Sean Philpott-Jones: Silence Equals Death

May 18, 2017

As Donald Trump fights for his political life following new revelations about wholly inappropriate disclosure of classified materials and potential obstruction of justice, he has quietly issued new orders that will condemn thousands of women and children around the world to death.

Largely overlooked given the media frenzy about the appointment of a special prosecutor to investigate Russian interference in the US Presidential election was an announcement that the Trump Administration will vastly expand the scope of the “Global Gag Rule”, the international anti-abortion policy first enacted by Ronald Reagan in 1984.

Also known as the Mexico City Policy, the rule prohibits organizations that receive family planning money from the United States Agency for International Development (USAID) from providing or promoting abortion. This is true even if they do so with private money. In fact, if they take so much as a single dollar from the US, they can’t even mention the word ‘abortion’ regardless of whether or not these organizations actually provide such services.

Every time a Democrat is in the White House, the global gag rule is rescinded. Every time a Republican enters the Oval Office, it is reinstated. President Trump himself did so just three days after assuming office. Until now, family planning organizations around the world have largely learned to deal with this ebb-and-flow. That is all about to change.

On Monday, Trump announced a new policy called Protecting Life in Global Health Assistance. That policy expands the scope of the Global Gag Rule. The restrictions of the Mexico City Policy now apply to nearly $9 billion in global health funding provided annually by federal agencies like the State Department and the Department of Defense, in addition to the $600 million in family planning support that is provided by USAID.

By denying funds to family planning clinics that provide information or referrals for abortions – be it in countries where the procedure is legal upon request, in cases of rape and incest, when the fetus is impaired, or when the life of the mother is placed at risk – the Global Gag Rule already leaves millions of poor women without access to reproductive health and family planning services. Without these services, which include low- or no-cost contraceptives, millions of women in the developing world will experience pregnancies that they neither want nor can afford. In fact, a study of nearly two-dozen countries in sub-Saharan Africa found that access to contraceptives dropped, unintended pregnancies increased, and abortions (both legal and illegal) doubled in these countries during the years when the Mexico City Policy was in effect.

Even in countries where selective termination of pregnancy is legal, the cost of obtaining a safe and sanitary abortion means that these procedures are out of the reach of many women. Instead, women seek abortions in illegal back-alley clinics where hygiene and post-operative care are an afterthought. Over 20 million unsafe abortions are performed every year, and the women who undergo them often experience severe complications that leave them infertile, crippled or dead. Unsafe abortion accounts for 13 percent of maternal deaths worldwide, accounting for nearly 50,000 preventable deaths per year.

Many more of these unwanted or ill-timed pregnancies will be carried to term, but with potentially disastrous physical and economic consequences for women and their families. Pregnancy-related complications are a leading cause of death and disability in developing countries, particularly in those nations where women lack access to family planning programs. Half-a-million women die in childbirth every year. Fifteen million more experience severe complications that leave them physically disabled, their children dead, and their families reeling from the economic costs associated with care and treatment.

Trump’s Protecting Life in Global Health Assistance policy will make that already tragic situation worse. By expanding the Global Gag Rule to every clinic that receives US aid, healthcare providers who work to treat or prevent infectious diseases like HIV or Zika virus will also be affected.

Consider the recent outbreak of Zika viral disease in the Western Hemisphere. Spread by mosquitoes or by sex, Zika generally causes a mild illness. Most people experience a few days of fever, headache, and joint and muscle pain. However, if a woman is pregnant at the time she is infected she is at increased risk of having a child born with a rare birth defect known as microcephaly (a condition in which an infant is born with a smaller-than-usual brain). During the last outbreak in Brazil, nearly a third of women infected with Zika during pregnancy had babies with brain-related birth defects, including but not limited to microcephaly.

There is no treatment for either Zika or microcephaly. Moreover, although some children born with microcephaly develop normally, most will experience lifelong symptoms that include developmental delays and disabilities, difficulties with coordination and movement, hyperactivity, and seizures. Thus, the only option for women in Zika-affected regions of the world is to avoid getting pregnant or to consider selective termination should prenatal testing suggest severe birth defects.

Thus the Catch-22 created by the new policy. In order to receive the foreign aid needed to combat Zika, these clinics will have to forgo any discussion of the potential consequences of microcephaly. The amount of money available for family planning services will also drop as organizations like the International Planned Parenthood Federation (IPPF) find their funding cut, despite the important role of contraceptives in preventing Zika-related complications. This will mean more pregnancies, more abortions, more maternal deaths, and more children born with severe birth defects.

Donald Trump, like so many of his Republican predecessors, claims to be a “pro-life President,” but his reinstatement and expansion of the Global Gag Rule shows that he is anything but. 

A public health researcher and ethicist by training, Dr. Sean Philpott-Jones is Director of  Research Ethics for the Bioethics Program of Clarkson University-Icahn School of Medicine at Mount Sinai in Schenectady, New York. He is also Acting Director of  the Center for Bioethics and Clinical Leadership, and Project Director of its Advanced Certificate Program for Research Ethics in Central and Eastern Europe.

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