HIV and SRHR are inextricably linked but under threat

Our Director of Programmes, Divya Bajpai, was invited to speak at last week’s She Decides conference. Here she blogs about her thoughts on the Global Gag Rule.

Over the last decade, the global consensus in health and development policy has pointed in one direction: towards greater integration of services.

We fear the Trump administration’s decision to re-instate the Global Gag Rule, also known as the Mexico City Policy, will undo our achievements in providing integrated Sexual and Reproductive Health and Rights (SRHR) and HIV services.

The World Health Organisation (WHO) framework calls for the development of integrated, people-centred health services, an end to the siloes around health provision, and a determination to put health needs at the heart of our approach. The Sustainable Development Goals (SDGs) point in the same direction.

Last year the Alliance reached almost 1.6m people with an integrated package of HIV and SRHR services.

The Global Gag Rule puts that under threat. The Alliance is first and foremost an HIV organisation, but HIV and SRHR have become inextricably linked across our work. For organisations who are dependent on US aid, the Global Gag Rule has the effect of severing the connection between these services. We are being forced, against our wish, to face impossible choices.

We fear the Global Gag Rule will undo our achievements in providing integrated SRHR and HIV services

The full implications of this seismic policy shift by the US government will be to:

• divide safe abortion from holistic SRHR programming, ruling out a whole portion of our work; and
• target “all global health funding” provided via USAID, potentially impacting how a whole range of health, HIV and SRHR services are provided.

Last week it was an honour for me to be invited by the Government of the Netherlands to attend the She Decides pledging conference. Although the final details of the initiative need to be ironed out, it was humbling to see such a strong mobilisation in defence of SRHR. The initiative aims to build on the groundswell of public opinion that preceded the announcement of the new Global Gag Rule when we saw millions of women globally, march in defence of their agency.

Today, on International Women’s Day, is another opportunity to make the connections between that grass roots movement, donor and member state action.

Future prospects

At the very least we are likely to see major gaps appearing in global health programming as organisations within the broader health field reject US funding. Up to $9.4 billion of health, HIV and SRHR funding could be at risk.

This decision by the US Administration is forcing us to think the unthinkable: literally to pick and choose between which vulnerable populations can and cannot be served by our Alliance. If we want to continue receiving US aid for services that support LGBTI, sex workers or people who use drugs, then we will have to renounce abortion under the terms of this rule.

It would mean an Alliance organisation working with sex workers being prohibited from referring a pregnant female sex worker to a family planning organisation that offers safe abortion.

This goes against the evidence of what works, against our values and commitment to person-centred health interventions. It is also contradictory to the policies advocated by other member states: the UK, Netherlands, Sweden, never mind the countries where our Alliance members work where abortion is legal.

We are being asked to ride roughshod over the global health consensus, over decades of experience and evidence, and over our own values. It is wrong that the Global Gag Rule is forcing organisations like ours into this impossible Hobson’s choice.

The SRHR ‘movement,’ law makers, and the wider public need to understand that this rule has implications that include, but also go beyond, family planning.

The gathering of civil society at She Decides is testament to the value we all place on an integrated, person-centred health system. It underlines that we are willing to defend it when it is threatened.

Not only do we stand in solidarity with those family planning organisations affected by the Global Gag Rule, but we are ready to work with others to find creative solutions to deliver the best evidence-based services possible, to those who need it most.  As one of the world’s largest civil society networks responding to HIV epidemics around the globe we support the ‘She Decides’ mechanism as one such creative solution.