Abort Mission

The television legacy of the Reagan administration has finally aired, on Showtime rather than CBS, bringing its screechy tales of 1980s conservatism only to a small, paying audience of devotees to kitsch.

The miniseries was blasted by conservatives for, among other things, supposedly exaggerating Ronald Reagan's blithe obliviousness to the AIDS crisis. But, in fact, it's hard to overstate the impact of the president's policy on the HIV/AIDS epidemic that is burning a hole in the developing world today. Reagan's global family-planning policy—called the "global gag rule" by its opponents—has been revived by the current Bush administration. It represents a disturbing example of a conservative moral export that has become ever more problematic, contributing to both HIV infections and deteriorating women's health.

It's been nearly 20 years since Reagan instated the so-called Mexico City policy, named for the site where Reagan announced—at a United Nations population conference in 1984—that USAID funding would be pulled from nongovernmental organizations that used funds, even from other sources, to address abortion, including counseling, referrals and lobbying to make it legal. It was an insidious bit of pandering to the right: Under the 1973 Helms Amendment, the United States was already forbidden by law from funding abortions outright. The Mexico City policy ensured that population-control organizations, family-planning centers and health-care providers couldn't even discuss the impact of (or alternatives to) abortion in the developing world. Since its inception in 1965, USAID funding for population programs has made the United States the single largest donor country, accounting for almost 40 percent of the total funds donated. The effect of the rule, on the books between 1984 and 1992, was to slash funding and undermine reproductive-health policies. Bill Clinton reversed the policy on his first day in office.

Ever true to his base, George W. Bush reinstated the policy the moment he arrived on Pennsylvania Avenue. Then, this August, he quietly extended the Mexico City policy, prohibiting the entire Department of State from funding groups overseas that addressed abortion as a reproductive-health issue. What's more, he tried to apply its restrictions to promised HIV/AIDS funding.

But, this time, opponents were ready. Upon Bush's inauguration, a handful of activist organizations immediately began collecting information for impact studies. In conjunction with AIDS activists, they were able to delink the gag rule fromAIDS funding. And in the past two months, they have released two key reports. "Access Denied: US Restrictions on International Family Planning"—penned by a consortium dubbed the Global Gag Rule Impact Project and led by Population Action International, Planned Parenthood and Ipas—looks at the devastating impact the Mexico City policy has had on family planning, integrated health care and preventing HIV/AIDS. "Breaking the Silence"—the second report, signed by the Center for Reproductive Rights—analyzes the gag rule's unintended effect of increasing the rates of unsafe abortions. Both address the subsidiary trauma to civil society in countries where the United States ostensibly has a vested interest in promoting democracy.

The strategy of fighting back with facts is a smart one. "We looked at impact on services," explains Wendy Turnbull, legislative policy analyst at Population Action International and an author of "Access Denied." "We went to clinics and talked to service providers. … [We asked,] 'What changes have taken place as a result of you signing or not signing the policy?'" Among their findings, all of which occurred since Bush has been in office:

  • In Kenya, five family-planning clinics have been shut down since 2001, one in an area with the highest rates of HIV in the country, another—which had been serving 300,000 people—in one of the poorest sections of Nairobi. Also, a massive USAID–sponsored integrated health-care project for family planning, children's health and HIV/AIDS lost crucial partners among NGOs that refused to sign the gag rule.
  • In Romania, a country where women have long relied on abortion as a means of contraception, the gag rule prevents abortion providers from working with organizations that receive U.S. funding to support educating women about alternative contraception.
  • Supplies of contraceptives are withering in 29 countries. That's because if an NGO doesn't sign the gag rule, the organization doesn't only lose money—it also forfeits the right to receive U.S. donated contraceptives, including condoms. Since Bush reinstated the rule, 16 countries have lost all U.S. supplied contraceptives and 13 have found their supplies severely limited.
  • In Peru the numbers of unsafe abortions increased between 2000 and 2002.
  • Across the world, health centers have been forced to scale back their general health services. For the most part, health centers in developing nations integrate services, both to husband resources and to make sure that a woman's contact with a health-care provider—which is infrequent—is as comprehensive as possible. With the gag rule in place, centers that discuss abortion lose funding, regardless of how many vital services they provide.
  • In addition to releasing their research, the coalition of organizations has also sent out speakers to spread the word on Capitol Hill. At an 8 a.m. meeting on the Hill in October, Dr. Sarah Onyango, a Nairobi-based physician, and Susana Chavez, the program director at Flora Tristán, a Peruvian feminist organization that refused to sign the gag rule, spoke to an earnest crowd of mostly female Hill staffers.

    Onyango related how clinics that once might have provided safe abortions now treat dying women who show up after trying to end their pregnancies themselves. This is "mopping the floor but leaving the tap leaking," she said, and it kills thousands of Kenyan women a year. Chavez described 350,000 illegal annual abortions in Peru, where the government refuses to fund contraceptive technology and yet turns away from the growing health crisis of unsafe abortions.

    She later told tap that the gag rule has been a disaster for liberal women's groups hoping to hold on to their American funding: Essentially, they are unable to debate the issues publicly, while anti-abortion activists speak freely. Both Chavez and Onyango underscored the extended effect the policy has had: Because no one fully understands what is permitted to be discussed, many critical health issues go undiscussed entirely.

    The findings in the two reports should have been incendiary, yet they've hardly received any press. That the gag rule is leading to women's deaths is little known beyond the Beltway. Worse, the Mexico City policy isn't going anywhere: An amendment added by Sen. Barbara Boxer (D-Calif.) to the appropriations bill that would have revoked the policy was stripped in conference by House Republican leadership at the last minute.

    Polls show that nearly 70 percent of Americans say they support USAID– funded family-planning efforts. But, in reinstating the Mexico City policy, Bush has managed to please the right without stirring the vast American middle. Meanwhile, hardcore conservatives are so pleased with the results of this policy that they're using the desperation it's causing abroad against the left. In a particularly cynical gesture, Wendy Wright, senior policy director at the ultra-right Concerned Women for America, suggested that nongovernmental health organizations have "set up integrated programs so they can say [that] immunization will suffer. … The idea of integrated [health care] is mainly a propaganda tool to first try and get around the Mexico City policy. They are literally holding patients hostage, [saying] 'We're not going to provide them immunization or health care unless we're allowed to get money to do abortions.'"

    Unfortunately, the only ones being held hostage are the health-care providers—by the administration itself.