‘This Policy Has Led to Reduced Access to Critical Health Services’ – CounterSpin interview with Nina Besser Doorley on Trump's global gag rule

Janine Jackson interviewed Nina Besser Doorley about Trump’s global gag rule for the February 22, 2019, episode of CounterSpin. This is a lightly edited transcript.


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Janine Jackson: Put in effect in 1984 by Ronald Reagan, the Mexico City Policy prevents foreign organizations that receive US government funding from performing abortions, even if they are using funds from non-US government sources, and even if abortion is completely legal in their country.

But it’s better known as the “global gag rule,” because it does more: preventing funding for agencies that “counsel, refer or advocate” for abortion, forcing NGOs and healthcare providers to choose between crucial resources and their ability to provide the best care for their patients, including speaking freely about the full range of safe, legal options.

The rule has been revoked and reinstated as the White House has changed parties—until Donald Trump, on his first full day in office, not only put it back, but expanded it categorically. Now the gag rule applies not just to family planning funding, but to all global health funding, some $9 billion a year worth of aid, including that going to projects fighting HIV/AIDS and malaria.

Will Donald Trump’s yet again making a bad thing worse be enough to generate some real scrutiny on this harmful policy? And is proposed new legislation a way to real change?

We’re joined now by Nina Besser Doorley. She’s senior program officer for US foreign policy at the International Women’s Health Coalition. She joins us by phone from Washington, DC. Welcome to CounterSpin, Nina Besser Doorley.

Nina Besser Doorley: Hi. Thanks for having me.

JJ: I wonder if you could tell us some of what we already knew about the impacts of the global gag rule, even before Donald Trump’s expansion of it, which is obviously very, very significant. But even before that, we do have a record, there is evidence, of the impact of this gag rule, isn’t there?

NBD: Yeah. Absolutely. What we’ve seen under previous incarnations of this policy is that it has led to a reduced access to services, has made it harder for women to access a complete spectrum of reproductive healthcare, including abortion, but also contraception and other really critical reproductive health services.

It’s also had a really chilling effect on civil society. It has limited how organizations can collaborate with each other, what organizations who do sign the gag rule and accept US government funding with the conditions, what they can participate in. And so it’s had these really wide-ranging effects.

There’s one really interesting study from Stanford University that looked at the Bush administration’s—George W. Bush administration’s—gag rule, and found that it led to clinic closures, it led to reduced services, it led to reduced access to contraceptives, and, in turn, it led to an increase in abortions in sub-Saharan Africa, which is where the study looked.

JJ: It’s interesting that it would lead to an increase in abortions. It’s interesting if you think, “Oh, but wait, I thought it was, you know, anti-abortion.” But it’s really not confusing: If you cut off access to birth control, well, that’s going to have certain repercussions. So in a way, it makes a certain kind of sense, if you don’t go at it thinking that abortion somehow is isolated from the rest of reproductive healthcare.

Nina Besser Doorley

Nina Besser Doorley: “This policy does nothing to reduce the amount women need abortion services. It just makes those services harder to access, and harder to access in safe and legal settings.”

NBD: Yeah. Absolutely. This policy does nothing to reduce the amount women need abortion services. It just makes those services harder to access, and harder to access in safe and legal settings.

JJ: And now we see Donald Trump expanding this to where it’s not just about family planning funding, but all healthcare funding. I’ve read that in some places, like in the Netherlands, they’re trying to do their own fundraising to try and fill the gap, but they just don’t think it’s anywhere near possible to match the funding that groups will lose if they decide not to sign on to this gag rule. I mean, it was bad before, but this really does take things up an order of magnitude, doesn’t it?

NBD:  Yeah, that’s absolutely true. So in previous versions of this policy, it applied only to family planning and reproductive health funding. So if you took those categories of funding, you had to abide by the conditions of this policy, and that’s a pot of money that’s about $500 million a year—significant and important, but what we’re talking about now is the Trump administration has applied this to all global health funding, which is something upwards of $9 billion a year.

And the US is the largest funder of global health worldwide, and these are gaps that can’t be made up by other donors.

JJ: You talked about the ripple effect; it can be difficult to convey to people, because it’s at a community level, right, where a clinic that provides comprehensive care, they do lots of things, may have to close, and of course that’s going to affect everybody, and not only pregnant women. But also, societal level: Groups that might want to advocate to their own government for freer access to abortion, now don’t have this funding that might be needed to support themselves. So it really affects the climate of conversation within these countries.

NBD: Yeah, it really does. And you know, we’re talking about, now, groups that accept HIV funding, groups that get funding for TB programs, groups that get funding for noncommunicable diseases. And in many cases, it’s exactly as you paint it: There’s one clinic that provides all of these services;  they may take funding for, say, TB, and now they’re in a country where abortion is legal, and where they were previously providing that as part of their package of reproductive healthcare. They’re forced to choose: Are they going to forego the TB funding and no longer be able to provide those services to the people in the community who count on them, or are they going to continue to accept that funding, and no longer be able to offer the comprehensive set of reproductive healthcare that is legal in their country, and that women in the community were relying on? And these are really painful decisions for providers, and for organizations that are put in this position to make this call.

Henry Hyde

Rep. Henry Hyde (1924-2007), author of the Hyde Amendment

JJ: Yeah, I would just underscore, by this rule, groups that advocate for more or freer access to abortion can’t get funding, but if they’re advocating for restrictions on abortion, they can still get funding. So in terms of affecting just the conversational climate….

Well, I think when folks are thinking about domestically, we might remember Henry Hyde, and pushing the Hyde Amendment, which means that women can’t use Medicaid funding for abortion. But I want to remind about how he said, in 1977:

I certainly would like to prevent, if I could legally, anybody having an abortion: a rich woman, a middle-class woman or a poor woman. Unfortunately, the only vehicle available is the…Medicaid bill.

I think in a sense, there are things that folks can’t do domestically that they can do through aid programs and for other countries. It’s very obvious that this is an ideological thing, and that it doesn’t have anything to do with medicine or safety or women’s well-being or economic growth or anything like that. I feel like we have to call it out for what it is, right, which has to do much more with control over women than with concerns about healthcare.

NBD: And I think it’s really important to note that this administration is trying to bring this policy home. They have a draft HHS regulation that’s currently being finalized—I’ve heard it could be out any day now—that looks to impose a very similar version of a gag rule to Title X funding in this country. And it’s not a coincidence that they rolled this policy out in the global sphere, in the foreign assistance sphere, which, as you mentioned, is easier to see as over there and not about us. They rolled that out right at the beginning of the administration, and now, a couple of years in, they’re pushing much harder to implement the same agenda and the same ideology in their domestic policy.

JJ: The thing is, though, that most Americans do still want women to have their right to choose when and if they give birth. Sen. Jeanne Shaheen told BuzzFeed right after Trump’s initial move:

If you’re doing it to try and limit abortion, if you’re doing it to try and support stronger families and healthier children and mothers—it does none of those things.

Talking about the gag rule, Rep. Nita Lowey said that the new policy, the expansion of the gag rule, “doesn’t make any sense,” and that that irrationalities might  “be the biggest concern,” because maybe they don’t even realize the impact that this is going to have. Shaheen and Lowey, of course, are co-sponsors of something called the Global Health, Empowerment and Rights, or HER, Act. How would that be responsive to the problem that we’re talking about?

NBD:  The Global HER Act would legislatively solve this problem, both in the immediate and the long term. It would take away the president’s ability to put this policy into effect. So it would basically say that organizations who provide legally permitted abortion services are eligible to receive US government funding, and would take away the possibility of using that as a criteria to not fund organizations.

And I think this is really important, because it’s important that we end this policy now, but because it’s gone back and forth between Republican and Democratic administrations, it has impact in Global South countries even when it’s not in place, because it’s really hard for organizations, particularly small, community-based organizations, to completely reframe and reassess their health programming based on the whims of whoever’s in power in Washington. So this legislation is really important because it would permanently end the global gag rule.

JJ: I actually meant to mention that; it almost goes without saying, but of course you have to say it, and there’s a new book called Crow After Roe that kind of evokes it: When access to abortion is restricted, people are affected differently, and poor and rural and women of color bear the brunt. And what I hear you saying is, that happens even when it’s just a threat, or even when it’s just hanging over people’s heads; it already has that impact, and that impact is felt differently by different communities.

NBD:  Absolutely. And my organization has started a project documenting the impacts of Trump’s version of the global gag rule. And that’s one of the first things that came out of that research and documentation effort, is that it is the people who already have the hardest time accessing healthcare—whether it’s young people, rural people, LGBT communities, and other marginalized groups—it’s those communities that feel the effects of this first, as clinics that they trust start to close, as places that they have access to begin to lose funding and have to scale down services; those are the people who feel these impacts first and most acutely.

JJ: Let me just ask you, finally, what is the situation with the Global HER Act? It has, I believe, a great deal of support that is bipartisan. What should we be looking for, in days ahead, in terms of that legislation?

NBD:  I think it’s really important to note that versions of this legislation have passed both the Senate Appropriations Committee, on a bipartisan vote last year, and the full House earlier this year, again as part of an appropriation. So we’re really close, and I think it’s going to be critical, in the coming weeks and months, to really bring to bear the stories of impact that we already have, the evidence we’ve already gathered around the impacts of these policies, to really bring to Congress a full picture of exactly how devastating this policy, and particularly this Trump version of the policy, is in communities, to help push that bill ahead.

JJ: We’ve been speaking with Nina Besser Doorley. She’s senior program officer in US foreign policy at the International Women’s Health Coalition; they’re online at iwhc.org. Her article with Vanessa Rios, “The Global Gag Rule Has Put Women in Danger for Decades. Here’s How We Can Stop It,” can be found at Rewire.News.

Nina Besser Doorley, thank you so much for joining us this week on CounterSpin.

ND: Thank you.


This piece was reprinted by RINF Alternative News with permission from FAIR.