A US government policy that restricts funding to organisations that conduct or support abortions has been linked to a 40% increase in terminations in African countries that depend on American foreign aid, according to new research.
The study, published on Thursday in The Lancet Global Health, also found that implementation of the policy resulted in a reduction of the use of modern contraceptives and an increase in pregnancies.
The policy – officially called the Mexico City policy but also known as the global gag rule – dates back to the Reagan era and demands that NGOs vow not to perform or promote abortions anywhere in the world if they are to receive money from US family planning funds.
It was twice repealed – by Bill Clinton and Barack Obama – but each time reintroduced by a Republican president.
Donald Trump reinstated the rule days after taking office in 2017 and expanded it significantly to prevent NGOs that do not sign from receiving any health assistance – including HIV, nutrition and primary care. In March, his administration widened it to include groups that fund or support organisations that provide or discuss abortion.
As the US is the biggest donor of development assistance in the world, adoption of the global gag rule has had a marked difference on the fates of women and their reproductive health, the study found.
Researchers from Stanford University studied the policy’s impact between 1995 and 2014 on sub-Saharan African countries strongly affected by the policy and compared them to those that were less exposed.
The study drew on data from 26 countries – including induced abortion, pregnancy rates and contraception use – during a period that covered two policy transitions: from Bill Clinton, who repealed it in 1993, to George W Bush, who brought it back in 2001, and from Bush to Barack Obama, who repealed it in 2009.
On average, the difference in abortion rates between high-exposure countries versus low exposure countries was 4.8 per 10,000 – equating to a 40% increase on when the rule was not instated. Meanwhile, contraceptive use dropped by 3.2 percentage points – to a 13.5% relative decrease – and pregnancies went up 3.2 points, to an relative increase of 12%.
Although the implied intention of the rule is to lower abortions in those countries, researchers suggested that because the abortion providers are often also suppliers of contraception it could have the opposite of effect, driving a rise in unwanted pregnancies and, in turn, abortions.
Dr Eran Bendavid, one of the study’s authors, believes the overall impact of the gag rule is potentially more harmful than their findings were able to show.
He said: “The full consequences of the policy include additional potential harms to maternal health that we do not capture. Because abortions are an important cause of maternal mortality, the increase in abortion uptake that we find might also increase maternal deaths—and possibly disproportionately given that abortions under the policy could be less safe if they were less likely to be performed or guided by experienced organisations and providers.
“Our estimates of excess abortion under the policy therefore provide only a partial estimate of the policy’s harm to maternal health.”
Co-author Nina Brooks added: “The health of mothers is a global priority. Our findings suggest how a US policy that aims to restrict federal funding for abortion services can lead, unintentionally to more – and probably riskier – abortions in poor countries.”
