Amid all the presidential scandals of the past week, it was easy to miss that the Trump administration vastly expanded the anti-abortion policy known as the "global gag rule." But it's big news, with significant consequences.
The global gag rule prohibits any U.S. foreign aid from going to organizations that provide, advocate for or even discuss safe abortion services. Under previous Republican administrations, the rule applied to approximately $600 million in funds for family planning. Under Trump's expansion, the rule puts $8.8 billion for a range of programs addressing health issues like maternal and child health, HIV/AIDS, malaria and Ebola in jeopardy.
This expanded gag rule is an economic attack aimed at preventing the poorest women in the world from obtaining or even learning about safe abortion services, which will inevitably result in increased mortality from unsafe abortion as well as collateral damage to poor people in need of other life-saving health services. It is a significant escalation in the broader campaign by U.S. abortion opponents to use economic coercion to stop women from obtaining safe abortions at home and abroad – a strategy abortion opponents have embraced because, after losing the legal battle decades ago, they have utterly failed to convince women that ending a pregnancy is immoral.
Though abortion opponents like to pretend the Supreme Court made up the right to abortion out of thin air, Roe v. Wade was in fact the inevitable result of the Court's gradual recognition that the Constitution applies to women, which means women also enjoy the fundamental rights to bodily integrity and personal autonomy that the Court had long recognized are protected by the Bill of Rights. Numerous lower and state courts had already ruled that the Constitution did not allow the government to force a person to carry a pregnancy to term against her will. Those decisions are in keeping with other rulings – and most people's intuition – that one's body and one's decisions about family are sacred. The government can't, for example, control how many children you have by forcing you to be sterilized. Nor can it invade your body by compelling you to donate an organ – or even just blood – to save a born person's life.
The Supreme Court has repeatedly upheld its ruling in Roe that a person has a fundamental right to end a pregnancy before fetal viability. The 1992 decision in Planned Parenthood v. Casey gave states greater leeway to try to persuade women to carry to term, but dashed any realistic hopes for recriminalization. As Justice Kennedy put it in a later case, "Foreclosed from using the machinery of government to ban abortions in early term, those who oppose it are remitted to debate the issue in its moral dimensions."
But opponents have had little success convincing women that abortion is immoral. Nearly half of all women with unintended pregnancies in the United States end them. Even after a significant drop in the abortion rate that coincided with improved access to contraception under Obamacare, close to a million women a year have abortions in the U.S. Even women who identify as anti-abortion tend to think their own abortions are justified. Studies show laws requiring women to undergo anti-abortion counseling or view embryonic ultrasounds do not cause women to change their minds.
So having failed to convince women not to have abortions, opponents have resorted to coercion. This isn't a new strategy – in the wake of Roe, Congress enacted the Hyde Amendment, barring women on Medicaid from using their insurance to afford safe abortion care and therefore ensuring poor women continued to die from unsafe abortions, even after the procedure was legalized. As abortion opponents' hopes of winning the legal or moral argument have dimmed in the decades since, they have focused their efforts on erecting new financial barriers to deprive low-income women of abortion care.
For example, the Trumpcare bill passed by the House bars individuals receiving federal Medicaid – who already lack abortion coverage thanks to the Hyde Amendment – from receiving non-abortion health care at Planned Parenthood. The end goal is to cause Planned Parenthood clinics to close, so that ending a pregnancy involves travel that will be cost-prohibitive for some women. The bill also aims to eliminate abortion coverage in private insurance plans by making anyone with coverage ineligible for tax credits. Similarly, targeted regulation of abortion providers, or TRAP laws, like those struck down by the Supreme Court last term, use bogus health regulations to shut down clinics and drive up costs and wait times at the clinics that remain.
Laws that put quality abortion financially out of reach are more effective at keeping women from having abortions than efforts to convince them to carry to term willingly – such laws are associated with later abortions, increased self-abortion attempts and moderately decreased abortion rates. However, a woman in the U.S. who has made up her mind to have an abortion will typically find a way to get one, come hell or high water – though doing so may jeopardize her ability to pay her rent or feed her kids. Thus, the biggest bang for one's anti-abortion buck, so to speak, is in depriving the global poor of information and safe procedures. That's exactly what the Trump administration's expanded global gag rule does.
More than 21 million women have unsafe abortions each year; the deaths that result from such procedures make up 13 percent of maternal deaths worldwide. When the gag rule is in place health organizations have to stop providing accurate information about safe abortion or lose all U.S. funding for their non-abortion services. As a result, organizations that continue to offer accurate health information can't provide as many women with contraception, so the rate of unintended pregnancies increases. Women determined to end their pregnancies who have little access to or even information about safe abortion then resort to unsafe abortion in greater numbers. The second Bush administration, during which the gag rule was last in place, amended it to allow funded organizations to treat women after they'd had unsafe abortions – but it isn't clear that Trump's version of the rule even allows for that.
To be clear, federal law already prohibits U.S. aid from going toward the provision of abortion services. The gag rule is about preventing groups from lobbying governments for safe, legal abortion and keeping women in the dark where legal services are available. There is no better illustration of the fact that abortion opponents have lost the moral argument than the harm they are willing to inflict just to stamp out dialogue and information. Abortion opponents can do little to stop a woman from deciding an abortion is a moral choice in the best interest of herself and her family – but they can use her poverty to prevent her from getting a safe one.