Just days after an estimated 3 million people in over a hundred countries including Ghana, Malawi, South Africa, India, Peru and Nigeria marched in the Women’s March on Washington, President Trump reinstated and expanded severe prohibitions on US funding for foreign non governmental organizations that advocate for or provide legal abortion services. Provide such services with your own money and lose all US funding for other services, said Trump. Hardest hit historically by the ban have been family planning organizations in developing countries, but the Trump ban, known as the Global Gag Rule (GGR), has extended its reach to include all groups that receive US global health assistance. While the roll out of ban remains to be published, agencies affected could include those health agencies where abortion is not even a routine part of their global health work: HIV-AIDS treatment and prevention where HIV positive women seek help, maternal health centers who see pregnant women with Zika, and for women’s health clinics including those that provide treatment for fistula or female genital mutilation.
Since 1973, US policy under the Helms Amendment has prohibited the use of US foreign assistance for abortion services in developing countries, even countries where abortion is legal and even when women have been raped in conflict and in refugee camps. Further limiting access to safe abortion by prohibiting groups from using their own funds will result in death and injury to many women in the developing world. Recent estimates indicate that 6.9 million women in those regions were treated for complications of unsafe abortion An estimated 40% more who have complications never received treatment. The burden on already overburdened health systems is enormous with an annual cost of providing treatment for abortion complications a staggering US$232 million. If all who needed treatment could get it, the cost would rise to a $562 million. And still women die — an estimated 22,500 to 44,000 annually.
The numbers are staggering, as is the misery associated with bearing children you can’t afford to care for or are a threat to your health. According to WHO, more than 21 million women annually decide to risk death each year by procuring an illegal abortion.
It is these facts that create an ethical dilemma for health care providers whether they provide abortion services or information regularly or infrequently. They can abandon those women and continue to receive much needed US funding for other services – mostly family planning – or they can continue to provide such services and lose significant support for family planning. According to the Gates Foundation “more than 220 million women in developing countries who don’t want to get pregnant lack access to contraceptives and voluntary family planning information and services. Less than 20 percent of women in Sub-Saharan Africa and barely one-third of women in South Asia use modern contraceptives.”
Both safe abortion and modern contraception are essential to women’s health and well being and reproductive health is increasingly considered among human rights. But they are also essential tools in accomplishing TLYCS’ goals –improving the lives of those living in extreme poverty. The provision of voluntary reproductive health services is the most significant factor in reducing population pressures that contribute to poverty and climate change. Every dollar spent on family planning in developing countries nets 2 to 7 dollars that can be invested in economic development, improving health, providing education and addressing climate change. A recent study sponsored by the Hewlett Foundation demonstrated that meeting the need for contraception were accomplished, it would contribute to a 15% drop in greenhouse gases.
The Global Gag Rule is renewed at a time that Africa is set to record the world’s largest population growth between now and 2050, According to the Population Reference Bureau its population will more than double from 1.2 billion to 2.4 billion people. Sub-Saharan Africa, where fertility rates are among the highest in the world, will account for the majority of that growth. Of the 830 maternal deaths daily, 550 occur in Sub-Saharan Africa, where the fertility rate is 5.03.
For the most part, population size and growth and family planning have been under addressed in the movement for effective philanthropy. Among the prominent effective altruist groups only TLYCS includes a major global family planning provider, Population Services International (PSI). Perhaps it’s time for effective philanthropy to take a closer look at the role family planning pays in saving women’s lives and well being as well as reducing poverty and our carbon footprint.