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International abortion rule led to lapsed health aid in some African countries, report shows

State Department review of the Trump administration’s policy to bar funding for foreign nonprofits that perform or promote abortions found it has also affected efforts to treat tuberculosis and HIV/AIDS and to deliver nutritional assistance, among other programs, and has had significant impact in sub-Saharan Africa.

The review, published Tuesday, looks at the impact of the Trump administration’s 2017 decision to reinstate the “Mexico City Policy” — which had previously impacted only family planning assistance — and extend it to all applicable US global health funding under the “Protecting Life in Global Health Assistance” policy.

Organizations that continue to promote or perform abortions lose all US health aid under the policy — potentially affecting more than 1,300 global health projects and an estimated $12 billion in US assistance, according to the Government Accountability Office, an independent, nonpartisan agency that works for Congress.

Administration officials said the policy caused no interruptions or harm to women’s health services, and is a testament to the strong anti-abortion stance President Donald Trump has advanced during his tenure. But reproductive rights advocates said the policy had been a “crushing blow” to health care access — and pointed to the State Department’s own review as proof.

‘Some impact’

According to the report, eight of the 1,340 prime awardees — those with direct agreements with US departments or agencies — opted not to comply with the policy from May 2017 to September 30, 2018. The majority of award recipients did “not experience a disruption in the delivery of health care or significant delays in implementation,” the report added.

Those eight awardees, however, represented millions of health services provided. In 2017, the year the policy was enacted, one of those eight prime awardees, International Planned Parenthood Foundation, provided 208.6 million sexual and reproductive health services. A second, Marie Stopes International, provided 9.3 million client visits, according to the organizations’ annual reports.

In fiscal year 2016, International Planned Parenthood Foundation and Marie Stopes International together represented less than 0.5% of the Department of State’s Global Health Programs implemented by the US Agency for International Development.

Forty-seven sub-awardees — groups that indirectly get funding from US departments or agencies — also declined the conditional funding. Of those 47 groups, all of which received aid through USAID, 12 “reported a gap or disruption in the delivery of health care as a result of a declination,” according to the report.

“USAID found that, in a few cases, the declination resulted in some impact on the delivery of health care, including for HIV/AIDS, voluntary family planning/reproductive health, tuberculosis, and nutrition programming,” the report says of the 12 sub-awards and three prime awards affected, before explaining that health services in entire countries in sub-Saharan Africa were affected.

Nonprofits in sub-Saharan Africa were the most affected, with 32 of the 47 sub-awardees located in the region — more than any other region noted in the report.

Lapses in aid

When USAID was unable to find other partner organizations to continue work done by International Planned Parenthood Foundation and Marie Stopes International — which lost awards dating back to 2014 of more than $145 million — several African countries saw lapses in aid.

“In the Republics of Liberia and Togo, for example, no other partners that operate in country are prepared to implement integrated, voluntary family planning through both mobile outreach and local fixed clinics, as IPPF affiliates had been doing,” the report stated. “In the Federal Republic of Ethiopia; the United Republic of Tanzania; and the Republics of Mali, Madagascar, and Sénégal, Missions needed additional time to identify other organizations to implement voluntary family-planning interventions that MSI had been performing.”

Tuesday’s report — the second such review of the policy, which was ordered “to enable a more thorough examination of the Policy’s benefits and challenges” — joins previous accounts demonstrating the policy’s significant consequences.

report by the GAO in March found that after some groups had refused to comply with the new restrictions, more than $150 million in health assistance funding was “not obligated as of September 30, 2018.”

David Gootnick, the author of the GAO report, told CNN in March that “according to the State Department, USAID would have had to reprogram the money, but they were unable to tell us exactly where those reprogrammed funds went.”

Gootnick said Wednesday that “we still don’t have any information about the extent to which that 152 million was reprogrammed, and to where it might have gone.”

Trump’s anti-abortion stance

Health workers in countries like Kenya told CNN in 2018 that the number of backstreet abortions had increased since the United States cut aid to programs that provide abortion services, in addition to contraception, in some of the world’s least developed health care systems.

Reproductive rights groups slammed the policy following the report’s release.

“Study after study has demonstrated that this policy has inflicted a crushing blow to health care access for people around the world, especially those who already face systemic barriers to care,” Monica Kerrigan, executive director of Planned Parenthood Global, said in a statement.

“No matter how much the State Department attempts to minimize the policy’s true impact, its latest report demonstrates what we already knew: the global gag rule is disrupting health care access for communities around the world, which is especially critical now as we face the COVID-19 pandemic,” she added.

Zara Ahmed — associate director for federal issues at the reproductive rights research group the Guttmacher Institute — said Tuesday that “while numerous studies have documented the policy’s harms, there is no evidence — none — that the global gag rule has had any positive impacts. The Trump administration’s own report released today confirms tangible harm around the world.”

But the administration asserted that the report and policy exemplified Trump’s strong anti-abortion stance without limiting access to health care resources.

“Contrary to claims from the left, report shows that the President’s policy has not hindered women’s health programs,” the White House press office said in an email to reporters Tuesday, characterizing the report as “further demonstrating the President’s clear commitment to protecting the sanctity of life.”

In a statement Tuesday, a State Department spokesperson told CNN that the 47 groups that refused US funding rather than comply with the administration’s restrictions were “out of hundreds of sub-awards.”

“This Administration has shown that we can continue to meet our critical global health goals, including providing healthcare for women and addressing such diseases as HIV/AIDS, while ensuring US taxpayer funding does not support foreign non-governmental organizations performing or actively promoting abortion as a method of family planning,” they added.

Health and Human Services Secretary Alex Azar said groups that continued to receive US funds saw no interruption, asserting in a statement that “the second review of the President’s policy to protect life in global health assistance shows that HHS implemented the policy without any interruption to the important and significant services our grantees provide.”


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