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Lives at risk as Global Gag Rule returns

03 Apr 2017

Foreign Minister Julie Bishop recently announced an additional $19 million to support the work of International Planned Parenthood. However, at the recent ‘She Decides’ conference[8] it was confirmed there was no extra pledge from Australia to contribute to the $250 million raised to help fill the gap left by the US Government decision to cut funding that could be used for family planning, including safe abortions.

  • Every eight minutes a woman in a developing country will die of complications arising from an unsafe abortion.4
  • Unsafe abortion is one of the five leading causes of maternal mortality (13%) and the only fully preventable cause.5
  • Every year, worldwide, about 42 million women with unintended pregnancies choose abortion, and nearly half of these procedures, 20 million, are unsafe. Most unsafe abortions (97%) occur in developing countries.
  • Of the women who survive unsafe abortion, five million will suffer long-term complications6
  • In developing countries, two-thirds of unintended pregnancies occur among women who were not using any method of contraception.7
  • In Australia, abortion is a safe and common medical procedure, with approximately one in three Australian women access an abortion at some time in their lives.

Whilst the Australian Government’s support for sexual and reproductive health has been solid there remains much to do. Médecins Sans Frontières (MSF) sees the impact on women and families of poor reproductive health options. We know that when support for sexual and reproductive health services is cut, the result is more (unsafe) abortions, not less, and more deaths and suffering for mothers and children.

The reinstatement of the US Government’s Mexico City Policy by President Trump, which prohibits non-governmental organisations that receive US funding from performing or providing counselling or information on abortion, will undermine access to safe abortion services and endanger the lives of many women worldwide.

Lives at risk

The US Policy, or so-called Global Gag Rule (GGR), restricts people’s right to make informed health decisions, as well as make it more difficult to access family planning services. Where safe abortion care is not available, women and girls will put their lives at risk. When left with no safe options or lack of information and education, women and girls will resort to abortions carried out by untrained people or in environments lacking minimal medical standards. According to the WHO, of the estimated 42 million abortions requested per year, roughly 20 million are considered unsafe.

Abortion law and policy liberalization could lead to drops in unsafe abortion and related deaths, as we can see bellow (graph 1), illustrating the dramatic decline in abortion-related mortality following policy reform in Romania from 1989.

Public policies governing abortion in the USA are contentious and highly partisan. For the past couple of decades, Republican administrations adopted the GGR and Democratic administrations rescinded it. The net impact of such policies on abortion rates is likely to be complex and potentially fraught with unintended consequences. The USA is the world’s biggest donor to family planning and women’s health programs in the developing world, and contributes around US$10 billion annually to global health. A total of US$607.5 million US government funds (of which $32.5 million is designated for the United Nations Population Fund (UNFPA)) is allocated for family planning and reproductive health programs for the 2016 financial year.

Sadly, the GGR cuts US funding for any other activities undertaken by organisations that provide abortion services. In some contexts these organisations are the only provider of a range of primary healthcare services, such as cervical screening, STI prevention and treatment including for HIV/AIDS, management of tuberculosis, pre- and post-natal care and even newborn health care. In low income settings, these services will not be replaced by the local government or other actors easily, leaving a gap in the system. The consequences are therefore a global health issue that has serious implications for the most vulnerable populations.


Broader benefits

Reducing access to family planning services contradicts the fact that investing in family planning is one of the most cost-effective interventions in global health and development. Every one dollar invested in reproductive health generates up to 120 times its value in economic and social benefits, including reductions in unintended pregnancy and maternal and child mortality, improved health and wellbeing, increased educational attainment for women and children, and greater female labour force participation. Also, family planning is essentially related to spacing out childbirth. The health and economic benefits of child spacing are well documented and include reduced pregnancy-related deaths and better child survival. 

MSF provides sexual and reproductive health care to over 200,000 women each year worldwide. Safe abortion care—the treatment of abortion-related complications, termination of pregnancy on request, and family planning—is just one part of MSF women’s health care in 28 countries across our field operations. In 2014 and 2015, MSF teams cared for more than 20,000 women with complications of abortion, including severe haemorrhaging, infections and peritonitis. Without treatment, these can result in injury, sterility and death. MSF estimates that between 50 and 80 per cent of the complications were due to abortions carried out in poor conditions and/or by unqualified personnel. 

MSF does not apply for any US government funding so is not financially affected by the GGR. However, as providers of medical care in places where women and children will be directly affected by this policy, MSF will witness the actual increase of unsafe abortions and the wider consequences for a range of other health issues, such as HIV/AIDS, STIs, TB and mother and child health and wellbeing.