Access Denied: U.S. Restrictions on International Family Planning

In January 2001, the U.S. government imposed restrictions on nongovernmental organizations overseas receiving international family planning assistance. The restrictions, officially called the Mexico City Policy, are also known as the Global Gag Rule by those who oppose it. Under the policy, no U.S. family planning assistance can be provided to foreign NGOs that use funding from any other source to: perform abortions in cases other than a threat to the life of the woman, rape, or incest; provide counseling and referral for abortion; or lobby to make abortion legal or more available in their country. Non-compliance will result in loss of funding from the U.S. Agency for International Development (USAID).

A diverse group of U.S. nongovernmental organizations came together to document the impact of the policy on family planning services. Research was conducted in four countries (Ethiopia, Kenya, Romania and Zambia) to assess whether and how the restrictions have affected women’s access to contraception and related reproductive healthcare. This document summarizes the major research findings as of mid-2003, and includes selected country examples.

As the leading donor of family planning assistance to NGOs overseas, USAID supports technical assistance, training, contraceptives, including condoms, funding, and other resources needed to assure efficient and effective delivery of services to millions of couples. These NGOs form strong community ties, create innovative solutions, and build local capacity to respond not only to the demand for family planning but also to other critical health needs. They often work closely with public health systems in providing care to the poorest and most vulnerable groups. Yet, under the Global Gag Rule, funds are denied to foreign NGOs that choose to counsel their patients on a full range of reproductive health options.

The Global Gag Rule therefore forces a cruel choice: In starkest terms, foreign NGOs can either choose to accept USAID funds for provision of essential health services — but with restrictions which may jeopardize the health of many patients — or the NGOs can choose to reject the policy and lose vital U.S. support. For those who reject the gag rule, the price is not just monetary. They are unable to obtain donated USAID contraceptives and are forced to cut services and raise fees. In a number of countries, established referral networks of providers are collapsing as leading family planning NGOs downsize and struggle to cope with budget cuts and rapidly declining stocks of contraceptive supplies.

The Global Gag Rule Impact Project is a collaborative research effort led by Population Action International in partnership with Ipas and Planned Parenthood Federation of America and with assistance in gathering the evidence of impact in the field from EngenderHealth and Pathfinder International. The Project’s objective is to document the consequences of the Global Gag Rule. The Project was initiated soon after the policy was reinstated by President George W. Bush in January 2001. While the missions of the collaborating organizations are diverse, we are united in our belief that policies governing U.S. assistance should be evidence-based and reflect proven public health practices.