Within 72 hours of his inauguration, President Donald Trump reinstated the "global gag rule." The gag rule (otherwise known as the Mexico City Policy) insists that the government can't allocate any federal assistance to organizations worldwide that provide abortions, refer women to abortion providers, or even advocate for liberalized abortion policies. A version of the rule has been on the books since 1984, and it has been struck down or revived based on who's in power. But this latest iteration marks a horrific expansion; under Trump, it's not only organizations that receive family-planning dollars that have to comply with the regulation. Now any initiative that receives U.S. health funds must observe the rule or else waive essential aid.
Moreen Majiwa is the advocacy adviser for the Africa Program at the Center for Reproductive Rights. She lobbies governments and intergovernmental bodies to prioritize women's access to reproductive health care across Africa. Devoted to the pursuit of women's progress, Majiwa has come to believe that a true power balance between the sexes depends on two essential and intertwined realities: economic empowerment and reproductive freedom. Without access to contraception and education around abortion, "if a woman gets pregnant at thirteen, fourteen, fifteen, sixteen, her life choices immediately are narrowed, not just economically, but socially," Majiwa says.
Majiwa warns that this regulation, particularly in its expanded form, won't end abortion around the world; it will only increase the likelihood of perilous, sometimes fatal procedures. But for all the harm it will do, the reinstated rule has only fueled Majiwa's commitment to her cause. If any good is to come from this, it will be, she tells me, a renewed global pressure on governments to write policies that provide for women and families and are less reliant on fickle international aid. It's a sad consolation, she admits. But it reminds her that no man, not even the president of the United States, should have the power to decide our fate.
Mattie Kahn: Before the global gag rule was reinstated, what kinds of obstacles were already keeping women from getting access to the reproductive health care they need?
Moreen Majiwa: The problem, nationally, regionally, and globally, I think, is a conservative attitude towards reproductive health care and particularly towards women's access to abortion. This view creates policies that limit the circumstances in which women can access safe and legal abortions and drives women to seek unsafe underground abortions, which can result in either death or severe complications.
MK: Do you mean the attitude itself is part of the problem? That it's not only a lack of literal access that's hurting women, but the taboo around the procedure?
MM: Yes. The conservatism is not just in law and policy. It's attitude, and attitude does affect — even where [abortion] is legal in certain circumstances — people's willingness to access the service, because of stigma, mainly.
MK: Until last month, how were United States funds used to promote family planning or education around reproductive health care for women?
MM: For years, the United States has been a big supporter of family-planning initiatives, and that has included access to contraception, to quality maternal health care, to post-abortion care, which is needed mainly in cases where women have had an unsafe abortion and then later seek care for complications that arise from that.
MK: Are there initiatives you've seen on the ground that you think have worked especially well in the past?
MM: Clinics like [Marie Stopes International] and [Family Health Options Kenya] are U.S.-funded. They do a lot of work and have access to rural areas, which [public institutions] may not always reach. They provide access to health care for the poorest and [most] rural women. And in some places, without these kinds of NGOs and international funds, women there would not otherwise be able to access health-care services, and reproductive-health-care services in particular.
MK: Obviously, the reinstatement of the previous policy alone would have had consequences, but the version of the rule that Trump implemented now applies not only to organizations that specifically address access to reproductive health care, but to all global health organizations. Did people anticipate that he planned to do that, or was this more dramatic than you expected?
MM: The expansion definitely wasn't expected. The reinstatement of the global gag rule under Republican government was expected, but not this expansion. That's new. And governments and NGOs will have to deal with that.
MK: Walk me through the dilemma organizations and governments are in now. Do they have an option to turn down funds, or is this just inevitable that they're going to have to accept the terms that the U.S. government has now laid out?
MM: They have options. The first option is to [continue to] accept U.S. funds; this means that the NGO or the government involved cannot provide information, counseling, or advocacy for abortion. They can't even refer women to places that give abortions. The second option is to reject, to not accept the funding. In that case, they would definitely seek contributions from other governments, from bigger nonprofits. But it's hard. Given how much money NGOs and even governments around the world receive in U.S. aid, they might not be able to make up the full deficit.
And if they can't, many things will happen at once. They will have to lay people off. They can't provide services in the same way that they did. In some places, they won't be able to provide services at all. They won't be able to stay open. And that will have a knock-on effect on other services: on access to contraception, and on HIV treatment, and the quality of maternal health care that women can access. And even if they can stay open, they can continue to provide services, if funding is uncertain, these organizations don't hire; they don't expand.
MK: So, what happens now? Do we know, based on what's happened before, how this will affect women?
MM: We do know there's no proof that the rule leads to a reduction in abortions. And I would think it probably will result in many more unsafe abortions. In a lot of African countries, the liberalization of abortion laws has been relatively recent; I'd say in the last five or six years. Even then, abortion is allowed in very limited circumstances — for the sake of a mother's health, rape, or incest. Because abortion was illegal before and not enough civic education has been done on the liberalization of the abortion laws, what has happened is that a lot of people still don't know they can access safe abortions.
MK: And if the clinician they see isn't allowed to tell them it's an option …
MM: Yes. If they don't hear about it from their doctor or they don't hear about it from NGOs that do this kind of civic education, they will seek unsafe abortions, done with herbs, sticks, hangers. It leads to severe complications and, in some cases, to death. And this will affect different women in different circumstances. There is no [one woman] who needs an abortion. Women seek abortion for different reasons. They're younger women whose lives would be impaired if they had a baby. They're poor women. They're more privileged women. Some are women in more severe circumstances, because they're cases of rape, incest, and where the mother's health is in danger.
MK: And the global gag rule has no provisions for those cases, yes? They're just lumped in with everybody else.
MM: Yes, they're lumped in with everyone else.
MK: What can women around the world do to help?
MM: They can appeal to their government. Donate to organizations that do this kind of work, so that there is less need for international governmental funds. And just, I think, be more aware of what is happening and context in which it happens.
MK: And since we know these issues affect men, too, what should men in powerful positions, in policymaking, in government, do to make a difference?
MM: These men need to create more space for women policymakers to be involved in this discussion. We can't continue to have these "man-els," these panels of men who discuss women's reproductive rights. Women need to be involved. The best decision that male policymakers can make for women is to include them in those spaces, in which they're making choices about women's reproductive health.
This interview has been condensed and edited.
Mattie Kahn is a writer for elle.com. Every day, she is more appalled.