Clinic forced to close in Kenya

Marie Stopes Kenya Health Centre in Mathare was forced to close its doors as a result of the Mexico City Policy. Photo courtesy of Marie Stopes International.

Chances are that few of the 300,000 people in Nairobi’s Mathare Valley had ever heard of the Mexico City Policy. These residents of one of Africa’s worst slums just knew that the only clinic providing them with malaria treatments, child checkups, and immunizations had shut its doors for lack of funding.

In Ghana, where the Mexico City Policy cost the Planned Parenthood Association of Ghana $200,000 in U.S. government funding for one of its projects, the loss of services – from HIV/AIDS counseling to pregnancy testing – was felt in more than 1,300 urban and rural communities across the nation.

And in Ethiopia, where HIV/AIDS rates are rising among young women, widespread misinterpretation of the Policy prompted some funders to refuse support to organizations working to fight disease even though they are still eligible for funding, compounding an already ominous trend. 

These reports from health workers in Africa are just a sampling of the unintended consequences of the Mexico City Policy (also known by its opponents as the Global Gag Rule), which the Bush administration invoked in 2001, when the president took office. The policy prohibited the U.S. Agency for International Development (USAID) from giving money to international aid organizations that “performed or actively promote abortion as a method of family planning in other nations.” The ban included organizations that might receive money for abortion counseling from other sources, even when such counseling was legal in the country in question.

Clinic waiting line in Tanzania

In Tanzania, a crowd of people line up outside of a rural clinic operated by Marie Stopes International. The clinic can barely cope with the local population’s high demand for its services. People begin gathering here early in the morning before the doors open, but still, the clinic and its health care workers may not have the capacity to see all these patients by the day’s end. Photo courtesy of Paul Rosenberg, Hewlett Foundation.

In January, President Barack Obama launched a new era for groups that provide reproductive health care in the developing world when he repealed the Mexico City Policy. The Reagan administration first imposed the rule in 1984 at a United Nations International Conference on Population in Mexico City. Since then, it has been alternately imposed and repealed by every successive Republican and Democratic administration.

“This reversal will save and improve thousands of lives in some of the poorest places on earth,” says Sara Seims, director of the Population Program at the Hewlett Foundation. “But much work remains to rebuild what has been lost in the past eight years.”

Intended by American anti-choice organizations to prevent U.S. government support for abortions anywhere in the world, the policy instead has had the paradoxical effect of increasing them. Health care providers who lost funding for refusing to abide by the ban were then unable to provide contraceptives and a broad array of other health services, some of them having nothing to do with abortion.

In an interview with the Washington Post after the ban was lifted, Gill Greer, director-general of International Planned Parenthood Federation – a Hewlett grantee and global provider of reproductive health services – estimated that her organization alone lost about $100 million in U.S. funding in the past eight years. Based on statistics provided by the United Nations Population Fund, Greer estimated that the lost funds could have prevented 36 million pregnancies and 15 million abortions. “This is the true legacy of the Global Gag Rule,” Greer contends.

In a letter to President Obama thanking him for lifting the ban, Greer said at least 200 million women worldwide lack access to family planning and contraceptive information and services, contributing to more than 40 million pregnancies that are terminated every year, half of them unsafely. Complications from unsafe abortion result in approximately 67,000 deaths and at least 5 million serious injuries annually, all of which are preventable.

New Era Begins as Mexico City Policy Is Lifted

With the lifting of the ban, organizations that provide family planning and reproductive health services – like the U.K.-based Marie Stopes International, a Hewlett grantee that works in forty countries around the world – are cautiously optimistic, but say much work remains to rebuild what was lost.

Marie Stopes spokeswoman Diana Thomas said that reversal of the Mexico City Policy has started new discussions between the organization, USAID, and other partners about how they might renew cooperation.

“We’re very excited about the repeal of the policy, even though it is too early to say what the eventual impact will be on our work,” said Grethe Petersen, country director for Marie Stopes International Ethiopia. Noting that new USAID leaders have not yet been named, she added that uncertainty remains about how the funds made available by the repeal will be used.

But, she says, there are hopeful signs.

According to Petersen, USAID officials in Ethiopia have said they will resume support for the United Nations Population Fund – an international development agency that helps host countries reduce poverty and support sustainable development with sound population policies – and have begun talking to Marie Stopes International about a supporting role in that work.

Similarly, Joana Nerquaye-Tetteh, a physician and program director of International Planned Parenthood Federation for the Africa Region, reports that meetings with U.S. aid officials and partners from Liberia, Uganda, Ghana, Kenya, and Sierra Leone began even before the November presidential election in anticipation of a change of the party in power. She said partners in Uganda, Ghana, and Kenya have begun making use of $30,000 in funding from other sources to plan for the return of USAID money.

Facing an Impossible Decision

In testimony before the U.S. House Committee on Foreign Affairs in 2007, Nerquaye-Tetteh had said the 2001 reimposition of the Mexico City Policy faced groups like hers with “a nearly impossible choice.”

Mother and newborn in a Nairobi hospital

Mother and newborn at Marie Stopes Kenya maternity ward, Nairobi. Photo courtesy of Marie Stopes International.

“We had to choose between losing our thirty-year partnership with USAID, which helped us reach the poorest and most vulnerable people in Ghana with family planning services and supplies, or to violate the trust we had painstakingly built with these same people and communities,” she told committee members. “If we signed the Global Gag Rule, we would breach the medical ethics of our staff by requiring them to withhold life-saving, medically necessary information from our clients – requirements that were being imposed by a foreign government.”

Wendy Turnbull, a senior policy and research analyst with Population Action International – an independent policy advocacy and research group that documented the impact of the Mexico City Policy after it was imposed in 2001 – said money was only a part of what was lost.

“Behind everything was community-based distribution: outreach volunteers and nurses going house-to-house in rural areas to dispense condoms and refer people to health centers,” Turnbull says. “Those networks of volunteers and health professionals collapsed in places like Ghana, Ethiopia, Tanzania, Kenya, and Zambia. This was health care at its most basic level that just went away.

“It’s going to take time to rebuild,” she said. “The task now will be to document the good impact of the increase in funds. We have to show that it makes a difference.”