Liz Lawrence looks at the importance of birth control for women’s liberation, the history of the global gag rule on healthcare funding for NGOs (non-governmental organizations) which provide abortion services, and the health impact of the global gag rule.
In the context of the forthcoming US Presidential election, in which Republican and Democratic parties take very different positions on abortion rights and in which the Democratic presidential contestant, Kamala Harris, is taking a clear pro-choice stance.
Why birth control is essential for women’s liberation
Decades of feminist campaigning in many countries have led to a widespread understanding among feminists, socialists and labour movement activists that access to birth control is essential for women’s liberation. Many trade unions now have pro-choice policies. Debates around access to birth control, both contraception and abortion, often contain debates about the position of women in society. For conservatives who seek to restrict reproductive rights women should primarily be wives and mothers, living in a traditional patriarchal family, with other activities, such as education, employment and participation in public life, secondary to the maternal role.
Supporters of women’s equality understand that equal participation in the public sphere, and for women living our lives as full human beings, involves the right for women to choose if, and when, to become mothers. A human being cannot participate equally in education, employment, politics or any other sphere, if life might be disrupted at any moment by unplanned pregnancy, and if their participation in the public sphere is always subject to the assumption that they might leave any position they occupy at any moment on account of pregnancy and motherhood. This stigma of potential maternity was used for generations to deny women equal opportunities in the workplace.
There are questions of bodily autonomy and access to health care involved. For the anti-abortionists the woman’s body is the property of anyone other than the woman, whether it be her parents, husband or the state. Birth control is healthcare. Without access to birth control many women suffer health damage and risk to life from repeated pregnancies and childbirth.
What is the global gag rule?
The global gag rule is a United States Government ban on foreign NGOs which provide abortion services (including abortion advice) from receiving any US Government funding. It is also known as the Mexico City policy, because this was the venue where it was announced by the US Government at the United Nations International Conference on Population and Development.
This ban also affects NGOs which advocate for abortion law reform such as the decriminalisation of abortion. Even if any abortion-related activities are funded by the NGO from other sources, it still loses all US Government funding. The global gag rule originally ended $600 million in money for family planning services. International Planned Parenthood lost 20% of its funding. Thus, healthcare organisations were faced with a choice of either losing funding or restricting the services they provided.
The global gag rule was first introduced in 1985 by President Ronald Reagan. Since then, each successive US administration has decided either to maintain or lift the gag. This has made funding for abortion-related healthcare services a party-political issue in the USA and a matter of increasingly sharp political division. In some countries such matters can be seen as healthcare issues where there is a bipartisan or multi-party consensus, which is based on respect for the right of women to choose and on medical and scientific evidence. In the USA a change of President can almost immediately mean either the lifting or the re-imposition of the global gag rule, with Democratic Presidents Clinton, Obama and Biden all lifting the gag.
In January 2017 President Trump expanded the global gag rule to cover more health areas. It had originally applied to NGOs in the family planning field, but it was extended to all international healthcare assistance and affected nearly $9 billion in healthcare funding. It thus affected areas like HIV education.
The global gag rule restricted the ability of healthcare workers to counsel clients properly and offer a full range of options or to campaign on healthcare issues. It had a chilling effect on health education and advocacy, similar to section 28 or other attempts by governments to limit sex education and advice by sexual health services. It can thus also be seen as a freedom of speech issue.
The health impact of the global gag
Maternal mortality worldwide is unacceptably high. About 287 000 women died during and following pregnancy and childbirth in 2020. Almost 95% of maternal deaths occurred in low and lower middle-income countries in 2020, and most could have been prevented by access to better healthcare.
Women in low-income countries have a higher lifetime risk of maternal death. A woman’s lifetime risk of maternal death is the probability that a 15-year-old woman will eventually die from a maternal cause. In high income countries, this is 1 in 5300, versus 1 in 49 in low-income countries.
For many women in the world today pregnancy is a life-threatening condition, as it was centuries ago world-wide. This means women go through pregnancy knowing it could lead to their death or permanent injury to health. This takes a toll on both physical and mental health.
Cutting funding for family planning services leads to more unplanned pregnancies, and may increase the abortion rate. Bans on abortion do not stop abortion; they just increase the likelihood that the procedure occurs under unsafe conditions, with higher rates of mortality and morbidity. The World Health Organisation estimates that 45% of abortions are unsafe.
The global gag has also impacted health education and health advocacy, including HIV/AIDS education and support for marginal and vulnerable groups, including workers in the sex industry. When funding for healthcare is cut, it is often the poorest and most vulnerable who are most affected.
How the abortion issue has been politicised
“My name is Ann Richards. I am pro-choice and I vote.” This is what Ann Richards, Democratic Governor of Texas said at the Democratic National Convention in 1992. This is a good example of how women and pro-choice activists can be galvanised by this issue, as is happening now with the Kamala Harris campaign for the US Presidency.
The Republican Party has made alliances with the Christian evangelical right, treating abortion as a key political dividing issue. Ultra-conservatives often pick an issue or two, whether abortion, homosexuality, transgender rights or sex education in schools as a focus for campaigning and as a test of political acceptability.
Right-wing Christian evangelicals and other religious fundamentalists subscribe to a theology in which salvation is linked with conformity to narrowly-defined, traditional gender roles, in which sex is only for reproduction and in which foetal life is given equal or higher status than the life of the pregnant person. Hence the woman who declines motherhood or the person who lives in a same-sex relationship or seeks to change gender cannot be accepted. This is a quest for Gilead, the dystopian society portrayed by Margaret Atwood in “The Handmaid’s Tale”.
Some Republican politicians are Christian nationalists; that is to say, they want to remove the separation of religion and the state, which was one of the major achievements of the American Revolution and to establish some version of a theocratic state. It can be hard for reasonable and liberal-minded people to appreciate just how reactionary all of this is.
Donald Trump and JD Vance use misogyny to mobilise a section of the electorate and to attack their opponents. It may fire up their base, but it will also turn off many American voters. Vance is mentioned often for his notorious remark that the US was governed by ‘childless cat ladies’ and the implication that only parents have a right to an opinion or a vote. Such views are off the wall and have sparked many amusing ripostes. Nonetheless they should not be ignored because they express both a serious level of misogyny and contempt for single people.
What happens in the US presidential election has significant implications for women’s lives and for reproductive rights and healthcare provision world-wide.
P.S.
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