The Global Gag Rule Isn't Just About Abortion

It wasn't a surprise to me to see President Donald Trump reinstating the so-called "Global Gag Rule" while Vice-President Mike Pence benevolently looked on, but it was a sharp reminder that Republicans like punishing women by any means necessary. The executive order bars the use of federal funds for overseas organizations that provide or "promote" abortion — say, by referring clients to abortion providers or providing information about abortion access to people who ask for advice. Reinstating the gag rule will have consequences that reach far beyond abortion, though, and that's something we shouldn't lose sight of, because this is about public health.

Many younger activists appear to be learning about the global gag rule — also known as the Mexico City Policy — for the first time today, but in fact, this political football has been a presidential rite of passage since 1984. It was first instituted via executive order by President Ronald Reagan, notes the Kaiser Family Foundation, and continued by his successor, President H.W. Bush. President Bill Clinton promptly repealed it... only for President George W. Bush to reinstate it. President Barack Obama also repealed it, and it was utterly unsurprising to see it become one of Trump's first priorities in office.

That's because the gag rule has become a symbol, and a very important one. The Republican base counts on Republican presidents to reinstate it, especially when their right hand man is Pence, the notoriously rabidly anti-abortion former governor of Indiana. Under Pence's tenure, the state experienced unprecedented abortion restrictions — not surprising that he was beaming as his running mate happily reenacted the gag rule.

The global gag rule, the Hyde Amendment, attempts at defunding Planned Parenthood, and the slew of anti-choice laws sweeping across state legislatures are all about punishing women.

NGOs have a lot to lose with the gag rule in place. If they want to receive federal funding for overseas activities, the Helms Amendment already states that they can't use those funds to provide abortions or offer help accessing abortion services. The gag rule is worse than that, though: They can't even use sequestered private funds for that purpose. The U.S. government is effectively dictating basic institutional policy for groups all over the world providing everything from vaccines to anti-malarial education.

That comes at a high cost, with the Center for Health and Gender Equity finding that millions of unsafe abortions occur every year in communities without access to modern contraceptive options. Restricting funding via means like this one means less access to reproductive health care, period, including of course prenatal and maternity care. A 2011 study in the Bulletin of the World Health Organization also notes that abortion rates increase with the gag rule in place — because groups that would otherwise be offering pregnancy prevention can't get funding.

The Republican crusade against abortion is deeply tied in the party's interest in punishing women, who receive the vast majority of abortion services. I use "crusade" advisedly, as the Crusaders very much believed that inflicting pain and suffering on people in the name of Christ was reasonable because it would bring them away from heathenism and closer to god. Similarly, many Republicans believe that people should be punished for seeking abortion because the ends — "protecting the unborn" — justify the means.

The global gag rule, the Hyde Amendment, attempts at defunding Planned Parenthood, and the slew of anti-choice laws sweeping across state legislatures are all about punishing women.

But they are also about something else: dismantling the public health infrastructure. It's not a coincidence that Indiana embarked on a costly and brutal Medicaid experiment with Pence at the helm, or that Republicans are swiftly moving to a block grant system for the venerable and critical public health program. Nor is it a coincidence that Republicans are moving to repeal the Affordable Care Act.

It is this that most concerns me, because I expected the global gag rule to be reinstated, given its history, and I also expect many of the reforms swirling around public health to take place as well. It's important that people understand that the global gag rule isn't just about abortion access. Fundamentally, it is about gross interference in global public health that could have far-reaching and devastating consequences.

It would be disastrous enough if it were just about abortion, but it's not, and virtually every person on earth stands to lose because of the reinstatement of the global gag rule.

It's not just groups providing family planning and abortions or referrals for same that stand to lose. For nations in the Global South with decimated public health budgets, USAID funding is key for rural health care, for reaching vulnerable urban populations, for responding to outbreaks and epidemics. Public health officials have already warned that we are living in a world out of balance, and we already know that disease knows no boundaries: Even the isolationist United States that Trump wishes to cultivate is vulnerable to the travel of devastating illnesses.

This goes far, far deeper than reproductive health and extends into every corner of the global health care framework. It would be disastrous enough if it were just about abortion, but it's not, and virtually every person on Earth stands to lose because of the reinstatement of the global gag rule. That includes anti-choicers and pro-choicers alike; people planning to have families and people with no intention of ever having children; people with uteruses and those without.

It precisely mirrors what Republicans want to do domestically: They want people to be unable to access health care services. To have to beg, borrow, and steal to meet basic medical needs. To endanger the public health framework by shrinking the ranks of inspectors, epidemiologists, and care providers. Republicans have been making war on public health for decades and now they think they have a mandate, so they're starting with the soft and easy stuff first: Repealing the ACA. Reinstating the gag rule. Weakening Medicaid by attacking Planned Parenthood. Don't just consider this an assault on women's lives or part of the fight for women's lives, because it's not. This is about everyone, about a collective fight for survival, with abortion as a fig leaf to distract people from the much bigger stakes.

New Hampshire Democratic Sen. Jeanne Shaheen understands this, and has vowed to introduce a bipartisan bill to permanently repeal the global gag rule. It will be a tough sell, given the Republican domination of Congress and the high probability that the bill would be vetoed if it somehow made it to the White House. Her efforts do highlight a huge problem, though: Executive orders can be abused to push incredibly harmful personal agendas. After eight years of happily watching President Obama circumvent Republican obstructionism with executive orders, Democrats are about to see what it looks like when the tables are turned, and the world is going to pay for it.