President Joe Biden’s first foreign trip for high-level meetings in Europe was intended as a strong signal to the world that “America is back.” While he was largely referring to the return to diplomatic leadership, the significant commitment that the United States and the Group of Seven countries made to provide more than 2 billion COVID-19 vaccine doses for the world also highlights the return of the United States as a leader in global health.
Such efforts resume a U.S. history of bipartisan leadership on global health, as demonstrated by initiatives like the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), which was launched by President George W. Bush in 2003 and has saved 20 million lives in more than 50 countries. As the Biden-Harris administration works to restitch the U.S. mantle of global leadership, Congress is also using its annual appropriations bill to address how certain U.S. policies on global health reduce the effectiveness of foreign aid and take action to ensure U.S. health policy increases — rather than decreases — access to care worldwide. At the top of that list is the Global Gag Rule.
The rule (also known as the Mexico City Policy) has severely limited the ability of global health professionals and foreign NGOs to provide quality health care to women and girls. Under previous Republican administrations, the Global Gag Rule has prevented foreign organizations that receive U.S. global health assistance from providing information, referrals, or services for legal abortions, even if these organizations choose to do so with their own independent funding.
The Trump administration expanded this policy to cover $12 billion in estimated planned funding for 2018, a 20-fold increase. This expansion in turn impacted global health programs focused on HIV/AIDS, nutrition, malaria, water and sanitation, tuberculosis, and other infectious disease. The policy not only exacerbated existing barriers to health care access but put health care providers in an impossible position: either forego critical U.S. funding or deny patients the information and care they need.
Globally, the COVID-19 pandemic has worsened existing gaps in access to quality, comprehensive health care. In August 2020, the World Health Organization (WHO) published its first survey on the impact of COVID-19 on health systems. Almost every country experienced disruption in health services, with 68 percent of countries reporting disruptions to family planning and contraception as one of the most affected categories of care. The U.N. Population Fund estimates that 12 million women experienced disruptions in their family planning services due to COVID-19, which led to 1.4 million unintended pregnancies.
Access to quality reproductive health care is critical for women’s overall health and has proven economic and social benefits. For example, women who can successfully delay the birth of their first child or plan the subsequent timing and spacing of their children are more likely to enter or stay in school and to have more opportunities for employment and for full social or political participation in their community.
Restoring and increasing women’s access to reproductive health care will be a crucial part of the global recovery from the coronavirus pandemic. Of course, global health security and resilient health systems are not possible without a strong health workforce. Taking the lead from 25 global chapters, Women in Global Health (with which co-authors Dhatt and Williams are affiliated), launched an initiative in March 2021 with the government of France and the WHO to support women working in the sector. Initiatives like this ensure that the health-care workforce is well supported to deliver services such as family planning and sexual and reproductive health.
In addition to the impacts and service disruptions from the Global Gag Rule, the COVID-19 pandemic has exacerbated many of the existing inequities related to sexual and reproductive health and gender-based violence. Skyrocketing rates of violence against women, for example, have created what some experts have called a “shadow pandemic.” Early reports and data indicate that all types of violence against women and girls, especially domestic violence, intensified during the period. Some countries reported a five-fold increase in calls to helplines handling cases of intimate partner violence. The compounding factors of restricted movement and social interaction and economic upheaval in nearly all countries have made women all the more vulnerable to violence in their homes.
The U.S. should consider how to better support access to reproductive health care as part of its larger plans to increase access to health care in the wake of the coronavirus pandemic. There is good news here: the Biden-Harris administration already repealed the Global Gag Rule via executive order in January. While that step ensures that health providers can again deliver comprehensive health services to women and girls, leaders should not allow the continuation of such flip-flopping as administrations come and go. The lack of consistent policy makes it hard for international health-care providers who need U.S. global-health funding to receive these necessary resources. Their responsibility to offer comprehensive health care, including abortion-related services or counseling, can impact their eligibility for such financial support. The United States cannot and will not be a reliable global health leader and partner while women’s access to health care remains at the mercy of U.S. election cycles.
Congress has the power and responsibility to put an end to the Global Gag Rule. Advocates recently spent a week urging members of Congress to commit to repealing the Global Gag Rule this year by enacting the Global Health, Empowerment and Right (HER) Act. The COVID-19 pandemic has been a painful reminder that global health is inextricably tied to the health of Americans. Thanks to Biden’s vaccine pledge, the United States is actively taking steps to help other countries provide the health care their populations need to recover from COVID-19. American leadership is critical to putting an end to this global scourge.
Women and girls have disproportionately suffered over the past 18 months. By permanently repealing the Global Gag Rule, the United States can again don the mantle of global health and help doctors worldwide provide women with comprehensive care. The world’s most vulnerable women and girls will continue to lose their lives, options, and dreams through unsafe deliveries, unsafe abortions, and unwanted pregnancies when they lack access to crucial services. It’s time to end the Global Gag Rule for good, and let women receive the health care they need.