In Epworth, a community on the fringe of Harare, Zimbabwe, 19-year-old Sithulisiwe Moyo represents the challenges faced by many young women in accessing reproductive health care. Holding her infant daughter, Moyo spent two hours waiting at an outreach clinic to obtain birth control pills — her best hope for preventing another unplanned pregnancy and fulfilling her aspiration of returning to school.
However, this essential service, supported by U.S. government funding, is at risk with the looming possibility of the global gag rule’s reinstatement under president-elect Donald Trump. This policy forbids the use of U.S. foreign aid for abortions or for providing information related to abortion, impacting women’s health services on a global scale.
Decoding the Global Gag Rule
The global gag rule, also referred to as the Mexico City Policy, has a contentious history that stretches back over forty years, enacted by Republican presidents and rescinded by Democrats. During Trump’s administration, the rule was expanded dramatically, causing a loss of approximately $600 million in U.S. family planning funds and over $11 billion in global health financing from 2017 to 2018. This funding was critical for numerous health initiatives, including programs for malaria and tuberculosis prevention, as well as water, sanitation, and contraception distribution.
Concerned advocates for women’s health, like Pester Siraha, director of Population Services Zimbabwe, voice their worries over the implications of Trump’s election. The policy requires foreign NGOs receiving U.S. funding to halt any abortion-related activities, even if these are financed by other means. Consequently, organizations like MSI Reproductive Choices have opted out of U.S. funding, leading to the closure of outreach clinics that provide the only healthcare access for many in rural settings.
The Impact on Health Services
The ramifications of the gag rule extend beyond Zimbabwe, impacting NGOs in countries such as Uganda, Ghana, Ethiopia, Kenya, and South Africa, which have been forced to cut back on or entirely eliminate services, including clinics, contraception, and education programs aimed at vulnerable groups. According to the Guttmacher Institute, these funding cuts have resulted in increased instances of unplanned pregnancies, unsafe abortions, and maternal fatalities.
Chinogwenya, a global marketing manager at MSI Reproductive Choices, reported that the organization experienced a $120 million loss in funding during Trump’s first term, which could have aided 8 million women worldwide with family planning services. The painful reality of the gag rule is evident: it fosters more unintended pregnancies and subsequently heightens the demand for abortions, directly contradicting the policy’s original intent.
Challenges in Restoration
Although organizations such as Population Services Zimbabwe saw an increase in funding following Biden’s rescission of the gag rule in 2021, the recovery timeline is slow. Siraha pointed out that restoring the services lost during the gag rule can take a minimum of five years. If the policy is reintroduced, it is estimated that 1.3 million women in Zimbabwe could lose access to vital health care, leading to an additional 461,000 unintended pregnancies and 1,400 maternal deaths.
Constrained Choices and the Struggle for Rights
Amid these challenges, MSI Reproductive Choices continues to advocate for abortion rights while seeking other funding avenues. Chinogwenya insists that even if Trump’s reelection may bolster anti-choice movements, the battle for women’s reproductive rights is steadfast. Nevertheless, many NGOs confront the tough choice of compromising their principles to secure necessary funding, especially in regions where abortion is legally permissible yet faces societal stigma.
As women like Engeline Mukanya, a mother of three, strive to navigate the complexities of family planning on limited budgets, the urgency for accessible reproductive health services intensifies. Mukanya, with a monthly income of $100, relies on outreach clinics for affordable birth control, as private providers charge prohibitive prices.
The Urgent Call for Change
The lengthy lines at clinics in Epworth highlight the desperate need for family planning services within impoverished communities. Women like Mukanya and Moyo yearn for the agency to space their births and make informed decisions about their futures. With shifting political landscapes, the quest for reproductive rights and healthcare access remains essential, extending beyond the borders of Zimbabwe to the global stage.
In a climate where political decisions can profoundly affect access to lifesaving health services, advocating for policies that prioritize women’s well-being and autonomy is crucial. The future of countless women hinges on these efforts.
