Jonathan Torgovnik for The Hewlett Foundation/Reportage by Getty Images

Ending America’s Global War on Reproductive Freedom

The Trump administration’s policy blocking US aid to foreign entities that provide abortion services is at odds with the laws of many developing countries, including South Africa. But with so much money on the line, how can governments uphold women’s rights?

JOHANNESBURG – My country liberalized abortion more than two decades ago, but on January 23, 2017, US President Donald Trump essentially took away my right even to write the word.

As a doctor in South Africa, I have provided abortion services for more than a decade. As part of my work, I often edit educational materials for an NGO working on HIV prevention. For young South African women, these texts offer life-saving information about issues related to sexual and reproductive health – including birth control, sexual violence, and our country’s progressive abortion law.

But two days after the American presidential election in November 2016 – and more than two months before Trump’s inauguration – the NGO I was working for halted distribution of a reproductive-health guide because it contained information on South Africa’s constitutionally guaranteed right to an abortion. The guide has since been reprinted, with all references to abortion deleted.

The cause of this self-censorship is an American policy known as the “global gag rule.” First introduced in the 1980s and revived by every Republican administration since, the policy blocks American foreign aid to organizations that offer abortion services, counseling, referrals, or advocacy. When the Trump administration formally reinstated the rule, it expanded the list of international aid programs that made funding conditional on meeting anti-abortion criteria.

Like many developing countries, South Africa receives hundreds of millions of dollars from the United States every year; in 2016, my country received $531 million from the US Agency for International Development (USAID) to help fund “health and population” programs. But while this assistance has done plenty of good, the attached strings are tying our hands.

South Africans are no strangers to health-care meddling by the US; we have lived with the global gag rule before. During George W. Bush’s administration, for example, reproductive health suffered, and abortion-related education services were decimated. Health-care providers receiving USAID money were barred from discussing abortion even with pregnant women who were HIV-positive. It is with this history in mind that health-care professionals in South Africa – and far beyond – are raising the alarm about Trump’s expanded policy.

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Even when US funding has been restored under Democratic administrations, women in South Africa have struggled to access abortion services. Although abortions have been constitutionally protected since 1996, just 5% of public clinics and hospitals offer the procedure, and as many as half of all abortions are conducted in unsafe facilities. Flyers advertising illegal abortions dot the country, including at the entrances to the National Department of Health, in Pretoria. These providers promise dangerous “same-day abortions,” which can include an indiscriminate cocktail of pills and operations that put women at risk of incomplete abortions, sepsis, and even death.

Last year, Amnesty International produced a report detailing what must be done to ensure that abortions in South Africa are safe, timely, and in compliance with local law. The recommendations included increasing affordable transportation to family-planning facilities, expanding access to modern contraception (including emergency contraception), increasing the availability of sex education, and developing strategies to reduce the stigma of abortions.

And yet, as a result of US policy, none of these changes will come easily. If countries like South Africa are ever to escape Republican administrations’ assault on reproductive freedom, new strategies are needed to fight the global gag rule.

Solutions start at home, which is why developing countries need to begin moving away from conditional aid that restricts health providers’ ability to work in accordance with local laws. Local NGOs, together with responsible global partners, must find new support for programs that educate women about their rights and provide access to safe abortion services. The point of Trump’s global gag rule is to silence advocates and medical professionals; we must not bend to this pressure.

But just as important as domestic support is backing from US lawmakers, who have the power to reverse Trump’s dangerous policy. The Global Health, Empowerment, and Rights Act (HER Act), introduced last year, would prohibit the application of restrictive eligibility requirements for foreign nongovernmental organizations that receive US assistance. Best of all, passage of the HER Act would create a permanent, legislative repeal of the global gag rule, and return a sense of apolitical morality to US foreign aid.

In South Africa, every woman has the legal right to control and make choices about her reproductive health. But that right is being trampled by a form of neocolonialism that ties aid to the political whims of the US party in power. South Africa’s people have decided to enact one of the world’s most liberal abortion laws; politicians 8,000 miles away should not be allowed to reverse their choice.

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