Two years and one month after imposing a global abortion gag rule abroad, Trump doubles down with a nearly identical gag rule at home. These ongoing attacks on women’s reproductive health and autonomy are totally consistent with Trump’s misogynistic history of sexual harassment, exploitation, and entitlement.
On January 23, 2017, as one of his first official acts, President Trump imposed a global gag rule forbidding all foreign direct and indirect recipients of U.S. global health funding from counseling women about abortions, referring women to abortion services, or advocating for the legalization or use of safe abortion (it was already illegal to use U.S. funds abroad to provide abortions). This prohibition applied whether or not the foreign organization used non-U.S. funding to provide such abortion-related counseling and referral services. The consequences of the global gag rule have been horrifying, impacting health services providing for women’s sexual and reproductive health, HIV prevention and treatment, and even primary health needs. Reports have poured in from around the world on adverse reproductive health effects including decreased access to contraception, antenatal care, safe conception, and, of course, safe abortions, resulting in higher rates of unwanted pregnancy and abortion and of maternal and child death.
On February 22, 2019, President Trump’s administration issued final rules, first proposed in May of 2018, that would strip Title X federal funding from Planned Parenthood and other women’s reproductive health services unless they agreed to refrain from referring women for abortion services and from providing abortion services unless there was total physical and financial separation between the non-abortion and abortion health services. Planned Parenthood and others have stated that they will not compromise their values and ethical duties to women by denying them access to information addressing their constitutionally protected health needs.
As a consequence, with the expected loss of tens of millions of dollars per annum in funding, Planned Parenthood predicts that the 4 million people relying on Title X funding for their sexual and reproductive health care face the risk of reduced access not only to lawful abortion services, but also to birth control, cancer screenings, HIV and STD testing and treatment, or even general women’s health exams. In addition, the domestic gag rule will disproportionately impact poor women of color, LGBT communities, and rural populations who rely on Title X funded programs and have limited opportunities to access sexual and reproductive health services elsewhere.
Poor rural women in Malawi and Mississippi face the same dire circumstances – limited resources for travel and health care, limited access to accurate and comprehensive health information, and few options for accessing even the most rudimentary care. They are also at disproportionately high risk of HIV. Trump’s policy fractures their existing, scant opportunities even further – showing a willingness that they be denied care in its entirety solely to achieve his political promise to the most conservative anti-abortion forces that women will never have effective and equitable access to abortion.
As a further erosion of women’s (and men’s) reproductive and sexual health rights, Trump’s policy at home and abroad is also returning to advocating for natural forms of birth control, including fertility-cycle awareness, and an increased emphasis on abstinence and faithfulness. These policies, unlike comprehensive sex education policies, have proven to be infamously ineffective –indeed counterproductive – in delaying sexual initiation, in reducing the number of sexual partners, and in preventing pregnancy and HIV and other sexually transmitted diseases.
Trump’s promise to end AIDS in the U.S. by 2030 in his 2019 State of the Union Address will be illusory if he insists on enforcing the domestic gag rule and the many other homophobic and transphobic policies of his administration. Coupled with his continuing attacks on the Affordable Care Act that pays for the lion’s share of the HIV-related health care in the U.S. and his paltry funding of key community-level HIV health interventions, Trump’s grand plan to end AIDS is dead on arrival. Likewise, his annual threats to defund the U.S.’s global AIDS funding by over a billion dollars a year will result in millions of new infections and deaths over the next decade. With a global shortfall of at least $5.4 billion a year in HIV/AIDS funding, the U.S. needs to commit a minimum of approximately $1 billion additional per year to help meet global targets for addressing the global AIDS pandemic.
Trump’s misogyny—from bragging about grabbing women’s bodies, to leering at young, undressed beauty contestants, to sexual exploit cover-up payments—is well known. His personal acts and words are bad enough, but it’s his policies that escalate existential harm to millions. Trump should impose a gag rule on himself and stop imposing it on essential health services for women here or anywhere else in the world.
About the author: Brook Baker is a senior policy analyst for Health GAP (Global Access Project) and is actively engaged in campaigns for universal access to treatment, prevention, and care for people living with HIV/AIDS, especially expanded and improved medical treatment. He is also a professor of law at Northeastern University and an honorary research fellow at the University of KwaZulu Natal in Durban, South Africa.