Issues & Implications
Many indigenous NGOs, desperate
for U.S. funding, have succumbed to
the policy. But the price for doing so
has been high. In Ethiopia, for
example, NGOs continue to provide
U.S.-supported family planning assistance but at the cost of their ability
to engage in a discussion—solicited
by the Ethiopian National Office of
By Susan A. Cohen
Population—about liberalizing
Ethiopia’s abortion law in response
Over the course of his first term,
eve of the commemorations of the
President Bush—with the tacit
ICPD’s 10th anniversary, siding with to the widespread occurrence of septic abortion. Maternal mortality in
approval of Congress—has moved to the Vatican and a handful of other
Ethiopia is among the highest in
isolate the United States ever more
countries such as Sudan and Libya
Africa, and unsafe abortion is a
sharply from the global consensus
on sexual and reproductive health
major contributor. Here and elseon critical matters of sexual and
and rights issues.
where, the gag rule’s reimposition
reproductive health policy. On day
has had no effect on “mak[ing] aborone of his presidency, he reimposed Payback Time
tion more rare,” the president’s statan antiabortion gag rule on recipiDuring his first presidential campaign ed rationale, but it has certainly
ents of U.S. family planning assisin 2000, President Bush assured his
helped to maintain the status quo
tance overseas as the first salvo in
antiabortion base that he would resur- when it comes to the public health
his administration’s campaign to
export its antiabortion agenda to the rect the so-called Mexico City policy tragedy of unsafe abortion.
instituted by President Reagan in
rest of the world. For the last three
Other NGOs—among them, the
years, he has refused on ideological
developing world’s leaders in family
grounds to authorize a contribution The president’s accumuplanning services and health care
to the United Nations Population
lated actions have disprovision generally—resisted.
Fund (UNFPA), rendering the United tanced the United States
Almost immediately, in fact, the gag
States the only donor country to
from its own position in
rule’s reimposition served its unstatdeny funding to UNFPA for nonbudCairo and from governed but primary purpose: to defund
getary reasons. And while—to his
International Planned Parenthood
credit—he has made addressing the mental reaffirmations of
Federation (IPPF), which is reviled
global HIV/AIDS pandemic a high
the Cairo Program of
by antiabortion activists around the
U.S. priority, public health experts
Action from every region world but is also the single largest
from around the world condemn his
of the world.
provider of primary health care seradministration’s overemphasis on
vices internationally through its affilmorality-based approaches to HIV/
1984 and continued by his father
iates in over 100 developing
AIDS prevention coupled with constant questioning about the effective- during his own presidency; the poli- countries. Beyond IPPF, the gag rule
cy, revoked by President Clinton,
forced out Marie Stopes Internationness of condom use.
requires foreign nongovernmental
al, a widely respected, London-based
As for the agreements reached at the organizations (NGOs), in order to be NGO that supports contraception
eligible for family planning aid from and safe abortion services in devel1994 International Conference on
oping countries but also provides
Population and Development (ICPD), the U.S. Agency for International
the president’s accumulated actions Development (USAID), to forego use services such as malaria screening
of their own funds to provide aborand treatment and childhood immuhave distanced the United States
tions or abortion counseling, or to
nizations. Another prominent victim
from its own position in Cairo and
from governmental reaffirmations of engage in any advocacy aimed at lib- was BRAC, the largest and most suceralizing their country’s abortion laws. cessful NGO in Bangladesh, which at
the Cairo Program of Action from
every region of the world. The Bush It was no surprise, therefore, when he the request of the Bangladeshi govreimposed the policy on his first full
ernment offers a form of very early
administration has tried repeatedly
abortion. BRAC is recognized worldto win converts to its approach; still, day in office, as tens of thousands of
wide not only for its work in providthe United States—even as it begins abortion protesters convened in
to recognize the importance of glob- Washington for their annual march on ing family planning and a wide range
the anniversary of the U.S. Supreme
of primary health care services but
al cooperation on the larger world
also for its income-generation prostage—stands virtually alone on the Court’s Roe v. Wade decision.
U.S. Global Reproductive Health
Policy: Isolationist Approach
In an Interdependent World
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jects aimed at some of the world’s
poorest women.
in November 2001 after the fall of the
Taliban in Afghanistan to help reduce
the astronomically high rates of
maternal mortality in that country.
mally, that they withdrew their support in part because UNFPA Executive Director Thoraya Obaid was a
In losing these and other valuable
featured speaker (on the topic of the
partners, the gag rule is taking its
dangers of early marriage and mothtoll on family planning service deliv- Nevertheless, over the objections of erhood). According to a report in
ery, despite the administration’s
Secretary of State Colin L. Powell
The New York Times that same
protests to the contrary. While
and despite the conclusion of a
month, the administration has gone
USAID’s overall contribution to fami- handpicked investigative team that
so far as to warn other United
ly planning overseas has not dimin- UNFPA was not complicit in promot- Nations (UN) agencies such as the
ished under the global gag rule,
ing coercive abortion practices in
UN Children’s Fund (UNICEF) and
investigations of the gag rule’s realChina, the president in July 2002
the World Health Organization
life impact demonstrate that women deemed UNFPA ineligible for U.S.
(WHO) that if they work too closely
are the paying the price in lost fami- support. The administration justified with UNFPA, their U.S. support
ly planning and related primary care
could be jeopardized as well. “The
As if punishing UNFPA
services in those areas where the
Bush administration’s [threatened]
U.S. cutoff forced clinics to close
directly were not enough, isolation of groups such as WHO and
(“Gag Rule Revisited: HIV/AIDS Ini- the administration has
UNICEF that work with UNFPA reptiative Out, Family Planning Still
resents nothing less than a global
signaled its willingness to assault on women’s health,” retorted
In,” TGR, October 2003, page 1).
punish other recipients of Rep. Barbara Lee (D-CA).
Indeed, even President Bush seems
U.S. funding for their
to recognize that the gag rule
association with UNFPA. Moralizing on HIV/AIDS
impedes access to services. To date,
Donor and recipient countries alike
he has resisted intense pressure
its decision based on a tortured
are welcoming the ramped-up U.S.
from his far-right political base to
interpretation of a long-standing
support for the effort to prevent and
extend the gag rule to U.S. global
anticoercion law—the same law
treat HIV/AIDS in the developing
HIV/AIDS programs, which would
under which just one year earlier
world. At the same time, the Bush
have precluded a wide range of oth- and with the same set of facts the
erwise highly qualified reproductive administration had found UNFPA to administration’s campaign against
condoms, along with its aggressive
health care providers in developing
be in full compliance (“Bush Bars
promotion of “abstinence until marcountries from participating. Accord- UNFPA Funding, Bucking Recomriage” programs and repetition of the
ing to Assistant Secretary of State
mendation of His Own Investigafor Population, Refugees and Migrators,” TGR, October 2002, page 13). mantra that abstinence is the only
100% effective method of preventing
tion Arthur E. “Gene” Dewey, the
Thus, the administration made it
HIV/AIDS, are causing consternation
president wanted to save lives from
eminently clear that it would find
in the global public health world. At
the ravages of AIDS and he saw the
the facts to fit its conclusion that
the XV International AIDS Confergag rule policy as interfering with
UNFPA does not and cannot qualify
ence in Bangkok in July, Britain’s
that mission. By contrast, the presi- for U.S. support.
international development minister,
dent is apparently indifferent to the
obstacles he has created when it
As if punishing UNFPA directly were Gareth Thomas, commented diplomatically that the United Kingdom
comes to the opportunity to save
not enough, the administration
women’s lives by preventing a high- recently has signaled its willingness “work[s] with the Americans in a
whole variety of ways, but we have a
risk pregnancy or a septic abortion. to punish other recipients of U.S.
difference of view on abstinencefunding for their association with
UNFPA. Just weeks before the annu- only campaigns” and “a different
Defunding UNFPA
approach on access to condoms.”
al conference of the Global Health
Lieve Fransen, head of the human
Unlike his reimposition of the gag
Council in June, which USAID had
and social development unit at the
rule, which was widely anticipated,
supported for 30 years as a way to
European Commission and the top
the president’s attack on UNFPA in
bring public health professionals
European Union official at the con2002 did come as a surprise, as he
from developing countries to Washference, echoed Thomas’ sentiments.
had affirmatively requested funds for ington to exchange information on
Thomas used the occasion of the
a UNFPA contribution in his FY 2001 best practices, USAID informed the
conference to announce Britain’s
and FY 2002 budgets. Indeed, the
council that it would lose $360,000
plan to boost global HIV/AIDS
State Department had even granted
in U.S. support for the conference.
funding, including supporting the
UNFPA a special infusion of $600,000 Administration officials say, infor-
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“excellent HIV, sexual and reproduc- this year; at that meeting, 37 Latin
American and Caribbean countries,
tive health work” of UNFPA and
almost all predominantly Roman
IPPF.
Catholic and some quite conservative, reaffirmed the Cairo Program of
The Bush administration remains
committed, however, to an HIV/AIDS Action while the United States stood
alone in opposition.
prevention strategy that is largely
reduced to “ABC”—promoting AbstiAt the final meeting of Latin Amerinence, Being faithful and Condom
can and Caribbean countries in
use in that order. In line with that
hierarchy, the United States eschews Puerto Rico in June, the United
condom promotion efforts aimed at States reluctantly joined the consensus—but only after failing to perthe general population, which it
prefers receive the “A” and “B” mes- suade any of the other countries in
sages. The administration still sancFrustration with the United
tions condom promotion to target
groups believed to be unreceptive to States among other donor
those messages, such as commercial nations is growing wider
sex workers (“Beyond Slogans:
and deeper.
Lessons from Uganda’s Experience
the region to dissent. The United
with ABC and HIV/AIDS,” and
“Understanding ‘Abstinence’: Impli- States lodged a host of official
cations for Individuals, Programs
“reservations” to what it characterand Policies,” TGR, December 2003, ized as “far-reaching language that
pages 1 and 4). To counterbalance
could be interpreted as promoting
services provided to sex workers,
abortion” and that called for “unlimhowever, U.S. law now requires that ited rights for adolescents to access
indigenous NGOs using U.S. HIV/
to reproductive health services with
absolutely no recognition of parents’
AIDS funds for any purpose have a
rights and responsibilities.” Earlier,
formal policy opposing sex traffickand with supreme irony, the U.S.
ing and prostitution.
delegation challenged other countries to remain consistent with the
Standing Alone
positions they had taken in Cairo
The cumulative effect of these radi- (some of these countries did refuse
cal policy shifts has been to isolate
to join the consensus at that time)
the United States from the groundand to reflect the views of their own
breaking consensus among the
people and laws. Their lobbying
world’s governments, which it had
efforts even featured a personal
been a leader in forging in Cairo in
appearance in Puerto Rico by a lead1994. The extent of U.S. isolation
ing family planning opponent, Rep.
has been made clear over the last
Chris Smith (R-NJ), who made a
two years at a series of UN regional
direct—albeit unsuccessful—appeal
meetings convened to review the
to the president and first lady of
first decade of the ICPD Program of Guatemala.
Action’s 20-year plan. The United
States made its first formal break
Frustration with the United States
from its historical position at the
among other donor nations is growAsian and Pacific regional meeting in ing wider and deeper. Outgoing
Bangkok in December 2002 (“Bush
European Commissioner for DevelAdministration Isolates U.S. at Inter- opment and Humanitarian Aid Poul
national Meeting to Promote Cairo
Neilson used the occasion of the
Agenda,” TGR, March 2003, page 3). June UN Development Program/
It did so again at the regional meet- UNFPA Executive Board meeting in
ing in Santiago, Chile, in March of
Geneva to blast the United States for
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9
its reversals. He noted that the European Development Fund, for the first
time, would be channeling support
to UNFPA and IPPF in direct
response to the U.S. withdrawals of
support. He expressed “dismay” over
the U.S. actions to defund UNFPA
and IPPF and to undermine the
Cairo consensus, as well as U.S.
efforts to promote abstinence while
disseminating “negative and factually wrong messages about condoms.”
For its part, Britain’s Department for
International Development (DFID)
published its new sexual and reproductive health strategy in July,
asserting that “women, especially,
need more choice and control over
their sexual and reproductive lives.”
DFID recommitted itself to remaining in the “forefront of the international debate on controversial
issues…to uphold everyone’s right to
sexual and reproductive health.
These rights have their opponents
who feel threatened by them and we
must therefore continue to explain
why they are important and relevant
to everyone.”
In September, NGOs will gather in
London for “Countdown 2015” to
look ahead toward fully implementing
the ICPD Program of Action’s plan for
the next decade. The UN General
Assembly will formally commemorate
the 10th anniversary of the ICPD on
October 14. Once again, the United
States will have an opportunity to
take a stand—either with the overwhelming majority of the world’s
countries or basically alone with its
small coalition of the “unwilling.” If
recent history is any guide, the signs
are not positive. Yet, even as the
United States announced on July 16
it would not fund UNFPA, Obaid
gamely noted: “Historically, the United States has been a world leader in
promoting reproductive health and
family planning and we hope it will
take up that role again.”
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