How the Administration is Attacking Repro Rights in the US and Overseas

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Every person, no matter who they are and where they live, should be able to make basic health decisions about their lives. Reproductive health and rights are both a domestic and international issue; we cannot talk about one without the other. But, attempting to keep up-to-date on the global fight on reproductive health can often be overwhelming. Helping us bridge that gap is Chloe Cooney with Planned Parenthood Federation of America. Because both in the United States and abroad, the intention behind every policy that limits reproductive health is an attack on women’s rights.

Opponents of women’s health are looking at every possible attempt to roll back women’s access to affordable health care. It can take different forms in different countries, but the intention of limiting or banning providers, services, or information is still the same. That’s what makes reproductive health and rights a global movement.

One attempt to curtail access to reproductive healthcare abroad is the Trump administration’s implementation of the expanded Global Gag Rule. Not only does this rule gag doctors from giving patients accurate abortion information, it gags organizations from advocating for their rights for providing legal abortion care. These limitations are a condition of receiving global health assistance, which puts foreign NGOs in a position to choose between proper funding and providing comprehensive care to their patients. As a result, there are increased rates of unintended pregnancies, unsafe abortions, and more maternal deaths due to lack of access to contraception.

A version of this rule has also been proposed in the United States. The rule attempts to block doctors, nurses, hospitals and any provider that receives funding from the Title X program, from being able to counsel their patients on safely accessing abortion care. The rule is designed to:

1) Make it impossible for millions of patients to get birth control or preventative care from Planned Parenthood or any other provider;

2) Prevent doctors, nurses, and providers of any kind from providing referrals for abortion care;

3) Remove the guarantee that patients can get the full and accurate information about their healthcare from their doctor.

Some clinics both abroad and in the United States may be the only source of care for a woman to access in her community. It may be the sole provider of STD testing, contraception access, cancer screenings, and well-woman visits. If shut down, women will have less options and nowhere to turn. 

The U.S. government is also in the process of pushing ‘sexual risk avoidance’ programs, which translates to abstinence-only. Access to sexual education in order to know what your sexual health needs are, basic facts about sexual health , and the skills and tools available to you are universal needs. Limiting that information means infringing on the right to information.

Religious refusals also carry domestic and global implications; the ability to deny care based on an organization’s religious views is far reaching. PEFAR (President’s Emergency Plan for AIDS Relief), for instance, has a very expanded religious refusal policy that goes well beyond the religious protections of individuals, meaning the U.S. government’s corporate rules are impacting how people receive healthcare abroad. It is important to remember that those who bear the brunt of religious refusals are those who already face extreme systematic inequalities, like rural women and young girls abroad or communities of color in the U.S.

The gag rules, religious refusals and ‘sexual-risk avoidance’ programs work to censor a provider’s ability to give information and care. This results in reproductive coercion by blocking certain reproductive health options, cutting access to sex education, and limiting contraception methods.

These monstrous policies, rules and programs impact individuals in the United States and extends abroad. Reproductive health and rights is a global fight.

Links from this episode

PPFA on Twitter
PPFA on Facebook
Tracking Trump
Planned Parenthood Defenders Program
File a public comment on the 'domestic global gag'

Transcript

Jennie: Welcome to rePROs Fight Back a podcast on all things repro. I'm your host Jennie Wetter. In each episode, I'll be taking you to the front lines of the escalating fight over our sexual and reproductive health and rights at home and abroad. Each episode, I will be speaking with leaders who are fighting to protect our reproductive health and rights to ensure that no one's reproductive health depends on where they live. It's time for repros to fight back.

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Jennie: Welcome to this week's episode of rePROs Fight Back. On this week's episode, we are going to talk about why we can't just pay attention to what the US is doing domestically or with the US is doing globally and why we need to talk about both together. Helping me dig into this topic, I'm really excited to have the wonderful Chloe Cooney with the Planned Parenthood Federation of America here to talk with me today. Welcome Chloe, and thanks for being here.

Chloe: Thanks Jennie. It's great to be here.

Jennie: So let's start with why should people pay attention to what both what the US is doing globally and domestically on reproductive health?

Chloe: Yeah, no, absolutely. I think it's a really important question, um, especially for our movement and the height of the fights that we're in. Um, and let me just step back because at Planned Parenthood, I think where we come to this is that we believe every person should be able to decide if and when they want to have children, how to make their family and to make basic basic health decisions about their lives and that's true no matter who they are and no matter where they live. So that's why we come at this fight globally as well as within the US um, and you know, I, in my very privileged perch where I get to sit in the middle of our domestic movement, but also hand in hand with our partners around the world, I can say that people all over the world are fighting for the same things that we are in the United States. So it really is a global movement. But stepping back further, I think we need to see that opponents of women's health, who don't believe people should be able to make basic decisions about their lives, are looking at every attempt to roll it back. And so this looks differently in different countries and different contexts. Um, but the intention is the same. And so if you're a person who doesn't believe people should be able to make their own health care decisions to have basic information to decide if and when they want to have children to decide who their family is, what do you do about that? Well, your first stop is you try and ban it. You try and ban access to those rights or services. Um, and if you can't ban it, what do you do? You try and limit access, you limit access to providers, you limit access to commodities and services. Um, and when that doesn't work, what do you do? You look to restrict access to information so people don't actually know what their rights are, know what the information is, don't have the information to those decisions. Um, and that's what we're seeing. And that's true in the global context. And it's true in the domestic context. And I think it's important to think about that basic roadmap with every fight that we're encountering these days. Um, and you know, this has been going on for a long time. Um, but what we're seeing now under the Trump/Pence administration is that effort on steroids.

Chloe: One thing I, I always want to remind folks of is that, you know, we all read the headlines. We're mired in what is, you know, an assault of news every day. Um, and it can very much feel like this administration is mired and chaos in some sort of free fall. Um, and you know, on some levels that may be true, but when it comes to their policy agenda on sexual and reproductive health and rights, they are disciplined, um, and they are systematic about it. Um, so let's never underestimate what's happening and how rigorously they're approaching that. One of the reasons that we look at all of this together is that when you look across all the ways they're making this policy, so disciplined and systematically, um, both in foreign policy and domestic policy, um, we really see the full strategy at work and understand what's coming. Often, for example, we'll see the first policy ideas come out in the global context. Um, and that's for a couple of reasons. Some of it is just the way global health policy is set. It's more discretionary, it can move a little faster. Um, whereas in the domestic context, there tends to be more regulatory processes. It's a little slower. Frankly, I think another reason it tends to, these ideas tend to manifest in the global space first is that, um, I think there's a cynical view that Americans don't care what happens to people in other countries. Um, but at Planned Parenthood, we do care and we know our supporters do too.

Jennie: Yeah. I think they really try and take advantage of the fact that not as many people pay attention to the global space. You know, we talk about it on the podcast, but some big policies are released, you hear about it, but you don't hear about some of the creep on, on a lot of the others. Um, and you may only hear about some of the things that will affect global and domestic. You might only hear about the domestic side and you'd never hear about how it also has global implications.

Chloe: Yeah, I think that's totally right. And one of the reasons why it's so important for us to be shining a spotlight on it. Um, and you know, I can just say having, um, talked to so many of our supporters across the United States, they care, um, and they're paying attention. Um, it may be that the media doesn't report on it as much. It may be that, um, there's not as much sort of air time given to the foreign policy context, but we should not underestimate, um, the viewpoints of, of, of our supporters and, and people across the country who really believe that, um, we should be doing everything we can as a country to advance people's access to health and rights, not withhold them.

Jennie: So as someone who, I definitely wasn't, uh, involved in this field when Bush first came into office, I don't think you were either.

Chloe: Actually I ran students for choice at college and under the Bush administration.

Jennie: Oh, nice. Um, I feel like the, uh, speak out speaking out against the global policies has been louder than I've ever seen it though under this administration, which I think while there are terrible things happening, it is exciting to see that you are seeing more push back on some of these global policies as well.

Chloe: I think that's right. I think that, um, and you know, I, we could probably spend a whole podcast theorizing about why that is. Um, no doubt, you know, access to, um, technology and Twitter and Facebook and whatnot that connects us to activists all over the world has definitely raised awareness. Um, you know, my Twitter feed for instance today is blowing up with some really cool things happening, uh, with young activists in Uganda. Um, so that, that's no doubt. Um, I think our ability to see, see, um, see what's happening in the global context is just completely different than it was, you know, 15 years ago. Um, you know, the data also holds that out where you do see young people and we sometimes say it's the global generation, right? Really seeing themselves as citizens of the world. But, but you know, there was outrage in 2001 when the global gag rule was first put into place under the Bush administration, which is important for us to remember because this, we've been through these cycles before and we cannot be complacent and we have to keep up our advocacy, um, because we don't want to see ourselves repeating the same mistakes in the future either.

Jennie: It's a great place to start is one of the very first things that happened when Trump took office is they reinstate it and vastly explant expanded the global gag rule. Do you want to talk a little bit about the global gag rule?

Chloe: Yeah, absolutely. You're right. It was one of the first things they did. First Monday and office and notably the, uh, the Monday after the historic Women's Marches all around the world, not just in the United States to our point, they were, they were really global. Um, so, uh, the Trump/Pence administration put in place the global gag rule, um, which is basically a policy that puts ideology in between a woman and her doctor. Um, and it impacts the poorest and most vulnerable women in the world. Um, and we call it a gag rule because it literally gags doctors from giving patients accurate information, from even talking about abortion. It gags organizations like local civil society organizations from advocating for their rights to safe and legal abortion in their own civic debate. Um, it really, you know, flies in the face of so much of what we say our foreign policy should stand for, which is improving global health and democracy around the world. To get a little wonky with you. I know that you guys had a whole episode on the global gag girls, so I won't go into too much in depth

Jennie: Yeah. If you want real in depth, check out episode five where we do a deep dive but feel free to get wonky.

Chloe: All right. Well yeah, I always like to get wonky. It's a, it's it's Washington after all. Um, someone should make a song about that. Get wonky with it. Um, yeah, so the Trump/Pence administration put the global gag rule in place, very early on in it. It says that as a condition of receiving US global health assistance organizations are prohibited from using their own money. So non, uh, US funds even, um, from doing anything related to abortion services, information, education, referrals, um, or even advocating for safe and legal abortion. Um, and what that means is that it effectively disqualifies, uh, some of the most expert providers in countries from receiving global health assistance. Um, you know, the very organizations that are best equipped to be a reproductive health provider in their communities are now losing access to US global health funding. Um, so it's, you know, it's, it's a horrendous policy on, on so many levels. It, you know, for many communities it means that the provider, they're counting on the, the local health care center is, has to close because they've lost the resources that they have. Um, and that health center may be providing any number of services from, you know, um, orphans and vulnerable children services, maternal health services, um, HIV, malaria, you name it, um, including reproductive health care. But by virtue of this condition, um, are now disqualified. It also means from a US, um, you know, policy making standpoint, um, our dollars are going to be less effective because we're not spending them and investing them in the most qualified organizations. Um, and that's just bad policy making. Um, as a citizen that makes me angry. Um, as far as the use of our tax dollars. You know, I think what's interesting about the global gag rule is, um, it was put in place appropriately enough in 1984 so it's been around, um, on and off for over 30 years. Um, but we're, we're seeing, which is a theme of course under this administration is that policy put on steroids. So a vast expansion. So in the past that applied to family planning funding, um, and now it applies to the entire global health, uh, portfolio, which is, you know, a 15-fold increase in terms of the scope. Um, and the US is the largest global health donor in the world, as we should be. We're the largest economy in the world. But that means that this kind of policy has enormous influence and it really puts organizations and providers in a terrible position in terms of having to decide how best to meet the needs of their communities. And, you know, we know what the impact is. Women have lost access to contraception. There have been more unintended pregnancies, more unsafe abortions, and more maternal deaths. You know, ultimately that's the impact felt in the lives of women, which is why it's so crazy that we are seeing the same, you know, something so similar being applied to the US.

Jennie: A lot of the argument is we, the global gag rule is needed to prevent abortion or prevent us funds for going for abortion, but what we're seeing is have seen as more abortions and unsafe abortions and women's lives at risk.

Chloe: That's exactly right. I think, you know, proponents of the policy claim that they want to, um, uh, limit the number of abortions. Um, I find that a very cynical claim cause the data's very clear. The outcome of this policy is not less abortion, it's more abortion, and it's more unsafe abortion, which is what's, what's so concerning to me.

Jennie: So we talked a little, you referenced that it's now coming domestic. Well, I guess by the time this comes out, it'll be about a month ago that the US has proposed a new domestic gag rule. Do you want to talk a little bit about that?

Chloe: Unfortunately, yes. Um, you know, the, the domestic gag rule is an attempt to take away women's rights period. Um, so similar to the global policy, it would block doctors, nurses, hospitals, community health centers, and really any other provider as part of the Title X program, which is the national family planning program, from being able to tell their patients how they can safely and legally access abortion. Um, it's completely incredible. So, you know, again, to get wonky with it, it'll do three things important to sort of lay it out here. Um, especially as, again, as of this taping, it's, it's a brand new proposal. Um, so the first thing it does is it, uh, is designed to make it impossible for millions of patients to get birth control or preventative care from Planned Parenthood, um, or any other provider. The second thing under this rule as I said, is that doctors, nurses, healthcare providers of of all kinds are no longer able to provide referrals for safe and legal abortion. Again, this is medical providers referring for safe legal, medical care. Um, and the third thing is it removes the guarantee that patients can get the full and accurate information about their health care from their doctor. So, um, I think it's important to note that for 20 years, almost the Title X rule has been very clear that health care providers cannot withhold information from you about your pregnancy options. Um, and that's been a very pivotal, um, assurance and guarantee. Um, but this gag rule means that they can.

Jennie: I mean, and it seems like such a basic assurance and guarantee, right, that you're going to get all the information you need to make the best decision for you and your family.

Chloe: Completely. I mean, I, you know, I just think about it as someone, as a person in the world who goes to the doctor as hopefully all of us are. Um, you know, when any of us go to the doctor, you know, I expect that I'm going to get accurate information. I'm going to know what my options are. Um, and I certainly hope I'm getting the best care possible. Um, it's a very scary thing to realize that you can't trust your own doctor. Um, and that you can't get the information you need from the doc, your doctor, because if you can't get the information you need about your own health from your own doctor, where can you get it?

Jennie: Yeah. Or how can you make the right choices if you don't even know there's options available or might be something you would want to choose?

Chloe: Yeah, I mean, this comes back again sort of where we started, which is we come at this at Planned Parenthood from this perspective that every person should be able to make their own health care decisions. Doesn't matter if you're in Kansas or Kampala. Um, that that is a fundamental right, um, of, of, of people. And this is part of an agenda to take away the ability of people to have basic information and be able to make their own decisions. And you know, I have to ask myself, what are people so afraid of? Why are you so afraid of people having the information?

Jennie: I think particularly striking is the real attack on Planned Parenthood in this policy. And you know, wanting to prevent basically Planned Parenthood from participating in Title X, but Planned Parenthood is a real integral part of Title X. And a major a source of where people go to get their health care with Title X.

Chloe: You're absolutely right. And I think, you know, listeners of this podcast, it will not come as a surprise that there has been, um, a systematic attack on, um, American's ability to access the health care they need at Planned Parenthood. Um, and that's an attack on our patients. That's an attack on the one in five women and men and young people in America, one in five women. But, um, in addition we serve, we serve men as well, who, who, uh, have gotten care at Planned Parenthood. As you mentioned, Planned Parenthood is a vital part of Title X, nearly 41% of all Title X patients access their care at Planned Parenthood, so that's, um, that's a huge piece of this program. And, and again, remember this is, um, this is an evidence based program. It's competitively awarded. So this is 41% of the most qualified providers that have been determined and it's not just Planned Parenthood that's going to be impacted. Um, but it's certainly, and you know, we've certainly heard it in the talking points of the proponents of this policy that they are aiming at Planned Parenthood. Um, I think it's important to note that the outrage on this policy has been widespread. So the American public, um, overwhelmingly opposes this and the medical community overwhelmingly opposes this, the American Medical Association came out against it. Um, many, many other, um, very, you know, important. Um, medical associations have similarly made statements. So, um, this is not, uh, something that the public health community in any way endorses. And in fact, quite the opposite. Um, this is clearly an ideological move to limit access to women's rights. Um, and the outcome as we know is unfortunately, people lose access to health care. They lose access to breast exams, STD testing and treatment, cancer screenings, well, women exams, birth control.

Jennie: I think one area where you see the similar impacts between the domestic one and the global one is that oftentimes these providers are the only ones available um, particularly in rural areas where women might not have another easy option to get to, to for access to this health care.

Chloe: That's exactly right. It's a great point. It's in many places. Um, Planned Parenthood is the only provider that a woman will see it in her in the year. Um, in many communities, they're the only provider of these services. Um, certainly on the global level we can see examples of that as well. Um, where, you know, the, the widespread attack that the global gag rule proposes means providers sometimes that are the only option for health care for an entire community have, uh, have had to shut down and that community doesn't have anywhere else to turn. The same thing is true in the u s um, in many parts of the country. Um, and, and again, also not just Planned Parenthood, but certainly, um, inclusive of Planned Parenthood. So we know what the intention behind these policies is. It's to limit women's rights and their decision making, but we need to stand up and fight back with everything we have um, because the public health impact is so strong.

Jennie: So unfortunately the gag rules aren't the only attack we're seeing domestically and globally. Um, the next thing we're really seeing is the US government pushing sexual risk avoidance uh, when they talk about sex education, this probably is a new term to most people. Um, what exactly is sexual risk avoidance?

Chloe: Um, well pro tip with you hear the word sexual risk avoidance, what they mean is abstinence only. And, uh, you know, it's not a surprise that the abstinence only agenda is being pushed under this administration. Um, but again, as is theme here today, the way it's getting pushed both globally and domestically, um, is, is, you know, disciplined and on steroids. Um, and I have to say, if you step back and think about this, um, if there ever was a case to be made about the need for sex education, I think it's, um, all the sexual abuse that's propelled the #MeToo movement that's coming to light. Um, you know, one of the best ways we know to fight coercion and to teach consent is sex education. Um, and it's those programs that this administration is trying to roll back. So, and that's again, like I said, it's a, we've seen it manifest in the global space. We've seen it come up through, um, the Global AIDS program, which is the largest global health program in the world, um, pushing sexual risk avoidance language. Um, and we've seen it certainly come up in attacks on the Teen Pregnancy Prevention program. Um, and another ways domestically, there was actually, um, a memo that got leaked in the fall. Um, and it was like a secret wishlist, but it was a nightmare wishlist if you're a woman or, um, really any person in America, um, about what they hoped to accomplish in a number of realms, um, and pushing abstinence only programs, um, across the board and, and, um, eliminating access to sex education was, was high up there. Um, so we weren't, we haven't been surprised as we've seen these efforts roll out in different programs, but, but it's definitely a clear agenda. And as I mentioned, you know, just today I was, my Twitter has been lighting up with, um, young people who are, uh, rallying all across Uganda for their right to sex education um, as part of a campaign called Silence is Deadly. Um, it's been very exciting to see all the activity and yeah, to live vicariously, um, from, from DC as, as that's unfolding. Um, but it is a good reminder that, um, access to this information to know, um, what your sexual health needs are, basic, uh, facts about your sexual health and, and to have the skills and tools to make good decisions for oneself are universal needs. Um, and it, you know, I, when I talk to partners we work with all over the world, um, you know, I could be having that conversation really anywhere and they're fighting for it everywhere because people are trying to restrict their access to it everywhere. Um, and I, as I said before, just have to come back to this question of what are people so afraid of? Why are they afraid of people having information about their own health and their own lives?

Jennie: Yeah, I have to say the fight against abstinence only is one that really is near and dear to my heart. As someone who went to Catholic school K through eight and had sex education from a nun, which was obviously abstinence only and very much the a Mean Girl's version of sex ed, like, you know, you have sex, you're gonna get this and you're going to die. Uh, so I know the importance of getting comprehensive sex education. There's, I've learned so much since I started working in this field what that I probably should have been taught much earlier.

Chloe: I mean, I think we all have a personal story because it is universal. Um, and I think that, um, that's why these efforts have been so systematic and you can really see them play out all over the world. And again, right? If you don't think that, if you're a person in the world who doesn't think people should have information about their own health and make decisions for their own lives, how are you going to go about stopping it? Well, withholding information is a really effective way of, uh, of stopping it.

Jennie: Yeah. So another area where we're starting to see the administration making changes is around method mix. But before we talk about what's happening in method mix, it's something that we talk about, but maybe our listeners probably don't know what we mean. So if you want to do a quick breakdown on what do we mean when we say method mix?

Chloe: Um, method mix is one of those jargony terms. Absolutely. Um, I mean method mix just basically means that when you are talking to your doctor or whoever you know, prescribes your birth control, that you have a variety of options to choose from. Different options have different benefits and different, um, downsides, um, different side effects. And each person for a variety of factors is going to have, um, a different need. Um, and it is vital for both the, um, efficacy of birth control and vital for, you know, the, the rights of patients to be able to choose from a variety of methods, um, so that they can find something that really works for them. Um, and so this is an issue that is, um, again, universal. Um, it is as necessary if you are, you know, in South Africa or if you are in Guatemala as it is, if you are in, you know, Los Angeles or Washington DC. Um, you know, every person is gonna have different reasons that they need different things. Um, and unfortunately, um, not all providers are able to offer that kind of variety. So, you know, in some communities around the world, we see really, really limited, um, options. Um, and, and that's true in the US as well. Some providers only carry limited options. Um, the other issue in this is that we really need more methods in general and you know, we need more innovation in the area of reproductive health care because the methods that we do have available are by and large, quite old. Um, and I think there's more science can do to reduce side effects and make methods that work better for, uh, for users. So, you know, one good example is we need multipurpose prevention technology. That's the jargon wonky term. Um, and what that means is, um, we need, you know, a method that doesn't just prevent pregnancy, it prevents it, uh, STDs as well. Um, so you don't need a condom and you know, the birth control pill or an IUD, um, that is still under development. Um, and it's, you know, it's vital. So we should be doing everything we can to not just ensure people have access to every method that's already available, but, but actually expanding the methods that are available on the market.

Jennie: Or the white whale that's always five years out, which is the male birth control.

Chloe: Right. Exactly. Yes. That would be amazing. Um, so we need, we need that innovation and investment in that space. Um, unfortunately what we're seeing is not just that, but we're seeing the opposite.

Jennie: I think we're seeing this both domestically and globally with the administration not being fully behind or even, uh, we're seeing with Title X being like, well, you know, Title X providers don't really need to provide all the services.

Chloe: Yeah. And in fact, um, the one of the aspects of the rule that just came out, I'm sighing cause it's like it's, it's, we, it's wearying to, to think about and talk about all, all the ways in which our rights and health are being assaulted. Um, one of the aspects of the new gag rule that we're seeing is a proposal that provider's, it's for deemphasis on modern contraceptive methods and an a demphasis on the need to provide all of them. Um, and we're also seeing an increased emphasis on something that you know, called fertility awareness methods, which again, pro tip, when you hear that that means not birth control. It means, and, and, and, and to say some people for that's a, that's the choice they want to make and that's a completely valid one. Um, but we certainly shouldn't be prioritizing that in the delivery of health care over modern methods that tend to work better for people.

Jennie: I mean, again, we're seeing the push on fertility awareness methods both domestically and then the global context.

Chloe: That's exactly right. In that I'm nightmare wish list I mentioned earlier, um, that was a, that was another theme was pushing fertility awareness methods, um, across the board. And we've seen it. I mean it's, they put it on their wishlist and they're following through. Don't say we weren't warned here. They, um, they've put it in their budget requests, they've put it in all manner of policy to push that method.

Jennie: So I know this next one is one that I know, Chloe, is near and dear to your heart and that is religious refusals. But before we talk about that, and again, if people want a deep dive, um, you can go back and listen to I think episode 12 where I'm, I have a deeper dive into religious refusals and what's going on around that. Um, but maybe you want to do a quick, like what are religious refusals?

Chloe: When we talk about religious refusals, what we're really talking about is the license to discriminate, um, and the special entitlements for faith based organizations. You know, this is the idea that, that, you know, the concept behind religious refusals is that you have the right to practice your own religion, but they've, that sort of debates been co-opted, um, to expand, to enable people to use their own faith as an argument to withhold information, services, um, and access to other people. You know, I, when I think about this, of freedom of religion, which is so cornerstone to our country and our democracy, I think about it as my right to practice my own religion, but I don't have a right to have my religion govern you. Um, and that's what's really at stake here. So we see this play out in a number of ways and this is long been a tactic of limiting access to reproductive health care and other issues too. I mean, we've certainly seen it in, um, in the, the fight for marriage equality. It's playing out right now, um, and in and other aspects of LGBTQ rights, for example, and a number of other spaces as well. But it's many, many, many places we can see, um, the effort to, uh, use this concept to, um, block people from getting information and getting access to health care.

Jennie: I think this was one of those ones where when the new proposed rule came out, you really heard a huge focus on what was happening domestically, which fair, there it was going to have huge implications domestically, but it was also going to have implications globally.

Chloe: That's right. I mean, I think, um, yes, the new rule has impacts for all manner of federal policy and uh, that includes global health policy, so it impacts, um, the work we're doing to fight, you know, HIV around the world, malaria to improve maternal health, family planning, access. Um, and I think it's important to start with like, you know, I think that a valid perspective, a lot of people come to this conversation with is, but shouldn't we protect the freedom of religion of, of people, right. And absolutely. Um, that's already in place. There are many protections already in place for people's own personal religious views. Even beyond that, there are many, many policies already that really privilege and give special entitlements to faith based organizations over and above other organizations. Um, and you know, as I started this conversation making the point, you know, a lot of times we do see some of this stuff come up in the global space first. And that has been true, especially with the religious refusal work. Uh, in the Global AIDS program for instance um, when they were reauthorizing that program, we saw a really, um, expanded refusal policy, um, that goes well beyond the protections of any, any person in and their religious views and really, um, is a way for organizations to impose their views on sub grantees and on patients and on people who are depending, um, on this funding source for, for health care.

Jennie: Uh, religious refusals are another one where it's just, you're really just blocking people's basic access to health care.

Chloe: And information. I mean, that's the thing I led where the, where we're at today has gone so, so far, in that there's already so many policies that are, are harmful and bad that block access to services. But these policies that we're seeing now are going much further into blocking information. And a lot of times what we're seeing is it's, it's, it's bestowing the freedom of religion on to corporate entities over people. So a US based organization that gets a grant, can impose its view on every sub grantee, everywhere it works in the world, and then onto their sub grantees and then onto their, the people that they're providing with. If you're, a woman seeking health care in a clinic in rural Kenya, do you have any idea that a US organization's corporate rules have now governed that you can't access information? It's, it's sort of, it's a, it's really impossible to kind of imagine the scope that these policies have, which is why I think we've seen such an intense effort to push them out into the world. I think one, one piece is really important to talk about. I want to make sure we don't sort of lose sight of, and it's a commonality between the global and the domestic space, is that the people who are most impacted by a lot of policies around access, and I think in religious refusal issues this comes out especially is, is the most vulnerable communities. It's people who already have systematic inequities that they're facing. Um, it's people who already have various levels of oppression they're dealing with that are going to bear the brunt of this, the most. Um, so in sub Saharan Africa is that, you know, young girls. Um, is it rural women whose access is so dependent on one or two providers and don't have the ability to turn to someone else if they're not getting their needs met because there isn't anywhere else to go. Um, in the US we see that playing out, especially with communities of color. And so these aren't these policies and efforts to restrict information to restrict access to block people's, um, basic health care are not evenly felt across the board.

Jennie: Absolutely. Thank you. I think that is such an important point. Like, I'm going to be fine. Right? I will be able to find care somewhere. I'm so privileged to be able to do that, but there are so many people who are not.

Chloe: That's right. And it makes it sometimes harder to see, especially for the people you know, media outlets telling the story, policymakers who have great health care in Congress to realize what that feels like. And again, I always just go back to that perspective of what do I expect when I go to my doctor? Um, you know, I work in health care, I fight for people's access to get, you know, a pap smear and, um, STD tests and treatment and so on. Um, but it's still very vulnerable when you walk into your doctor's office. And, um, and I expect I'm getting the best information. And, uh, these policies basically mean that a lot of people in the world, a lot of people across the US are not going to get that best information and they're not even going to know it.

Jennie: Right. And I think that's also really important is the lack of information on so many levels. Just even that these policies exist. Somebody I'm very close to is actually the president of the local hospital back home. Um, and I was venting to them about, uh, what was going on in refusals when the comment period was about to end and kind of ticking through all the things it would do. And she just had no idea... I mean, she had some idea, but no idea how expansive it was. So I feel like the information dissemination is just lacking all around.

Chloe: Yeah. And it's, it's hard to keep up. I mean, there's a lot to keep up with. So, um, it's hard enough for those of us who work in this space to stay on top of all of it. Um, and we spend, you know, all day doing it, let alone the public or again, I think about a woman in rural Kenya who doesn't even have access to the information to track these policy debates yet these are debates that are impacting her life. You know, I think the other thing with a religious refusals that's important to think about is, again, where, where do they impact people who have no other options to turn to? And we know that there are many people in the United States who live in communities whose only health care system is, um, is a Catholic health care system, for example. Um, or you know, some sort of religiously affiliated health care system. So what do you do if the only health care access in your community actually refuses to provide you, um, the services you need.

Jennie: Or the information they don't even know that you're not getting the full range of services that maybe you need.

Chloe: That's right. So that's what's on the line. And again, it's what are people so afraid of inter people having access to information. Why is that so scary?

Jennie: Well, I think this follows right on. So the next thing I wanted to touch on, which is affecting global and domestic and that's censorship. Um, so what are we seeing around censorship? Um, domestically and globally?

Chloe: Well, I mean, let's talk about the gag rules. Again, those are censoring policies. They are censoring doctors and what they can say. Um, and that is I think one reason that we've seen such an enormous response from the medical community that the idea that you can interfere with the doctor, patient relationship, uh, so forcefully is really appalling. And again, if you don't know your doctors being censored from telling you everything that is a real threat to your, your health and your rights. And uh, you know, one actually one issue I wanted to mention in the context of this is that, you know, again, looking at these issues globally and domestically, you really can see the full scope of, of what's at stake and what, um, what the strategy is in terms of restricting access to what is such a universal need. And so one of the commonalities that I think that that big perspective offers us is that what we're really talking is reproductive coercion. And when you're censoring people from giving information, when you're blocking certain kinds of health care options, when you're limiting the kinds of birth control methods people can choose, when you're cutting access to sex education, what you're doing is coercing the decisions people are making in their reproductive lives. And that is something that I think anywhere you look in, um, certainly in the United States people would say they oppose. Um, in fact, we've seen many a policy pushed that limits access to reproductive healthcare done under the guise of opposing coercion. Um, but I think we need to step back and really say this is reproductive coercion. When we're limiting access, when we're withholding information and we're not trusting people to know what their options are, we are coercing them. Um, and that's, that's part of what's on the line.

Chloe: I think to continue on the coercion point, we're seeing real censorship in, um, the state department's new human rights reports. I think that's a prime example where they actually eliminated references to reproductive health and rights. Um, and that is very damaging. You know, activists around the world rely on those reports as an accountability tool, which means when we cut that out, we're saying to women all over the world that we're standing on the side of autocrats and dictators who are pushing coercive policies and we're not standing on the side of women's human rights. Um, which is appalling. So, you know, it's one of those policies that, and I think across the board censorship policies that we'll start to see some immediate impacts of, um, quickly, but the longterm impact is going to be much, much more severe. And um, by the time you really see that full picture of what it means to withhold information, um, it, it'll be too late to reverse it.

Jennie: Yeah. I think that's another really great point is, you know, uh, all of these things, you know, cutting funding or whatever we use getting these clinics to close, it's not like you can just turn the funding back on and everything's fine and the clinics just pop back up. Um, so it really, longterm impacts are something that we really need to be thinking about.

Chloe: Like we, we, we always say we live in like a, you know, 24 hour news cycle. I mean, I feel like these days it's like a 24 minute news cycle. It's very hard to keep, you know, I can't keep up with what news was coming out on Monday, practically, let alone remember. Yeah, yeah, exactly. Let alone what's, um, you know, what's happened a month ago or a year ago. Um, God knows it's hard to keep up with what happened two years ago, three years ago. And that's what's so I think frightening, but also galvanizing right now is that we have to, we have to put stakes in the ground and, and raise our voice. A lot of these things we've, we can fight back on. And I think we've seen incredible success with the outpouring of Americans standing up for what they believe in and, and, uh, calling out policies as harmful. Um, you know, that's why we didn't see the, uh, the effort to repeal the Affordable Care Act, um, go succeed. Um, it really was the grassroots mobilization. Um, but there are policies, we're not going to be able to stop the global gag rule. We, you know, there's incredible opposition to that in Congress, but, uh, but that is a policy that the is at the discretion at this point of the President. And as long as this president is in office, that policy, it's going to be very hard to remove that. So we need to raise our voices to also put a marker down on what is happening because we are going to see the effects of this much longer, um, than, than this administration is in office. Um, and we need to remember what caused, caused the impacts. We're going to see down the road and, and, and make sure our public policies are responding to that and learning the lessons of this time.

Jennie: Well, I think that leads us perfectly into, I always like to end on a positive note or at least an action oriented note. And what can people do to fight back? Now that we know about all of these policies and the ties between domestic and global, what actions can people take?

Chloe: I think the good news here and it, it is really the, the thing that I think keeps all of us working in this space. Um, getting up and out of bed each morning and, and feeling like, you know, we can fight another day is the incredible grassroots outpouring that's come out. And, and again, I just want to emphasize this is not just in the United States. We're really seeing people all over the world stand up for their rights, um, in their own with their own countries and governments. But also, you know, in response to US policy as, as I said before, and I think, I'm sure listeners know w w w historic Women's March was not just the largest mobilization in United States history, it was a global mobilization happened on every continent in the world. Um, and I know people from countries all over the world who participated and really feel ownership and stake in that moment. So that's very exciting. Um, we are seeing advocacy as I mentioned in Uganda, there's, you know, rallies across the country happening right now in support of sex education. We're seeing efforts like that around the world. Um, so people aren't, are not taking this sitting down. And, um, and that is especially true in the United States. You know, one in five people have rallied, um, since this administration started, in opposition to these policies and they're being mobilized by women's rights. And, uh, and so that's very exciting. So I think the piece I want to say is we all should stand up and fight back because we actually do have a shot at stopping some of these things. The, as a, as I mentioned before with the domestic gag rule, which is just the latest, this is just a proposed rule. The take is not good people. People do not like this policy. The medical establishment doesn't like it, the public doesn't like it. So we really do need to keep fighting on that. Um, so there's a number of ways people, um, can get involved. Um, one piece I just want to call out is, um, the Planned Parenthood defenders program is a great way for people who really want to get at, get active, um, to be on the front lines and you can find information about that by going to plannedparenthoodaction.org sign up to be a Planned Parenthood defender and you'll get lots of good, um, up to the minute opportunities to fight back. I, you know, I think also downloading the, onto your phone, the number of your, your members of Congress, their offices. So that speed dial, that right. Um, make it up, make it a regular practice. But I've also been just really impressed by all the creative ways people have been fighting back. So I think there's no wrong way to get involved. Um, there is no bad way to show your resistance to the attacks we're seeing. All that really matters is that we are, we are showing them.

Jennie: Well so we'll meet, definitely make sure to include the link to the Planned Parenthood defenders on our take action section of the website. Um, but also this podcast should come out in time for, there will be a comment period for the domestic gag rule and I'm sure Planned Parenthood will have, um, a template where you can file a file comments for the gag rule and we'll also include that there.

Chloe: Yup, absolutely. And I, you know, the defenders is in addition to our usual email list, which you should also get involved in because that will give, um, all of these opportunities as well.

Jennie: Well, Chloe, thank you so much for being here. This was fun.

Chloe: Yeah, I always love talking about the global movement, so this is great.

Jennie: Well, we'll have to have you on again and again, thank you.

Chloe: Thank you.

Jennie: For more information, including show notes from this episode and previous episodes, please visit our website reprosfightback.com you can also find us on Facebook and Twitter at rePROs Fight Back. If you like our show, please help others find it by sharing it with your friends and subscribing, rating and reviewing us on iTunes. Thanks for listening.

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