Expanded Global Gag Rule Limits Women’s Rights and Endangers Their Well-being

An expansion of the “global gag rule” or “Mexico City Policy”-a policy that denies United States development funds to organizations that perform or advocate for abortion, even with their own, non-U.S. funds-poses a grave danger to the lives and health of countless women around the world.

Bush Administration Takes Global Gag Rule Even Further

On Friday, August 29, the Bush administration released an executive memorandum extending the reach of the global gag rule to family planning programs that are funded through the State Department. This move extends the gag on funds for family planning, which previously had affected only voluntary population funds provided through USAID. This drastic expansion means that more of the world’s most vulnerable women, including refugees, will be denied basic health care services.

In response, in September the Senate Appropriations Committee adopted a provision to the Commerce, Justice, State Appropriations (CJS) bill that would have prohibited the use of funds to implement the expansion. The Senate also showed its disapproval of the global gag rule generally when it voted 53 to 43 to overturn the policy in July.

Ultimately, however, Congressional efforts to repeal or prevent the extension of the gag rule failed. Anti-choice conference committee negotiators for the CJS appropriations measure prevailed. The State Department is now free to implement the President’s expansion of the global gag rule.

This new expansion should be seen for what it is: another malicious attack on reputable international organizations doing the real work to save women from HIV/AIDS, unwanted pregnancies, maternal mortality, and sexual violence,” says Nancy Northup, President of the Center for Reproductive Rights.

Expanding the Global Gag Rule to HIV/AIDS Programs Will Cost Many More Lives

The Bush Administration has also threatened to extend the abortion ban to foreign non-governmental organizations (NGOs) that receive any of the $15 billion in U.S. foreign assistance funding for programs aimed at treating and preventing sexually transmissible infections such as HIV/AIDS, as well as other funding aimed at reducing maternal mortality and gender-based violence, and providing reproductive health education. Although this expansion of the gag rule to HIV/AIDS programs has not been carried out yet, it suggests that the Bush Administration is willing to implement draconian policies on the backs of the world’s most vulnerable women.

Under the administration’s proposed scheme, NGOs that agree to abide by the gag rule and receive funds for HIV/AIDS programs would be prohibited from “,diverting”, those funds to family planning activities, while NGOs that refuse to abide by the gag rule could accept HIV/AIDS funds, provided they do not engage at all in family planning activities. This forced separation of HIV/AIDS program from family planning is an illogical, impractical, and dangerous expansion of the previous gag rule. In the context of populations struggling with sky-high rates of HIV/AIDS and high rates of unintended pregnancy, the cutting off of integrated reproductive health services could mark the difference between life and death.

We examine the abortion laws in the 14 countries identified as recipients of the Bush Administration’s new $15 billion funding initiative to shed light on how the gag rule will limit the ability of NGOs in these countries to provide or advocate for comprehensive and compassionate reproductive health care that includes abortion.

Countries Where Abortion is Legal

• Guyana Abortion is permitted on request during the first eight weeks of pregnancy and on broad grounds, including socioeconomic considerations, before 12 weeks have elapsed.¹ The government liberalized the law in 1995 in an effort to reduce maternal mortality due to unsafe abortion and to enhance safe motherhood. ² Prior to 1995, abortion was permitted only to save a woman’s life or to protect her physical or mental health. ³


• South Africa The 1996 Choice on Termination of Pregnancy Act is one of the most liberal abortion laws in the world. Abortion is available on request during the first 12 weeks of pregnancy, for socioeconomic reasons and in cases of rape, incest or fetal impairment up to the 20th week, and to save the woman’s life or in cases of fetal impairment at any stage. ⁴

Under the proposed expansion of the gag rule, foreign NGOs that receive U.S. HIV/AIDS funds would be forced to withhold legal abortion services and information, including counseling and referrals, from HIV/AIDS-afflicted or at-risk women even when that information may be health- or life-saving. The policy contradicts the legal and ethical standards of sovereign countries that have progressive abortion laws.

By decreasing the overall availability and accessibility of safe abortion services, the policy also contributes to the already widespread problem of unsafe abortion and abortion-related mortality in these countries.

In South Africa, where women account for more than half of the 4.7 million adults living with HIV, ⁵ thousands of women resort to unsafe abortion each year, despite the liberal law. South African women’s poor access to safe abortion services can be attributed to a number of factors, including distance from abortion facilities, poor quality of services, hostile attitudes of medical personnel, and inadequate information about abortion.

In Guyana, where the abortion law was liberalized for the very purpose of reducing the high incidence of unsafe abortion and associated mortality, the global gag rule threatens to turn back positive gains for women’s health. Admissions for septic and incomplete abortions in the capital’s largest maternity hospital, for example, declined by 41% within six months after the liberal abortion law went into effect. ⁶ Before that time, septic abortion had been the third largest, and incomplete abortions the eighth largest, cause of admissions to the country’s public hospitals. ⁷

The expansion of the global gag rule will cause health-care organizations that do provide access to safe abortion services to stop these services in order to address the severe HIV/AIDS pandemic. For those organizations that continue to provide safe abortion services, the expansion of the global gag rule renders them ineligible for U.S. assistance for HIV/AIDS programs. Either way, more women will die.

Countries Where Abortion is Legal Under Limited Circumstances

• Ethiopia Under the 1957 Penal Code, abortion is permitted if the continued pregnancy poses a threat to the woman’s life or physical health. ⁸


• Mozambique A 1981 Ministry of Health decree provides exceptions to the general prohibition of abortion in cases of risk to the woman’s life or physical health as well as contraceptive failure. ⁹ The Penal Code, a remnant of former Portuguese rule that is still presumably in force, establishes the general illegality of abortion. ¹⁰


• Rwanda The 1977 Penal Code allows abortion to protect a woman’s life or physical health. Under the former Penal Code, there were no stated exceptions to the general prohibition of abortion. ¹¹


• Botswana Under the 1991 Penal Code, abortion is available to protect a woman’s life or physical or mental health, and in cases of rape, incest or fetal impairment. ¹² The government liberalized the former law, under which abortion was completely prohibited, following pressure from medical professionals concerned about the country’s high maternal mortality and morbidity rates. ¹³


• Namibia The 1975 Abortion and Sterilization Act, a South African statute that Namibia inherited prior to its independence in 1990, permits abortion to protect a woman’s life or physical or mental health, and in cases of rape, incest or fetal impairment. ¹⁴


• Zambia The 1972 Termination of Pregnancy Act is one of the most liberal abortion laws in Sub-Saharan Africa, permitting abortion to protect a woman’s life or physical or mental health, to prevent socioeconomic hardship and in cases of fetal impairment. ¹⁵

Despite the legally permissible grounds for obtaining abortion in these countries, women’s access to safe abortion services is already limited due to various factors, including a shortage of trained providers, lack of medical facilities, high fees and burdensome abortion regulations. The problem of poor access is indicated by alarmingly high maternal death rates due to unsafe abortion in many of these countries. In Ethiopia, over 1,200 women between the ages of 16-20 die for every 100,000 who undergo abortions. ¹⁶ In Ethiopian hospitals, more women die from complications relating to illegal abortion than for almost any other reason. ¹⁷ These deaths are preventable, as safe abortion procedures are less risky than childbirth. ¹⁸ In Mozambique, most local hospitals perform abortion for a fee, putting safe abortion beyond the reach of most women who need it. ¹⁹

The Bush Administration’s expanded gag rule would prevent many health care providers from providing desperately needed abortion services that are affordable and safe. The Bush policy would also prevent health-care providers that witness firsthand the deaths and injuries from illegal abortions from contributing to debates on the further liberalization of abortion laws. Finally, the expanded gag rule would prohibit those organizations that continue to provide safe abortion services from receiving assistance for their HIV/AIDS programs.

Countries Where Abortion is Illegal

• Cô,te d’Ivoire Under the 1981 Penal Code, abortion is prohibited unless it is performed to save the woman’s life. ²⁰ The Code also prohibits incitement to abortion by public discussion, advertisement or distribution or sale of substances or objects. ²¹


• Kenya The 1973 Penal Code allows abortion only to save the woman’s life. ²²


• Nigeria Two separate but substantively similar laws govern abortion. The 1959 Penal Code applies to the predominantly Muslim northern half of the country, while the 1916 Criminal Code applies to the largely Christian southern half. Both laws permit abortion only to save the woman’s life. ²³


• Tanzania The 1945 Penal Code permits abortion only to save the woman’s life. ²⁴


• Uganda The 1984 Penal Code permits abortion only to save the woman’s life. ²⁵


• Haiti Abortion is governed by the French Penal Code of 1810, which makes no explicit exceptions to the prohibition of abortion. ²⁶

In countries with prohibitive abortion laws, reform efforts are critical to curbing high rates of maternal mortality and morbidity. Under the Bush Administration’s expansion of the gag rule, U.S.-funded health care providers that want to speak publicly about abortion or advocate for reform would be silenced. This stifles the free speech of these NGOs and cripples their ability to liberalize their country’s draconian abortion laws. In Kenya, the urgent need for abortion law reform is highlighted by the fact that approximately one-third of all maternal deaths result from unsafe abortion. And in Nigeria, support for abortion law reform and the provision of care for complications resulting from abortion is increasing due to concerns about high rates of abortion-related mortality. ²⁷

The expanded Bush gag rule would force many health care providers in these countries into the no-win situation of either accepting U.S. funding and remaining silent on reform efforts to save women’s lives, or foregoing funding at the risk of jeopardizing their programs for HIV/AIDS and other affected services. The critical need for such programs is demonstrated by the staggering prevalence rates of HIV/AIDS in these countries. In Kenya, an estimated 2.5 million adults and children are living with HIV, 1.4 million of whom are women. ²⁸ In Nigeria, the total figure is 3.5 million, with 1.7 million infected women. ²⁹

Endnotes 1 United Nations Population Division, Abortion Policies: A Global Review, Vol. II, Guyana (2002) [hereinafter UN Abortion Policies: A Global Review]. 2 Id. 3 Id. 4 South Africa, Choice on Termination of Pregnancy Act, No. 92 (1996). 5 UNAIDS, Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections, South Africa (2002) [hereinafter UNAIDS Fact Sheets on HIV/AIDS and STIs]. 6 F.E. Nunes and Y.M. Delph, Making abortion law reform work: steps and slips in Guyana, Reproductive Health Matters, Vol. 5, No. 9, p. 66-76 (May 1997). 7 Id. 8 Ethiopia, Penal Code of the Empire of Ethiopia, Proclamation No. 158 (1957). 9 UN Abortion Policies: A Global Review, supra note 1, Mozambique. 10 Id. 11 Id, Rwanda. 12 Botswana, Penal Code (Amendment) Act (October 11, 1991). 13 UN Abortion Policies: A Global Review, supra note 1, Botswana. 14 South Africa, Abortion and Sterilization Act (1975). 15 Zambia, The Termination of Pregnancy Act, No. 26 (1972). 16 United Nations Integrated Regional Information Networks, Ethiopia: High Death Rate from Illegal Abortions, October 28, 2002. 17 Id. 18 Planned Parenthood Federation of America, Inc. Fact Sheet: Medical and Social Health Benefits Since Abortion Was Made Legal in the U.S. 19 UN Abortion Policies: A Global Review, supra note 1, Mozambique. 20 Cote d’Ivoire, Loi. No. 81-640, arts. 366-367 (July 31, 1981). 21 Id. at arts. 368-369. 22 Kenya, Penal Code, arts. 158-160, 240 (1973). 23 UN Abortion Policies: A Global Review, supra note 1, Nigeria. 24 Tanzania, Penal Code, arts. 150-153, 230 (1945). 25 Republic of Uganda, The Penal Code Act (CAP 106), revised edition (1984). 26 Haiti, Code Pé,nal. 27 Center for Reproductive Rights, Common Reproductive Health Concerns in Anglophone Africa (May 2002). 28 UNAIDS Fact Sheets on HIV/AIDS and STIs, supra note 5, Kenya. 29 UNAIDS Fact Sheets on HIV/AIDS and STIs, supra note 5, Nigeria.