What is the “Global Gag Rule” and what does it mean for Women and Girls?

Two days after the Women’s March, the new president of the Unites States signed an executive order reinstating the Mexico City Policy, popularly known as the “Global Gag Rule”. The moment was captured in an emblematic photo: Donald Trump – surrounded by men – signing an order that so significantly affects the lives of women around the world, in what many described on social media as a picture of patriarchy.

But what exactly is this controversial policy, and what are its implications for women, girls and beyond around the world?

1) The policy’s origins

This policy is a U.S. government foreign policy. It was not originally created by Trump, simply reinstated by him. It was created by the Reagan administration in 1984 and first announced at the International Conference on Population and Development, which took place in Mexico City (hence the name “Mexico City Policy”). Since then, the policy has been in effect during every Republican president’s term, but not in effect during Democrat presidencies (with the exception of a temporary imposition of the policy during Clinton’s presidency as shown in the table below). 

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Photo Credit: http://kff.org/global-health-policy/fact-sheet/mexico-city-policy-explainer/

2) What it says 

The original text of the policy states that “the United States will no longer contribute to […] nongovernmental organizations which perform or actively promote abortion as a method of family planning in other nations.”

When this policy is in effect, international NGOs that receive U.S. government funding are prohibited from performing, promoting, or providing information on “abortion as a method of family planning”.

The policy does provide an exception: performing, promoting, or providing information on abortion in the cases where the pregnancy poses a risk to the woman’s life, or where the pregnancy is a result of rape or incest is not prohibited. But according to CHANGE (Center for Health and Gender Equity), it is unclear if these exceptions have actually been observed and if services were offered in those cases.

3) Its implications

Many NGOs that will be affected by this policy have been speaking up about its implications on the work they do and the services they provide. 138 organizations have joined Planned Parenthood in a joint statement opposing the policy.

The implications go beyond abortion and women’s health. It could negatively impact serious health issues around the world, since many NGOs that provide services for issues such as Zika and HIV/AIDS would be affected. Melinda Gates has expressed her concern for the way this rule could be implemented by the Trump administration, saying it could affect clinics that provide lifesaving HIV/AIDS, malaria, and tuberculosis drugs. Beyond that, the policy could have negative impacts on humanitarian aid: after the Nepal earthquake in 2015, Marie Stopes International United States (which under the policy would be disqualified from receiving U.S. aid) was able to provide a variety of much needed women’s health services such as contraceptive implants and safe-deliver kits.

Governments have joined NGOs in expressing concerns about the policy. Several countries including Belgium, Canada and Sweden have joined in support of the Netherlands’s initiative to raise money “to help women access abortion services”, saying Trump’s ‘global gag rule’ would “cause a funding shortfall of $600 million over the next four years”.

The flaw of the policy is that, as with most policies and laws that attempt to stop abortions, it won’t stop abortions. It will instead mean that women will be more likely to access abortion through unsafe and unhealthy ways, risking their health and lives. A 2011 World Health Organization study found that, after President George W. Bush reenacted the policy in 2000, abortion rates increased significantly in sub-Saharan African countries.

At the moment, there’s uncertainty about the specific instructions government agencies and NGOs would have to follow. What is known is that comprehensive access to information about sexual and reproductive health is essential for women’s lives around the world, and that whatever measures are created to deter that will be – quite literally – putting lives at risk.

The policy means NGOs will struggle to keep providing lifesaving services, but it’s clear that they won’t stop doing their work. Sexual and reproductive rights may have struggled under this policy in the past, and will likely do so again. But they are still human rights, and they will be fought for.

Cover Photo Credit: Eleanor Gall

Potato Salad or Global Public Health: Invest in Something that Matters

I sat with Derek Fetzer, Co-Founder and Team Leader of Caring Crowd in a quaint café in the Johnson & Johnson headquarters during their Global Citizen Summit. He told me about the significance of this new crowdfunding platform and the various ways young leaders in the health sector can become involved.

After explaining the purpose of Caring Crowd, he pointed out that Johnson & Johnson is genuinely invested as a sponsor and truly values the needs and wellbeing of those they serve. During his thirty second shark-tank-style pitch, he – the multimillion dollar investor – explained to me why I should donate to a Caring Crowd project. Among some of those reasons were:

  • We are sponsored by Johnson & Johnson
  • Health workers are passionate about their involvement
  • The sole focus is global public health
  •  All projects are registered 501 © 3

The projects on the Caring Crowd platform highlight the power of people working together to ensure the wellbeing of others. In his interview he talked about the easy process for individuals to apply as well as the role of a digital presence and accountability. He shared his thoughts on the typical idea of infectious diseases as interconnected but also mentioned the limited attention to health and well being as a point of interconnectivity. A couple of years ago, a Kickstarter project for making potato salad raised over $50,000 – just imagine what we could achieve, if people would be as willing and eager to invest in public health as they were in a side dish. Consider this:

In some parts of the world it only takes $100 to treat tuberculosis for 6 months.

Derek Fetzer finds a never-ending wealth of inspiration from the patients and people benefiting from the Caring Crowd platform. An inspirational platform and an inspiring leader.

Girls’ Globe was sponsored by Johnson & Johnson to provide coverage during the Global Citizen 2016 Festival and to share the stories of the Young Leaders who are participating in the activities in New York. 

Featured image: Russell Watkins/Department for International Development

The Vital Need for Data to Improve Maternal Health

Globally and daily, around 830 women die from causes related to pregnancy and childbirth – equivalent to nearly 35 women an hour. This results in over 300 000 maternal deaths each year – deaths that could be prevented if adequate care was provided. Skilled care before, during and after birth has been identified as one of the key strategies to reducing maternal deaths, a care that 25% of women still do not have access to.

Bernice lives with her father and her four younger siblings in a small rural village in the north of Burundi. Her family, along with eight out of ten Burundians, live below the poverty line, and they depend fully on their household food crop production for their survival. Due to several droughts lately, they are currently facing severe food shortage. Bernice is pregnant with her first child, and even though she’s more than half way through her pregnancy, she hasn’t yet seen a doctor. She is severely malnourished, putting both her and her baby at an elevated risk of complications.

Two years ago, Bernice’s mother Thalia passed away when giving birth to her fifth child, due to a post partum haemorrhage – one of the most common causes of maternal deaths in both developing and developed countries. As with 40% of the deliveries in Burundi, each of Thalia’s childbirths have taken place in their family home – every time without a skilled birth attendant by her side, without both water and electricity.

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Bernice represents a population that is facing numerous challenges that arise from their individual circumstances. Living in extreme poverty in rural Burundi – a country with one of the highest maternal mortality ratios (maternal deaths per 100 000 live births) in the world – makes Bernice and her baby highly vulnerable in regards to surviving pregnancy and birth. In just a couple of months it is her turn to face the difficulties that often come with childbirth in her condition. She fears what is to come, knowing what happened to her mother.

Bernice and her family are fictional characters and fortunately, this time the story is a fictional one. However, based on the latest data on maternal and child health, this is the reality of countless women, adolescent girls and babies around the world, with sub-Saharan African countries facing great challenges in regards of maternal, newborn and child health. In this region, a woman’s lifetime risk of dying during pregnancy or childbirth is an appalling 1 in 36, and the newborn death rate is the highest in the world with 34 deaths per 1000 live births. Compared to a woman in a high-income country, a woman in sub-Saharan Africa faces a 100 times greater risk of dying during pregnancy and childbirth.

The future might look nothing but dark when looking at numbers related to maternal health, but we also need to recognize the improvements that have occurred. Globally, since 1990, the maternal deaths have dropped by 44%, and ¾ of women now have skilled care during their childbirths. Furthermore, at least four antenatal care visits are received by  ⅔ of women worldwide. This increase in maternity services is imperative in showing us that some interventions are successful – hopefully leaving us with a somewhat optimistic mind.

However, in spite of ubiquitous efforts, much is yet to be done. The gap between the countries with the highest and the lowest maternal mortality has grown despite the increased use of maternal health services, resulting in a bigger gap between countries and populations. In other words: millions of pregnant women are left behind from the progress, with minimized opportunities for health gains not only for themselves, but also for their babies.

“We are determined to take the bold and transformative steps which are urgently needed to shift the world onto a sustainable and resilient path. As we embark on this collective journey, we pledge that no one will be left behind.”
The UN 2030 Agenda for Sustainable Development

For us to be able to achieve the Sustainable Development Goals by 2030, and the underlying aim of “leaving no one behind”, accurate, reliable and population-based data on maternal health is essential. It is more crucial today than ever before, and vital to decrease the inequities in care that remains and seem to increase between and within populations.

The percentages in the illustration refer to to following numbers and statistics:

  • 25% of women do not have access to skilled care during birth
  • 99% of all maternal deaths occur in developing countries
  • Between 1990 and 2015, the global maternal mortality dropped by 44%
  • A woman in sub-Saharan Africa is at a 100 times greater risk of dying during childbirth compared to a woman in a developed country
  • Every hour, nearly 35 women die from causes related to pregnancy and childbirth

What Happens to Community Projects after Organizations Leave?

Post Written By Annemijn Sondaal

“It’s not a drug, it’s not a vaccine, it’s not a device. It’s women, working together, solving problems, saving lives” -Richard Horton, editor-in-chief of the Lancet, May 2013

Participatory women’s groups all over the world have created spaces for women to engage in dialogue, exchange their ideas and experiences and spur them to take action to improve their community’s health. The Institute of Global Health, University College London and its’ partners including Women and Children First, have shown that participatory women’s groups can, with participation of at least a third of pregnant women, cut maternal deaths in half and newborn deaths by over a third.

Women’s groups are run and attended by local women (and sometimes men), mobilising local resources to address local problems. This type of capacity-building and community-mobilising intervention is perhaps the most likely to sustain after the supporting organisation leaves, but organisations rarely investigate the long-term effect of interventions or their sustainability. This means that little is known about optimal times and methods to withdraw support, the capacities needed, and support mechanisms necessary for sustainability.
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Mother and Infant Activities (MIRA) has worked with participatory women’s groups in rural Makwanpur, Nepal in collaboration with the Institute of Global Health since 2001. A paid local woman, supported by a supervisor, ran each group. She was also given a meeting manual and training. In 2008, MIRA enacted a handover strategy when the project ran to the end of it’s funding. Twelve to eighteen months passed with no intervention, and we were interested to find out what had happened to the groups. Some essential questions asked were:

  • Had they continued meeting and organising activities?
  • How had they sustained their activities?
  • If they had stopped meeting, why?

The result?

80% of the women’s groups were still ‘active’ (groups who formally conduct meetings, work on strategies and keep meeting minutes). Anecdotal evidence suggests that these groups are still active to this day.

How?

Local importance: Women had experienced how the groups improved maternal and newborn survival. This motivated them to continue meeting and enable the next generation to learn about how to look after themselves and their babies.

Financial independence: Many groups had established maternal and child health funds. Being able to save, and have some financial independence attracted women to the group and motivated them to continue meeting. One woman told us: “When we save, we don’t have to depend on our husbands. We don’t have to beg for money.” Also, we found that many groups had increased their fund to support community activities unrelated to maternal and newborn health.

Leadership capacity: Active groups were led by a strong female community health volunteer or community leader. Or members themselves were confident in owning and leading the group. One group member told us: “MIRA showed us the way. They showed us the right track, and we are now confident to walk that track. Because of this, the group is still running.”

Those groups who were not meeting, or meeting infrequently felt that they had not been given enough time to reach the level of confidence and capacity necessary to continue activities and meetings. These groups told us they wanted more skill-based training: “If there would be [skill-based] training for the chairperson, treasurer, secretary on how to run the group, than we would have planned to do more.”

It is important to consider how interventions can continue after a project support stops. In Makwanpur, the participatory nature of the group and local embeddedness were not enough to sustain groups. They also needed leadership capacity, a unifying activity (such as the fund) and a strong belief in the value of their meeting to sustain.