The global gag rule - An antithesis to the rights-based approach to health

Health and Human Rights

Volumn 9, Issue 1, 2006, Pages 17-32

  Bogecho, Dina ^a,c   Upreti, Melissa ^b  

^a Population Action International   (United States)

^b Center for Reproductive Rights   (United States)

^c HARVARD SCHOOL OF PUBLIC HEALTH   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 33750221363     PISSN: 10790969     EISSN: None     Source Type: Journal    
DOI: 10.2307/4065387     Document Type: Note

References (69)

1. This statement was made by a Kenyan government official in early 2005, during the course of an interview conducted by the Global Gag Rule Impact Project (see note 8 for further details on the Gag Rule Impact Project). The speaker asked to remain anonymous.
2. USADD, Family Planning (Washington, DC: USAID, 2005). Available at www.usaid.gov/our_work/global_health/pop/index.html.
3. Population Action International, The Global Gag Rule, History & Resource Library. Available at www.populationaction.org/resources/ publications/globalgagrule/GagRuleTimeline.htm#. The Mexico City Policy has its genesis in an announcement made at the international Conference on Population in Mexico City in 1984, where the US delegation announced that the United States would no longer fund foreign, nongovernmental organizations that provide, refer, counsel, or advocate for abortion: "... the United States will no longer contribute to separate nongovernmental organizations which perform or actively promote abortion as a method of family planning in other nations."
4. Policy Statement of the United States of America (United Nations International Conference on Population [Second Session], Mexico DF: August 16-13, 1984). Available at www.populationaction.org/resources/ documents/MexicoCityPolicy1984.pdf. These restrictions became known as the Mexico City Policy and were later dubbed the "Global Gag Rule" by opponents. The Mexico City Policy was repealed in 1993 by President Bill Clinton.
5. (To read Clinton's Memorandum repealing the Mexico City Policy, see http://www.clinton6.nara.gov/1993/01/ 1993-01-22-aid-family-planning-grants-mexico-city-policy.html.) It was reinstated by President George W. Bush in January 2001.
6. (To read President Bush's memorandum reinstating the Mexico City Policy, see http://www.whitehouse.gov/news/releases/20010123-5.html.)
7. Presidential Documents, "Memorandum of March 28, 2001 - Restoration of the Mexico City Policy," Federal Register, Vol. 66, No. 61 (March 29, 2001): pp. 17301-13. Available at the Federal Register Online at www.wais.aecess.gpo.gov.DOCID:fr29mr01-157.
8. Cited in Center for Reproductive Rights, The Bush Global Gag Rule: A Violation of International Human Rights (New York: October 2000): p. 3. It is also important to note that these activities are already prohibited by the Helms Amendment introduced in 1973. The Helms Amendment prohibits the use of US foreign funds for abortion. It states: "None of the funds made available under this Act may be used to pay for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortions." HR 2673 Omnibus Appropriations Bill, Division D. FY 2004. Available at www.usaid.gov/our_work/global_health/pop/helms.html. The Mexico City Policy goes one step further than the Helms Amendment, however, by prohibiting not only the use of US funds for abortion but prohibiting organizations that accept US funds from using any other non-US funds for abortion activities, too.
9. Revealed to co-author Melissa Upreti in numerous interviews. Also supported by Center for Reproductive Rights, The Bush Global Gag Rule Endangering Women's Health, Free Speech and Democracy (New York: Center for Reproductive Rights, July 2003). Available at http://www.reproductiverights.org/pub_fac_ggbush.html.
10. Population Action International, The Global Gag Rule, History & Resource Library (see note 3): 1984, Mexico City Policy Introduced.
11. Basically, the Mexico City Policy states that US funds will simply not go to nongovernmental organizations that engage in abortion-related activities (see note 3). This means, therefore, that if an NGO decides to either provide, refer, counsel, or advocate on abortion at all (even with its own funding), it cannot receive US funds.
12. "It is unconstitutional for the federal government to prohibit US-based NGOs from using their own, private funds to exercise their constitutional right to free speech and to lobby in order to be eligible for federal funding ... With respect to federal funds for family planning, two lower courts have held that prohibitions on abortion counseling, referrals or services as requirements for eligibility for such funds are unconstitutional." Center for Reproductive Rights, The Bush Global Gag Rule: A Violation of International Human Rights (see note 4): p. 17.
13. Basically, freedom of speech laws prevent such a policy from being imposed on US NGOs. "Although it is constitutionally permissible for the US government to restrict how a US-based organization spends US government funds, the Constitution does not permit the legislature to impinge upon that organization's constitutional interests - including the right to free speech and association - by restricting how a grantee spends segregated funds received from other, non-US government sources." Center for Reproductive Rights, The Bush Global Gag Rule: A Violation of International Human Rights (see note 4): p. 17.
14. The Global Gag Rule Impact Project is a collaborative research effort led by Population Action International in partnership with Ipas, Planned Parenthood Federation of America, and the International Planned Parenthood Federation, with assistance in gathering evidence of impact in the field from EngenderHealth and Pathfinder International. Recognizing the historic leadership role of the United States in supporting voluntary family planning and related health care internationally, the project's objective is to document the effects of the Global Gag Rule on the availability of life-saving family planning services, as well as on efforts to address other major threats to public health, including HIV/AIDS and maternal deaths due to unsafe abortion. Available at www.globalgagrule.org.
15. Research was carried out through in-depth interviews with health workers and policy-makers. Available at www.reproductiverights.org/ pub_bo_ggr.html.
16. In addition, the impact of the Gag Rule on free speech has been established by testimonies provided by activists from Nepal and Peru at Congressional briefings organized by the Center for Reproductive Rights. Available at www.reproductiverights.org.
17. Testimonies from the first Congressional briefing are available at http://www.reproductiverights.org/hill_int_ggr.html.
18. Although the Gag Rule has had an impact on both health services and human rights in Kenya and Nepal, due to the shortage of space, we have focused on just one aspect of its impact in each country in order to go into some depth - something we would not be able to do if we attempted to cover both aspects of the impact in both countries.
19. C. E. Chimbwete, E. Zulu, and S. C. Watkins, "The Evolution of Population Policies in Kenya and Malawi," Population Research and Policy Review (2005): p. 3. Available at www.aphrc.org/ pubheation?Working%20paper%2027.pdf.
20. Ibid.
21. Central Bureau of Statistics, Kenya Demographic and Health Surveys, 2003, Preliminary Report (Nairobi: 2003). Available at www.measuredhs.com/countries/country.cfm?ctry_id=20.
22. Central Bureau of Statistics, Kenya Demographic and Health Surveys, 2003, Final Report (Nairobi: 2003). Available at www.measuredhs.com/pubs/ pdftoc.cfm?ID=462;
23. and Global Gag Rule Impact Project, Access Denied: The Impact of the Global Gag Rule in Kenya (2005). Available at www.globalgagrule.org/ caseStudy_kenya.htm. Also note that abortion is illegal in Kenya except to save the woman's life.
24. Access Denied: The Impact of the Global Gag Rule in Kenya (see note 15).
25. Ibid.
26. Ibid.
27. Ibid.
28. Ibid.
29. Ibid.
30. Committee on Economic, Social, and Cultural Rights, General Comment No. 14, The Right to the Highest Attainable Standard of Health, UN Doc. E/C.12/2000/4 (2000), para. 12. Available at www.unhchr.ch/tbs/doc.nsf/ (symbol)/E.C.12.2000.4.En?OpenDocument.
31. Full text is available at www.reproductiverights.org/ pr_01_0214ggranand.html.
32. WHO, Maternal Mortality in 2000: Estimates Developed by WHO, UNICEF, UNFPA (Geneva: 2004): p. 25.
33. Family Health Division, Ministry of Health, Maternal Mortality and Morbidity Study (Nepal: 1998): p. 75.
34. Save the Children, State of the World's Mothers (Westport, CT. Save the Children, 2003): p. 40.
35. A. Bankole, S. Singh, and T. Haas, "Characteristics of Women Who Obtained Induced Abortion: A Worldwide Review," International Family Planning Perspectives 25/2 (1999): pp. 68-77.
36. P. Rana, "Fight Continues to End Harsh Abortion Law," IPPF South Asia (2000): p. 22;
37. WHO, Mother-Baby Package: Implementing Safe Motherhood in Countries (Geneva: 1994): p. 2.
38. Global Gag Rule Impact Project. Available at http://www.globalgagrule.org/caseStudy_nepal.htm.
39. Ibid.
40. Ibid.
41. International Covenant on Civil and Political Rights, GA Res. 2200 (XXI), UN GAOR, 21st Sess., Supp. No. 16, at 49, UN Doc. A/6316 (1966). 999 UNTS 171. (Entered into force March 23, 1976.) Date of ratification by the US, June 8,1992. Date of ratification by Nepal, May 14, 1991.
42. Information provided by local providers to the co-author "off the record." Also supported by research documented by the Global Gag Rule Impact Project (see note 29).
43. Center for Reproductive Rights and Forum for Women, Law and Development, Abortion in Nepal: Women Imprisoned (New York: Center for Reproductive Rights, 2000): p. 23.
44. Family Health Division (see note 25).
45. Center for Reproductive Rights and Forum for Women, Law and Development (see note 34).
46. The Family Planning Association of Nepal (FPAN) was established in 1959, and it has been a leading provider of reproductive health services in the country. In his capacity as a member of the National Assembly (the upper house of Parliament) from 1993-1999, Sunil K. Bhandari, President of FPAN from 1991-2001, tabled a bill in Parliament for the legalization of abortion and the establishment of comprehensive services. This bill lapsed with the conclusion of his tenure as a member of Parliament, but his initiative has been recognized as one of the major contributing factors leading the inclusion of amendments to the ban on abortion in the 11th Amendment Bill that ultimately led to the decriminalization of abortion on broad grounds in 2002. Details are available in Forum for Women, Law and Development (FWLD) and Planned Parenthood Global Partners, Struggles to Legalize Abortion in Nepal and Challenges Ahead (IPPF, 2003): p. 44.
47. Information communicated to Melissa Upreti in interviews with experts in Nepal. FPAN felt the impact of the gag when the International Planned Parenthood Federation - South Asia Region made a decision not to comply with the gag even if it meant that USAID would terminate its funding. Center for Reproductive Rights, The Impact of the Global Gag Rule in Nepal. Available at www.reproductiverights.org/pdf/bo_ggr.pdf.
48. Ibid.
49. See Global Gag Rule Impact Project, The Gag Rule's Impact in Ethiopia. Available at www.globalgagrule.org/caseStudy_ethiopia.htm;
50. The Gag Rule's Impact in Ghana. Available at www.globalgagrule.org/ caseStudy_ghana.htm;
51. The Gag Rule's Impact in Tanzania. Available at www.globalgagrule.org/ caseStudy_tanzania.htm;
52. The Gag Rules Impact in Zambia. Available at www.globalgagrule.org/ country_zambia.htm;
53. The Gag Rule's Impact in Zimbabwe. Available at www.globalgagmle.org/ country_zimbabwe.htm;
54. The Gag Rule's Impact in Romania. Available at www.globalgagrule.org/ caseStudy_romania.htm;
55. The Gag Rule's Impact in Nepal. Available at http://www.globalgagrule.org/country_pepal.htm;
56. and The Center for Reproductive Rights, Breaking the Silence, the Global Gag Rule's Impact on Unsafe Abortion (New York: Center for Reproductive Rights, 2003). Available at www.reproductiverights.org/pub_bo_ggr.html.
57. Center for Reproductive Rights, The Bush Global Gag Rule (see note 4): p. 4.
58. American Bar Association, Section of Individual Rights and Responsibilities, Report with Recommendations #10H (unanimously adopted August 1991): p. 4. Available at www.abanet.org/irr/committees/ completereport.doc.
59. Cited in Center for Reproductive Rights, The Bush Global Gag Rule (see note 4): p. 4.
60. "The protection of fundamental human rights was a foundation stone in the establishment of the United States over 200 years ago. Since then, a central goal of US foreign policy has been the promotion of respect for human rights, as embodied in the Universal Declaration of Human Rights. The United States understands that the existence of human rights helps secure the peace, deter aggression, promote the rule of law, combat crime and corruption, strengthen democracies, and prevent humanitarian crises." US Department of State, Bureau of Democracy, Human Rights, and Labor, Human Rights. Available at www.state.gov/g/drl/hr/.
61. J. Asher, The Right to Health: A Resource Manual for NGOs (London: Commonwealth Medical Trust, 2004): pp. 21-4.
62. "No funds made available to carry out this Act, or any amendment made by this Act, may be used to provide assistance to any group or organization that does not have a policy explicitly opposing prostitution and sex trafficking." United States Leadership against HIV/AIDS, Tuberculosis and Malaria Act of 2003, 22 USC 7601 (23) (2003). This amendment ensures that no taxpayer funds designated for HIV/AIDS prevention may be used to promote or advocate the legalization of prostitution or sex trafficking, and that no funds may be given to any group or organization that does not have a policy explicitly opposing prostitution and sex trafficking.
63. SIECUS, "US HIV/AIDS Funding Dependent on Anti-Prostitution Pledge that Jeopardizes HfV Prevention Success," Making the Connection, 4/2 (2006). Available at www.siecus.org/inter/connection/conn0053.html#1.
64. Ibid.
65. United States Leadership Against HfV/AIDS, Tuberculosis, and Malaria Act of 2003 (see note 45).
66. Human Rights Watch, "US Policy of Abuse Undermines Rights Worldwide," World Report 2006. Available at hrw.org/english/docs/ 2006/01/13/global12428.htm.
67. C. Connolly, "Bush Budget Would Cut Popular Health Programs," Washington Post (February 14, 2006). Available at www.washingtonpost.com/ wp-dyn/content/article/2006/02/13/AR2006021302065.html.
68. "The United States is consistently the world's largest bilateral donor to the developing world." The White House, "The Administration's Commitment to the Developing World," News & Policies. Available at www.whitehouse.gov/infocus/developingnations/ developingworld.html.
69. Also see USAID, Key Achievements in Family Planning. Available at www.usaid.gov/our_work/global_health/pop/news/achievements.html.