Kevin Duffy, independent public health consultant and former Marie Stopes director, comments on why we need to be aware of how we are funding on-demand abortion overseas.
Less than two hours after the Biden/Harris win was announced, abortion advocates were rushing onto social media to celebrate the end of the Global Gag Rule (GGR), reporting that Biden had promised to remove this policy on his first day in office. International abortion organisations posted many articles suggesting that millions of women worldwide had been harmed by the Trump administration’s support for this anti-abortion legislation.
So, what is the GGR and if you are a UK taxpayer, or a pro-life supporter, why should you care about these political issues in the USA?
For those who don’t have time to read this full article here’s my takeaway:
It’s time to stop using our UK taxes to fund international NGOs in their provision of and campaigning for abortion on-demand across Africa.
What is the Mexico City Policy?
The Kaiser Family Foundation recently published a helpful ‘explainer’ of the Mexico City Policy.
In 1973, the Helms Amendment prohibited U.S. foreign assistance from being used to support abortion services. Under this policy, international sexual reproductive health and rights (SRHR) organisations could receive and use U.S. donor funding to support their family planning services whilst continuing to use other donor funds for their provision of abortion on-demand services.
In 1984, President Reagan changed this when he introduced the Mexico City Policy (MCP), a foreign aid funding policy that limits what organisations can do with any funding, if they wish to also accept U.S. global health funding. The MCP states that all foreign non-governmental organisations (NGOs) which receive family planning assistance from the U.S. Government must stop using either other donor funding or their own income to undertake any abortion-related work, such as:
- Providing abortion as a method of family planning [abortion on-demand].
- Providing counselling and referrals for abortion as a method of family planning.
- Conducting public information campaigns on the availability of abortion; or
Advocating for the liberalisation of abortion laws or lobbying for the continued legality of abortion.
It was for this reason, the prohibition of freely using any other non-U.S. funding, that abortion advocates call the Mexico City Policy, the Global Gag Rule, in memory of Margaret Sanger (founder of Planned Parenthood), who wore a gag in 1916 after being banned by Boston City authorities from delivering a speech on family planning.
The MCP has been invoked by every Republican President since 1984 and revoked by every Democrat President, often as one of their first acts of office.
On January 23, 2017, President Trump reinstated the MCP and directed the Secretary of State to implement a plan to extend the requirements of the policy to ‘global health assistance furnished by all Departments or Agencies’. On May 9, 2017, Secretary Tillerson approved a new policy with much broader reach, Protecting Life in Global Health Assistance (PLGHA).
The Mexico City Policy has been in effect for 19 of the past 34 years, primarily through executive action, and has been instated, rescinded, and reinstated by presidential administrations along party lines.
The requirements of the PLGHA are described by USAID as follows:
“The policy requires foreign NGOs to agree, as a condition of receiving global health assistance, that they will not perform or actively promote abortion as a method of family planning [abortion on-demand]. Under this expanded policy, ‘global health assistance’, as it applies to USAID, encompasses all global health programs, including HIV/AIDS, maternal and child health, infectious diseases including malaria, tuberculosis, and neglected tropical diseases, global health security, and family planning and reproductive health.”
This expansion of scope, from the funding of family planning which MCP covered, to this much wider set of USAID funded programmes is significant. The U.S. Government Accountability Office (GAO) states that, as of September 2018, PLGHA applied to over 1,300 global health projects with an estimated $12 billion in planned U.S. assistance; this is 21 times greater than the $560 million worth of funds which would have been affected by the previous implementation of the MCP.
In stating the prohibited services, the PLGHA uses the term “abortion as a method of family planning,” meaning abortion on-demand by the choice of the woman. It is important to note that this policy does not restrict NGOs from providing post-abortion care nor performing or offering referral for abortion in cases where the pregnancy either poses a risk to the life of the mother or has resulted from incest or rape. Another exception permits NGOs to respond to a question about where a safe, legal abortion may be obtained when a woman who is already pregnant clearly states that she has already decided to have a legal abortion (passively providing information, versus actively providing medically-appropriate information). In addition, the expanded policy does not apply to healthcare providers who have an affirmative duty required under local law to provide counselling about and referrals for abortion as a method of family planning.
- The PLGHA prohibits an international NGO, wishing to receive and use U.S. funding, from engaging in the promotion or provision of abortion on-demand, by the choice of the woman, sometimes referred to as social abortion.
- The PLGHA permits an international NGO receiving U.S. funding to provide essential post-abortion care, and abortion to save the life of the pregnant woman and in cases in which the pregnancy has resulted from rape or incest.
This position against the overseas provision of abortion on-demand by U.S. funded organisations, is one in which the Trump administration has been deliberately consistent. It recently signed the Geneva Consensus Declaration, reaffirming that there is no international right to abortion and that it is the sovereign right of every nation to make their own laws in regard to abortion, absent external pressure (from United Nations agencies and pro-abortion lobby groups).
Trump and his administration were not aiming to reduce the amount of U.S. foreign assistance but simply restricting access to these $12 billion of funds, to those organisations which signed their agreement to the terms of the PLGHA policy. The choice is very much left to the NGO boards. They can agree not to promote or provide abortion on-demand and be eligible to receive U.S. taxpayers’ funding, or they can choose to provide these abortions and/or to lobby foreign governments and ministries to change national abortion laws, in which case their organisation would become ineligible for continued U.S. financial support. A free-choice, one entirely theirs to decide.
What has been the monetary impact of PLGHA?
Even though its scope is much wider than the Mexico City Policy, the implementation of the PLGHA in 2017 has had a negligible impact on the disbursement of U.S. financial assistance. The GAO reported that of the 1,300 NGOs to which the policy applies, only six refused to accept the terms and conditions of the PLGHA, resulting in $150 million in declined funding, just 1.25% of the total funding.
The two largest of the six prime awards declined were global awards to Marie Stopes International (MSI) and International Planned Parenthood Federation (IPPF), both of which publicly stated that they could not meet the conditions of PLGHA because abortion on-demand or referrals are part of reproductive health care services they provide and a right to which their patients are entitled.
MSI (now MSI Reproductive Choices) and IPPF are both headquartered in the UK. As at September 30, 2018, these two organisations, by their refusal to accept the terms of the PLGHA, declined previously agreed funding, but not yet obligated, of $24m (£18m) and $54m (£40m) respectively, and of course any new future funding from the U.S. whilst the PLGHA is in force.
So how much impact has this had on the global services of MSI?
Impact of PLGHA on Marie Stopes International
In the MSI 2016 annual report, its CEO Simon Cooke signposted a potential future annual funding gap of $30 million (£23m) because of the MCP.
In the 2017 report, Cooke warned that there will be a gap of $30 million per year in income from 2018. This would be a loss of about 12% of total donor funding. He noted a drop of £4.3m in total funds in 2017, not from the MCP but due to accounting adjustments made under the UK SORP regulation. Commenting on the Mexico City Policy, he said: “the MCP has had the expected chilling effect on the whole sector, and will continue to undermine progress made in increasing access not only to safe abortion and post-abortion care but also to contraception and family planning in some of the world’s poorest communities.” (It’s interesting that Cooke mentions post-abortion care, which of course is not prohibited by PLGHA, and ‘safe abortion’ means abortion on-demand.)
In the 2018 report, he enthusiastically reported that MSI had successfully maintained its total donor income level of £158m, even without USAID funding, and that the organisation had been able to serve more women and girls than ever before.
The MSI 2019 report showed, for the first time ever, a drop in the total number of abortion and post-abortion care services. This was not due to the PLGHA, but rather it was because of challenges in four MSI country programmes, including tightened regulations around medical abortion provision in India, issues with supply in Nepal, clinic restructuring in Bangladesh, and a temporary service interruption in Kenya early in the year due to political engagement by pro-life groups.
The following table has MSI data from each year’s ‘Financial Statement and Annual Report’. These data show no negative impact on MSI services or income since the reintroduction of the Mexico City Policy in 2017.
- The number of core services provided by MSI, abortion and family planning, were both higher in 2019 compared to 2016, the year just before the reintroduction of MCP.
- 4.6 million abortions in 2019 and little evidence of the ‘chilling effect’ or an undermining of progress in family planning, predicted by Cooke et al.
- MSI has maintained the same level of annual grant income, £160 million.
- Its financial reserves were effectively the same in 2019 as in 2016, £118 million, not bad for a charity.
So, given the ‘loss’ of £42 million in U.S. funding over the three years 2017-19 (compared to the previous annual funding of £23m), how has MSI managed to do this?
The table above shows that direct funding from UK taxpayers through DFID (now FCDO) didn’t change much over these years, remaining at £46 million in 2019.
The annual reports show that funding from some donors increased significantly between 2016 and 2019, helping to make up the gap from the loss of U.S. funds.
- Funding from Australia increased by £6 million and from Canada by £5m.
- Norway and Finland increased grants by £3.5m and £2.8m, respectively.
- The Children’s Investment Fund Foundation increased its grant by £4.4m.
But these generous increases alone would still have left MSI with a funding gap.
UK launches a new reproductive health programme
The 2018 and 2019 reports show that MSI received £2 million and £9m in each of those years from International Planned Parenthood Federation. Why would IPPF, which in 2017 also declined to accept the terms of the PLGHA and walked away from more than $54m (£40m) of U.S. funding, now be one of the major donors to MSI?
The answer is that IPPF and MSI are the two prime recipients of new funding from UK taxpayers, through the government’s three-year programme ‘Women’s Integrated Sexual Health’ (WISH). This programme started in August 2018 and over three years will pay MSI a forecast total of £77 million and IPPF £132m.
MSI operates as an implementation partner to IPPF, helping it to fulfil some of the delivery requirements of its WISH contract by providing abortion on-demand and post-abortion care in some parts of Africa in which IPPF is not currently operating. MSI is paid for this work by IPPF.
The WISH programme will pay these two abortion provider organisations a total of £209 million of UK taxpayers’ money over three years to provide services which would not be fully compliant with the terms laid out by the U.S. in the PLGHA, including the provision of abortion on-demand and active lobbying and campaigning for the liberalisation of local national abortion laws across Africa.
Call to action
- In 2019, UK taxpayers increased their overseas funding to Marie Stopes International by 20%.
- In 2019, MSI received £55 million from UK taxpayers to support the promotion and provision of abortion on-demand overseas.
The UK government is currently reconsidering how best to use its foreign aid budget, so perhaps this is the right time to make it known that we don’t want our taxes used to pay for abortion on-demand across Africa, especially in those countries in which such provision may not be in line with national laws and regulations.
This is not a call for the UK to reduce its foreign aid but to reconsider which overseas activities we want to use our taxpayers’ monies for.
If we want to continue using our taxes to provide foreign aid to help women and girls, then there are better ways to do so, without providing and promoting abortion on-demand; which we should note is not legally permissible here in Great Britain.
One proven effective intervention is to help recruit, train, support, and equip midwives to provide quality comprehensive maternity care, including ante-natal, attended deliveries, and post-partum family planning; healthier mothers, healthier babies and improved birth spacing.
Perhaps the UK should introduce its own version of the Protecting Life in Global Health Assistance policy, with the same life-affirming conditions on the use of our foreign aid. Yes to supporting improved healthcare for women and their babies; no to abortion on-demand.
It’s time to stop using our taxes to fund Marie Stopes International and International Planned Parenthood Federation in their provision of, and campaigning for, abortion on-demand across Africa.
Photo of Margaret Sanger by Adrian Scottow (edited)