The Global Gag Rule: Impacts of conservative ideology on women’s health

Gezinski, Lindsay B.

doi:10.1177/0020872811421619

Cited by 8 publications

(11 citation statements)

References 14 publications

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“…38 Impacts on both certifying and non-certifying NGOs have significant adverse effects on the Kenyan health system, which relies on NGOs to provide services, training for health workers, and commodities. While anecdotal research on previous iterations of the GGR suggest similar impacts on service-providing NGOs, 26,[39][40][41][42][43] little empirical research has shown its impact at the facility level to date. Our study identifies pathways through which GGR-related funding cuts and changes in service provision affect both private and public health facilities in Kenya.…”

Section: Discussionmentioning

confidence: 99%

Foreign assistance or attack? Impact of the expanded Global Gag Rule on sexual and reproductive health and rights in Kenya

Ushie

Juma

Kimemia

et al. 2020

Sexual and Reproductive Health Matters

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In 2017, the Trump Administration reinstated and expanded the Global Gag Rule (GGR). This policy requires non-governmental organisations (NGOs) not based in the US to certify that they will not provide, counsel, refer, or advocate for abortion as a method of family planning in order to receive most categories of US global health assistance. Robust empirical evidence demonstrating the policy's impacts is acutely lacking. This paper describes the effects of the expanded GGR policy in Kenya eighteen months after its reinstatement. We conducted semi-structured interviews with purposively selected representatives of US-and non-US-based NGOs, as well as managers and health providers at public and private health facilities, between September 2018 and March 2019. Organisations reported critical funding loss as they were forced to choose between US government-funded projects and projects supporting safe abortion. This resulted in the fragmentation of sexual and reproductive health and HIV services, and closure of some service delivery programmes. At public and private health facilities, participants reported staffing shortages and increased stock-outs of family planning and safe abortion commodities. The expanded GGR's effects transcended abortion care by also disrupting collaboration and health promotion activities, strengthening opposition to sexual and reproductive health and rights in some segments of Kenyan civil society and government. Our findings indicate that the GGR exposes and exacerbates the weaknesses and vulnerabilities of the Kenyan health system, and illuminates the need for action to mitigate these harms.

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Section: Discussionmentioning

confidence: 99%

Foreign assistance or attack? Impact of the expanded Global Gag Rule on sexual and reproductive health and rights in Kenya

Ushie

Juma

Kimemia

et al. 2020

Sexual and Reproductive Health Matters

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“…Only with the recent unearthing and digitization of the original 1930s maps (55,170) has it become possible for health equity researchers to start to investigate the long-term impacts of the original legal discrimination on both neighborhood trajectories and health inequities (79,130,135 By contrast, present-day legal and policy conflicts over, say, same-sex marriage and civil unions (19,34), and over the rights of transgender and third-gender persons (e.g., travesties in South America, hijras in India, and muxes in Mexico) (19,34,47,190,193), render it feasible to analyze the contemporaneous health impacts of the explicit rules at issue. The same holds, in relation to sexism, for current conflicts over laws and policies regarding sexual harassment (81,86,149,204), gender-based violence (24,86,133,188), and sexual and reproductive rights and health, e.g., regarding access to contraception, abortion, or inclusive health care for sexual or gender minorities, or policies regarding pregnancy and parental leave (13,24,53,59,62,67,68,86,144,181).…”

Section: Historical Contingency and Choice Of Structural Measures And Comparison Groupsmentioning

confidence: 93%

Measures of Racism, Sexism, Heterosexism, and Gender Binarism for Health Equity Research: From Structural Injustice to Embodied Harm—An Ecosocial Analysis

Krieger

2020

Annu. Rev. Public Health

260

237

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Racism. Sexism. Heterosexism. Gender binarism. Together, they comprise intimately harmful, distinct, and entangled societal systems of self-serving domination and privilege that structure the embodiment of health inequities. Guided by the ecosocial theory of disease distribution, I synthesize key features of the specified “isms” and provide a measurement schema, informed by research from both the Global North and the Global South. Metrics discussed include ( a) structural, including explicit rules and laws, nonexplicit rules and laws, and area-based or institutional nonrule measures; and ( b) individual-level (exposures and internalized) measures, including explicit self-report, implicit, and experimental. Recommendations include ( a) expanding the use of structural measures to extend beyond the current primary emphasis on psychosocial individual-level measures; ( b) analyzing exposure in relation to both life course and historical generation; ( c) developing measures of anti-isms; and ( d) developing terrestrially grounded measures that can reveal links between the structural drivers of unjust isms and their toll on environmental degradation, climate change, and health inequities.

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“…MCP imposes a view on abortion which many NGOs do not share.Gezinski, L.B. (2011) [32]: The Global Gag Rule: Impacts of a Conservative Ideology on Women’s Health.Peer-reviewn/aQualitative literature review & narrative policy analysisOutline the legislative history of the Global Gag Rule and will describe the key stakeholders responsible for the policy’s passage and promotionImpact on: human rights; political advocacy; law; reproductive health; abortion, perceived and real loss of funding; and the health system effects that were associated with that (decreased access to contraceptives, increased rates of unwanted pregnancies, as well as increased abortions resulting in harm or deathJones, A. A.…”

Section: Resultsmentioning

confidence: 99%

The impacts of the global gag rule on global health: a scoping review

Mavodza

Goldman

Cooper

2019

glob health res policy

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Background The 1984 Mexico City Policy is a U.S. federal policy that has prohibited foreign nongovernmental organizations that receive U.S. international family planning assistance from using their own, non-U.S. funds to provide, counsel on, or refer for abortion services as a method of family planning, or advocate for the liberalization of abortion laws- except in cases of rape, incest, and life endangerment. The policy became known as the global gag rule (GGR) due to its silencing effect on abortion advocacy. Historically, it has only been attached to family planning funding, until 2017 when a presidential memorandum expanded the policy to nearly all US$8.8 billion in global health foreign assistance. In light of the aforementioned expansion, this scoping review aimed to describe and map the impacts of the GGR on global health, which in turn would identify research and policy gaps. This is the first time that all of the existing literature on the policy’s impact has been synthesized into one article and comprehensively reviewed. Methods The review utilized Arksey and Malley’s five-stage methodological framework to conduct a scoping review. Fourteen peer-reviewed databases and 25 grey literature sources were searched for publications between January 1984 and October 2017. Organizations and individuals working on GGR research and impact were also contacted to access their works from the same time period. These publications reported on impacts of the global gag rule on 14 domains in global health. Results The searches yielded 1355 articles, of which 43 were included. Overall, 80% of the identified sources were qualitative. The misunderstanding, miscommunication, and chilling effect of the policy underpinned the GGR’s impacts. The frequently reported impacts on family planning delivery systems (34 articles) and the loss of U.S. funding (21 articles) were often related. Sources reported on the impact of the GGR on HIV and AIDS programs, advocacy and coalition spaces, and maternal and child health. Only three studies (6.9%) quantified associations between the GGR and abortion rates, concluding that the policy does not decrease rates of abortion. Discussion The GGR’s development and implementation was consistently associated with poor impacts on health systems’ function and outcomes. More peer-reviewed and quantitative research measuring and monitoring the policy’s impact on health outcomes are needed. More research and policy analysis exploring the GGR’s development and its implementation on the ground will improve knowledge on GGR consequences, and potentially shape its reform.

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The Global Gag Rule: Impacts of conservative ideology on women’s health

Cited by 8 publications

References 14 publications

Foreign assistance or attack? Impact of the expanded Global Gag Rule on sexual and reproductive health and rights in Kenya

Foreign assistance or attack? Impact of the expanded Global Gag Rule on sexual and reproductive health and rights in Kenya

Measures of Racism, Sexism, Heterosexism, and Gender Binarism for Health Equity Research: From Structural Injustice to Embodied Harm—An Ecosocial Analysis

The impacts of the global gag rule on global health: a scoping review

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