In his second week in office, President Joe Biden plans to make it easier for providers around the world to offer the full spectrum of reproductive health care.
On Jan. 28, he reportedly overturned what is sometimes referred to as the “global gag rule,” which bans groups overseas who receive US aid in performing or even discussing abortion. It was also known as the Mexico City Policy and was first adopted by President Ronald Reagan in 1984. Then it became a kind of political light switch that was turned off by every Democratic president and turned on by every Republican.
President Trump expanded the policy, however – while previous Republican administrations had excluded family planning organizations overseas that received US aid from the abortion discussion, Trump had the policy applied to any health organization receiving US money. It was part of a broader push by Trump to restrict access to abortion, a key policy priority of his administration that impacted all aspects of reproductive health care in the US and around the world.
Biden has promised to reverse that legacy and expand access to reproductive care. And lifting the global gag rule is likely just the first step. On Thursday, Hill will also order a review of the Trump administration’s restrictions on Title X’s family planning program, according to Hill. These restrictions have been known as the “domestic gag rule” as they prevent recipients of Title X funds in the US from having or requesting abortions – a ban that Biden, as a candidate, wanted to overturn.
Reproductive health groups are already pushing Biden to go beyond election promises to secure access to contraception, abortion and other services in the US and around the world. And just a few days after his term in office, his agenda on these issues is still taking shape. But if the Trump years were a time of increasing restrictions on abortion and other reproductive health care, Biden is already moving in the opposite direction.
The “global gag rule” limits reproductive health funding around the world
The global gag rule “essentially allows US presidents to wage the country’s domestic abortion wars abroad,” as Sarah Wildman wrote at Vox in 2017. Since the landmark 1973 Supreme Court ruling Roe v. Wade, the extent to which the federal government could restrict abortion was limited. Social conservatives have looked for other ways to restrict the procedure – and restricting federal funding has been one of their greatest tools.
By denying U.S. aid to reproductive health care providers, the global gag rule has the effect of restricting access to all the services they offer, not just abortion – from birth control to STI checkups to prenatal care is everything affected. And the Trump administration has taken the impact even further with the expanded regime, which not only applies to family planning providers, but also to nonprofits dealing with tuberculosis, malaria and all other health issues. Suddenly they too could lose their funding if they even brought up an abortion with patients.
Research on the global gag rule shows devastating effects. For example, President George W. Bush’s re-enactment of the rule led the US to reduce or eliminate supplies of contraceptives to 16 countries, according to a 2019 analysis. “Condom corners” that distributed free condoms in rural Ethiopia, Ghana and Kenya have been closed. The Planned Parenthood Association of Ghana closed 57 percent of its clinics and nonprofits in Kenya, Tanzania, Zimbabwe and other closed clinics.
This reduction in contraceptive services actually led to an increase in abortions, which is contrary to the goal of the gag rule. For example, a 2011 study of the effects of the rule under the administration of George W. Bush found a 12 percent increase in pregnancies in rural Ghana, which, according to the Guttmacher Institute, led to an additional 200,000 abortions and 500,000 to 750,000 unplanned births.
And under Trump, the rule continued to cause harm to reproductive health around the world. A 2019 study in Kenya, Nepal, Nigeria and South Africa found that access to contraception, prenatal care, HIV testing and screening for breast and prostate cancer and abortion was limited.
Biden promised to end the rule last year, stating on his reproductive health campaign agenda that it “is currently preventing the US federal government from supporting major global health efforts – including malaria and HIV / AIDS – in developing countries just because of the Organizations Do This This guide also provides information on abortion services. “Next week he plans to keep his promise so that aid can be restored.
Biden also plans to review Trump’s Title X restrictions
The president’s plan to overturn the policy on Thursday is part of a string of executive health care measures, Hill said. Those moves include ordering a review of Trump-era restrictions on Title X, a federal family planning program for low-income and other underserved Americans. These restrictions, completed in 2019, prohibit healthcare providers from receiving Title X money for performing or referring abortions – even though they did not actually use the money to pay for abortions themselves (which was already banned by the Hyde Amendment).
The restrictions have largely been viewed as an attempt to strip funding of Planned Parenthood, a long-standing Republican goal. In fact, Planned Parenthood left the Title X program because of the new rule. So are many smaller providers – an estimated 981 clinics in total, according to Guttmacher. This estimated the program’s ability to provide contraception services by at least 46 percent, the group estimates.
And it wasn’t just birth control. Many Title X clinics also offer services such as STI testing, prenatal care, and cancer screening – and in many cases, a Title X provider may be the only doctor a patient sees year-round. As clinics reduced hours or services, or even closed due to lack of Title X funds, some patients lost their only real source of routine medical care.
Biden has said he would reverse the Trump administration’s Title X rule – one of the key planks of his campaign Reproductive Health Agenda was “Restoring Federal Funding for Planned Parenthood.” His plan to order a review on Thursday appears to be the first step in that direction.
Other questions about Biden’s reproductive health policy remain open in the short and long term. For example, he has pledged to lift the Trump administration’s sweeping exemptions from the Obama-era requirement that employer-provided health insurance cover birth control at no cost. However, it’s not clear if such a reversal will be part of his executive action on Thursday.
And reproductive health advocates want Biden not only to reverse Trump’s moves, but to take greater action to improve access to care in the US and abroad. They ask him to stand up for that Global Health, Empowerment and Rights Act (HER)that would permanently suspend Mexico City’s policy. And Guttmacher has asked the Biden administration to significantly increase the US contribution to international family planning programs by the $ 575 million Currently earmarked for $ 1.66 billion in 2021. Reproductive rights groups have also called for a substantial increase in funding for the Title X program.
All of these moves would require the approval of Congress, where the Democrats now have the lowest majority. But Biden should lead reproductive health not just with instructions from the executive branch but with all the tools at his disposal, including pressure on Congress, Zarah Ahmed, deputy director of federal affairs at the Guttmacher Institute, told Vox last year. “The Trump administration has attacked reproductive health so aggressively on so many fronts that our response and that of the Biden administration must be equally aggressive and diverse.”
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