossed legged © Gemma Taylor/Frontline AIDS

On the third anniversary of the reinstatement of the US policy that blocks many women’s access to safe abortion around the world, Frontline AIDS will not be silenced.

Three years ago today, President Trump re-instated and expanded the Mexico City policy – also called the global gag rule. Under this rule, organisations that provide, refer, or counsel women for safe abortion services outside of limited exceptions, or advocate for greater access to safe abortion care, are disqualified from receiving US government health funding. This is the case even if the programme they are seeking funding for is not related to their work on abortion.

The gag rule is harmful to our work and to the HIV response, because it undermines the efforts and evidence of the last two decades on integrating HIV and sexual and reproductive health and rights.

Frontline AIDS refused to comply with the global gag rule and lost out on US government funding as a result. We continue to oppose the global gag rule because:

1. The global gag rule harms women

Almost 100 million unintended pregnancies occur each year globally and more than half of these end in abortion. The global gag rule restricts women’s access to safe abortion care, including in circumstances where abortion is legally available. It also threatens a range of other sexual and reproductive health services, including access to contraceptives, increasing the likelihood of unintentional pregnancy. Research by the International Women’s Health Coalition finds that the policy also negatively impacts women’s access to cervical and breast cancer screening, HIV testing and treatment, and services for survivors of gender-based violence.

2. The global gag rule harms communities most affected by HIV

In 2018, Frontline AIDS carried out research into the impact of the global gag rule in Cambodia and Malawi. We found that sex workers and men who have sex with men are among the communities affected by the gag rule. HIV programmes are being disrupted, which compromises access to HIV prevention and treatment services. In addition, safe spaces for most marginalised populations affected by HIV have closed. As a result networks are eroding, and referrals to friendly health service providers are being disrupted.

3. The global gag rule harms integrated services – and service providers

We have contributed to global evidence showing that integrating HIV as part of comprehensive sexual and reproductive health and rights programme and service packages is effective and improves efficiency. By targeting one component of an integrated package (safe-abortion care), the gag rule undermines the whole package. Organisations which provide abortion care have lost funding which has led to the closure of clinics serving whole communities on a range of needs, including family planning and HIV treatment and care. Service providers have lost their jobs, and others have experienced a loss of trust between themselves and their clients. Some feel a responsibility to continue providing assistance for clients using their personal resources to do so.

4. The global gag rule harms civil society

Several research projects have found that the gag rule has an insidious effect on civil society. It creates confusion, an environment of secrecy, fear, and mistrust, and an additional administrative burden of compliance. The result of this is a breakdown of partnerships, shrinking opportunities for local NGOs, over-enforcement of the gag rule, and weakened advocacy for comprehensive sexual and reproductive health and rights. This is all at a time when these rights are often already under threat from conservative forces.

5. The global gag rule harms other donors’ investments in communities

Any organisation which complies with the gag rule is effectively having all their funds ‘gagged’. Research by amfAR found that 32% of the Global Fund’s HIV grants and 26% of the HIV and TB integration grants risk being restricted by the gag rule. The biggest share of affected funding is that allocated to programmes with and for adolescents, as well as those for men who have sex with men.

With these damning facts in mind, we call upon donor governments, multi-lateral agencies, and private foundations to step in and work with civil society to minimise the impact of the gag rule. We will hold dialogue with allies within the US and outside to reverse the extended Mexico City policy. We will keep the pressure up during the AIDS 2020 conference, to be held in the US in July.

Frontline AIDS stands with partners and allies around the globe to call for the permanent repeal of the global gag rule. Join us. End it.

Find out more about ‘ungagging abortion’ by reading our discussion paper on safe abortion in the context of HIV

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AIDSGlobal gag ruleHIVMexico City policysafe abortion careSRHR