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A World Without Choice:
The Global Gag Rule
The Global Gag Rule, also known as the Mexico City Policy, is an Executive Order that prohibits non-US organizations from receiving US Government funding if they provide, counsel or refer women for abortion services. The policy also prohibits funding for organizations that advocate for wider access to safe abortion care. Organizations are banned from US funding even if abortion services are paid for with their own money, or funds from other donors. President Trump re-enacted the policy on his third day in office.
Marie Stopes International believes that safe abortion is a vital component of women’s reproductive healthcare, and that no woman should ever be denied access to a contraceptive method of her choice. We fundamentally cannot and will not agree to the policy because it violates our core belief in individual choice. Instead, we choose to stand in solidarity with women around the world and unquestionably support their ability to choose if and when they have children.
This means that under a Trump Administration, we will no longer be eligible to receive new funding from the US government. Since 2009, Marie Stopes International has been a trusted partner of US Agency for International Development (USAID), providing voluntary contraceptive services to underserved and vulnerable women and girls living in some of the poorest countries around the world. It is these women and girls who will ultimately pay the price for this harmful policy.
Take a stand against the Global Gag Rule. The fight starts today against a world without choice.
Learn more about the impact of this policy’s reinactment by exploring the following sections:
A counterproductive and unnecessary policy
The Global Gag Rule will have detrimental effects on individual women and public health across the globe by dramatically increasing unintended pregnancies and abortions, as well as maternal deaths and illness.
By blocking funding to some of the world’s largest providers of voluntary modern contraception, it blocks women’s ability to prevent unplanned pregnancies, and will increase the number of abortions. Each year, almost 50,000 women die from and 6.9 million women are treated as a result of an unsafe abortion. By driving women to resort to clandestine abortions in areas where the procedure is restricted, the Global Gag Rule will undoubtedly increase maternal deaths and health complications around the world.
Marie Stopes International has never used US funding to support our safe abortion and post-abortion care services overseas. There are long-standing legislative restrictions in place to ensure that USAID does not ever fund abortion services. However, before the Global Gag Rule was re-enacted, USAID was able to fund family planning programs with organizations like Marie Stopes International, which provide safe abortion services using funding from other donors. The Global Gag Rule therefore is unnecessary and will only cut off women’s access to contraception.
Cutting off access worldwide
In 2016, USAID funded MSI at
17% of our donor grant income
Over the last seven years, thanks to USAID funding and the generous support of the American people, we provided 5 million women in the developing world with contraception. The result of that work will be:
unintended pregnancies prevented
maternal deaths prevented
healthcare costs saved
In 2017, MSI’s USAID-funded work would have provided voluntary modern contraception to approximately 1.5 million people. Our services during President Trump’s first term (2017-2020) would have resulted in:
unintended pregnancies prevented
maternal deaths averted
in direct healthcare costs saved
For many women and girls around the world, Marie Stopes International is their only option for family planning care – and often any health care at all. Don’t let the Global Gag Rule cut off their only lifeline to care.
Putting women and girls at risk
Every day, Marie Stopes International empowers each individual woman we serve to choose when she has children so she is free to pursue her dreams. But the Global Gag Rule denies women access to contraception and therefore strips them of their individual choice and agency. Read the stories below to learn more about the impact of the Global Gag Rule on individual women.
Putting womens lives at risk:
Zorodzai remembers what it was like before long-term contraceptives were available in her community. She would struggle to afford contraceptive pills, and was always in fear of an unintended pregnancy because of forgetting to take the daily dose.
“I decided to use a long-term contraceptive method because my third child was a result of an unplanned pregnancy.
When I was using pills, I would find it difficult to purchase them sometimes because of a lack of funds. Sometimes I would ask my ex-husband for money to buy pills and he would say, ‘I don’t have money’ but he would also want to have sex. This gave me a lot of stress because I would live in constant fear of being pregnant.”
After unexpectedly becoming pregnant, Zorodzai’s husband left her. Without support from her husband, her economic situation deteriorated.
“I had to travel to my rural home to get my oldest child’s baby clothes in preparation for the new child. It was a difficult time because the clothes were really old and some of them had holes in them from rat bites.
I gave birth at home. I couldn’t even give birth in a clinic because my husband just said he didn’t have money. When you give birth you want to give birth at a hospital and dress the baby in new clothes. If I had had a complication during the birth, it would have caused problems again.”
Zorodzai has been using long-acting contraceptive methods for 5 years now. She started with the Jadelle implant and recently switched to an IUD. Now that she has an IUD, she feels more confident and relaxed because she knows that she won’t have an unplanned pregnancy. Zorodzai is now separated from her husband, but is thankful that she is protected from other risks.
“Where I live, a lot of things can happen to me. For example, someone can decide to be cruel and rape me, but because I know I am protected I have nothing to worry about. I can confidently take care of the children I have.”
Now a single mother to two girls and a boy, contraceptive access has enabled her to support and protect her children. With the re-enactment of the Mexico City Policy, this access is no longer guaranteed.
We estimate that, with the re-enactment of the Global Gag Rule, each year approximately 1.6 million fewer women across the developing world will have access to contraception from a trained Marie Stopes International provider.
Putting womens lives at risk:
Kudzai Mujuru has always dreamed of becoming a nurse. When she got pregnant at 17, she was forced to put those dreams on hold.
Before her pregnancy, she had been working as a housemaid in the town of Chitungwiza, Zimbabwe. Her plan was to save enough money to pay her way through nursing school. The father of her child was a friend from church but, when she told him she was pregnant, he refused to accept any responsibility.
“I had to leave my job and move home with my mother. She has been helping me take care of my child ever since. It is very hard because my mother struggles to earn a living herself.”
Now 19, Kudzai was taking her baby daughter to her local health clinic in Epworth, a settlement on the outskirts of the capital, when the nurses told her about the free voluntary contraception services offered by Marie Stopes International’s Zimbabwe program. She gave it some thought, and decided this was something that could set her back on the path toward her dreams.
“I want to start planning my future again. I want to look for a job and I want to go back to school because you never know what might happen in the near future. I might find a man to date and I might fall pregnant again, which will ruin my plans.”
Kudzai returned to the clinic on a day when she knew the Marie Stopes International outreach team would be there. A nurse counselled her on the full range of contraception available, and she decided on a contraceptive implant, which will protect her from unplanned pregnancy for five years. As the outreach work was supported by USAID, all services were provided free of charge.
“The service was good. The staff treated me with warmth. I will now tell all my friends about the benefits of using long term contraception. They all have plans for the future too.”
Thanks to the support of USAID, our teams in Zimbabwe have been able to provide voluntary family planning services from dozens of outreach sites like this one, all over the country. Annually, USAID funding has supported the program to prevent more than 92,000 unplanned pregnancies, more than 27,400 unsafe abortions, and nearly 300 maternal deaths.
On the day Kudzai visited the clinic, she was one of 91 women who accessed free voluntary contraception through the service. With the re-enactment of the Global Gag Rule, this access is no longer guaranteed, and the futures of tens of thousands of women are once again hanging in the balance.
Putting womens lives at risk:
To Tarisai Ndemera, a mother of six children and step-mother to two more, contraceptive choice and counseling means more than just planning her family. Tarisai is HIV-positive, and having access to a voluntary, long-acting method of contraception helps her to remain healthy and focus on supporting her children.
As a famer, days can be long and burdensome, especially when she has to bring along young children.
“My work of farming and traveling with children to the market in Harare with my produce is not easy. The transport we use is often not comfortable and requires one to be strong.”
She came to access a long-acting contraceptive method from Marie Stopes International’s Zimbabwe program because she decided, together with her husband, that the children they have are enough.
“It is hard to take care of the children, especially the ones that are still in school. So at times, the older children chip in and with the money I get from selling produce we are able to pay for their school fees. We have decided to concentrate on earning a living for our children who are in school because times are hard.”
Previously, Tarisai had been using the Depo injectable contraceptive, which lasts approximately three months, and condoms. Last time she came to get an injection, she saw a poster for long-acting contraception and made plans to return to the clinic when the outreach team would be visiting.
“Contraception has made a difference in my life because I can be with my husband and not have to worry about having an unplanned pregnancy. We can concentrate on taking care of the children we already have.”
Thanks to the support of USAID, which funds 100% of Marie Stopes Zimbabwe’s mobile clinical outreach services, our teams have provided voluntary family planning services from dozens of outreach sites like this one, all over the country. Annually, USAID funding has supported the program to prevent an average of more than 74,000 unplanned pregnancies, more than 22,000 unsafe abortions, and nearly 250 maternal deaths.
The impact of USAID-funding family planning services does not end there. Counseling from Marie Stopes providers had benefits for Tarisai that she had not expected: she learned that the antiretroviral medication she takes can reduce the effectiveness of some contraceptives, and chose a contraceptive implant that will protect her from unplanned pregnancy for five years accordingly.
“I received good service today and learnt about things I did not know. I will encourage young women who want to have children to plan their families.”
Tasirai was one of 50-120 clients the Marie Stopes outreach team provides free, voluntary contraception to outside of Harare areas each day. With the re-enactment of the Global Gag Rule, this access is no longer guaranteed in some of the world’s poorest countries. It is women and girls who will pay the price.
USAID is a major funder of Marie Stopes Nigeria’s work in strengthening the public sector. This includes the training of 2,125 public sector health workers to provide voluntary family planning services to women and families in 20 of Nigeria’s 36 states, some of which are the most fragile regions, including serving people who have been displaced by conflict.
We estimate that, from 2017-2020, the program would have prevented more than 1.8 million unintended pregnancies, and averted more than 660,000 abortions and more than 10,100 maternal deaths. This would have saved the Nigerian government more than $87 million in direct healthcare costs over that period.
Currently, more than half of Marie Stopes Madagascar’s work is supported by USAID. Funding is focused on the program’s mobile clinical outreach work, bringing voluntary contraception to women in remote and rural areas. USAID also supports our franchised family planning clinics and work to strengthen Madagascar’s public sector. An estimated 75% of women, men and youth accessing these services live on less than $1.25 per day, and almost 90% live on less than $2.50 per day.
We estimate that if USAID funding continued to support the services delivered to our clients from 2017-2020, the program would have prevented more than 1 million unintended pregnancies, and averted almost 340,000 abortions and more than 2,200 maternal deaths. This would have saved the Madagascan government more than $48 million in direct healthcare costs over that period.
USAID currently funds 100% of Marie Stopes Zimbabwe’s mobile clinical outreach services, which provide a choice of voluntary contraceptive methods to women in remote and rural areas. Marie Stopes outreach services are often the only way women in underserved areas of Zimbabwe can access contraception. Of the total number of clients who received services at one Marie Stopes Zimbabwe’s 1,700 outreach points, over one-third were under age 24.
We estimate that, from 2017-2020, the program would have prevented more than 380,000 unintended pregnancies, and averted more than 118,000 abortions and more than 1,000 maternal deaths. This would have saved the Zimbabwean government more than $19 million in direct healthcare costs over that period.
USAID currently funds over one-third of Marie Stopes Mali’s work, which provides and strengthens voluntary contraceptive services. The majority of women we serve are living in underserved and rural areas and earn less than $2.50 per day, and one-third are under age 20. Mali has one of the world’s highest maternal death rates in the world, as well as one of the world’s highest population growth rates. A reduction in services could have staggering consequences.
We estimate that, from 2017-2020, the program would have prevented more than 275,000 unintended pregnancies, and averted nearly 100,000 abortions and more than 1,000 maternal deaths. This would have saved the Malian government more than $12.6 million in direct healthcare costs over that period.
USAID currently funds 100% of Marie Stopes Ethiopia’s mobile clinical outreach services, expanding choice of voluntary contraceptive methods to women in remote and rural areas. Marie Stopes Ethiopia is also strengthening the public sector’s capacity to provide high-quality, voluntary permanent method services – resulting in increased access to comprehensive family planning method choice.
We estimate that, from 2017-2020, the program would have prevented more than 88,000 unintended pregnancies, and averted more than 27,000 abortions and 82 maternal deaths. This would have saved the Ethiopian government more than $4 million in direct healthcare costs over that period.
Learn more about the policy and its impact on women worldwide below.
Maries Stopes International Resources
(new) The Guardian: Trump expands the policy that bans US aid for overseas abortion providers
New York Times: President Trump’s War on Women Begins
New Yorker: Trump Makes the Gag Rule on Abortion Even Worse
New York Magazine’s “The Cut”: It’s Not Just American Women Who May Be Harmed by Donald Trump’s Presidency
Foreign Policy Magazine: The Global Gag Rule: America's Deadly Export
Inside Philanthropy: Gag Reflex: Melinda Gates Isn't the Only Funder Worried About the Mexico City Policy