Bonus Pod: The Helms Amendment Hurts And It Needs To Go

The Helms amendment is an amendment to the U.S. Foreign Assistance Act which states that U.S. government foreign assistance funds cannot be used for “the performance of abortion as a method of family planning.” The Helms amendment undermines U.S. efforts to improve maternal health and mortality by denying access to abortion services. Anu Kumar, President and CEO of IPAS, talks to us about how dangerous this 47-year-old amendment really is and why it has to go. 

Abortion is an extremely common procedure. Of the approximately 55 million abortions that take place around the world, 25 million of them are considered unsafe. The majority of these unsafe abortions are taking place in the global south, including regions like Sub-Saharan Africa and South Asia. The Helms amendment allows for the provision of abortion counseling, information, post-abortion care, and abortion in cases of rape, incest, or if someone’s life is at risk. However, there is little clarity around restrictions, leaving the amendment to be interpreted as a total ban on abortion services and information. This means U.S. foreign funds have not been utilized to provide abortion care. 

How exactly does the Helms amendment impact people around the world? Unsafe abortion is an entirely preventable cause of maternal mortality. By not allowing U.S. funds to be used, people are needlessly suffering and dying overseas. Because reproductive justice and racial justice are so closely intertwined, the Helms amendment is a fundamentally racist policy and impacts mostly Black and brown people around the world. On top of the current pandemic, these restrictions are more visibly disproportionately impacting Black and brown people.

 The good news is, The Abortion is Healthcare Everywhere Act (Rep. Jan Schakowsky, D-IL-9) was just introduced in the House of Representatives. This is the first time that there has been discussion around striking the Helms language and replacing it with more proactive language. The bill will include a statement of U.S. policy that safe abortion is a critical component of safe maternal health care, should be widely available, and should be funded by the U.S. government. If the bill were to pass, U.S. foreign funding could be used for safe abortion care.

Links from this episode

IPAS on Twitter
IPAS on Facebook
Repealhelms.org
Abortion is Health Care Everywhere Act

Transcript

Jennie: Welcome to RePROs Fight Back, a podcast where we explore all things reproductive health, rights and justice. I'm your host, Jennie Wetter, and I'll be helping you stay informed around issues like birth control, abortion, sex education and LGBTQ issues and much, much more-- giving you the tools you need to take action and fight back. Okay, let's dive in.

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Jennie: Welcome to this week's episode of RePROs Fight Back. I'm your host, Jennie Wetter, and my preferred pronouns are she/her. Welcome to a special bonus episode of RePROs Fight Back So I cannot believe it is mid-July. Not really sure how that happened, this year has gone so fast. And again, it's that mix of the days are taking forever and this year has gone by so fast. But like when I think back to things that happened in like early March, or even thinking back to being back in Wisconsin for the holidays, it feels so long ago. It's just, this year has been a real whirlwind. And I know things probably aren't going to change anytime soon, at least in my situation of working from home and working remotely, you know, I've known we're not coming back anytime soon. There's like the knowing that you're probably not going to be back in the office before 2021. And it's just wild to think that there's so many people that I'm not going to see, and it's going to be like a year since I've seen them when we actually can get together in person. Again, it's really weird to think about. And I know thinking like when the next time I'm going to see my family is, you know, I was hoping to be able to go home in August to go to the celebration of life for my grandma who had passed away this summer. But now I can't imagine traveling right now. It seems impossible. And then thinking like we could be in another big wave over the holidays. So it's just really weird to think about not being home for the holidays. My family is really, really big. So while I'm an only child, so it's just me and my parents for the holidays. My mom is from a very large family. So every year we get together on Christmas Eve and she's one of 11, so we rent out a hall for all of us to get together. And it's the one time of year that like all the aunts and cousins, their kids, and now even their kids get together every year. And to think about not being there feels really weird. You know, there's things that like when I moved away from home, like were really weird. Like the first couple of times that happened, same with my mom's side of the family every year, the Saturday after Thanksgiving, the aunts and cousins get together and make a literal shit ton of holiday cookies. Like there are no words to describe how much baking is done that day. And it's so much fun. And I really missed it the first couple of years and I still miss it. Like, it's still sad to see all the pictures, but my mom always sends me like a huge box or two of cookies. So, it's kind of like being there but not, but so this'll be like the second Christmas I've ever missed if I can't go home. And the last one we missed was because of really terrible weather. Like there was a really bad ice storm. So, me and my parents didn't drive up to where the rest of the family is. And that was very bizarre to do and to think of not being there this year and not even being in Wisconsin is really weird, more and more looking at the world right now. That's where it feels like it's going. That makes me sad. I hope that's not true, but you know, I have to stay here. If it makes the most sense. I can put my family's health at risk by flying home or traveling home.

Jennie: So that's where my head is at right now. I guess I didn't realize that until it all just came spilling out. So, thanks for letting me share y'all. I guess yesterday it just hit me when I saw that the Washington Post was saying they probably weren't going to be back in their offices till at least 2021 and we had that same conversation then with our office. And I guess that's just, while I was talking y'all made me think of all of the rest of the things through the end of the year that I'm not going to be able to do that I normally do and love to do so let's all do our parts, make sure that things change. So, make sure you're wearing a mask when you go out. I definitely do. And wash your hands frequently and make sure to, you know, protect those the most at risk and being safe. So with that, let's just switch gears and talk about our special bonus episode today. So something really exciting happened yesterday. There was a proactive abortion bill introduced in the House. I'm not going to spoil it and tell you all about it yet, because we're going to talk about it in the episode, but it's a big deal. It's the first time that this particular bill has been introduced and we are all very excited to tell you all about it. So, joining me today to talk about the problem, which is the Helms amendment and this new bill, I'm really excited to have with me today, Anu Kumar with IPAS. It was a great conversation and we talked all about Helms and what it means and about this new bill. So I hope you all enjoy the conversation and are energized to take action.

Jennie: Hi Anu, thank you so much for being here today.

Anu: Thank you for having me.

Jennie: Do you want to do a quick introduction and include your preferred pronouns?

Anu: Sure. My name is Anu Kumar. I am President and CEO of IPAS and my preferred pronouns are she and her.

Jennie: I’m really excited to talk about the Helms amendment today, but before we get started, we should probably do a little bit of background. So, people know the landscape we're talking about before we start. So, do you maybe want to talk a little bit about what does abortion access look like in the global south right now?

Anu: Right. Okay. So, let's first start off with maybe putting it into a global context. You know, abortion is a very common medical procedure that's used throughout the world… over 55 million abortions take place every year around the world and about 25 million or so are unsafe abortions. So, the definition of unsafe abortion also varies, and it is a World Health Organization (WHO) definition. And it's been changing a bit over time to accommodate the way women are now seeking abortions, but 55 million abortions. That means that there are quite a lot of abortions that are taking place every year. And the majority of the unsafe abortions that take place are actually taking place in the global south. So Sub-Saharan Africa, South Asia make the bulk of those abortions in many of those places, but certainly not all access to abortion is difficult. So, it's hard for women who want to end an unwanted pregnancy to actually find their way to a safe abortion. In many situations, women and young women in particular have a hard time accessing contraception. And so accessing effective means of contraception is obviously a good way of preventing pregnancy. But without that, it means that many women do rely on abortion to prevent pregnancy. So what that means in the global south is often that women are going to providers who aren't really trained and aren't actually, you know, medically qualified to provide an abortion, or they are doing it on their own, which can be safe, but they may not have all the support that they need. So, I'll give you examples. Young women in particular are especially vulnerable. They often don't have the resources or the information to deal with an unintended pregnancy. They often don't have access to contraception. So, when they find themselves in a situation where they have an unwanted pregnancy, they don't know how to handle it. They don't know where to go. And they often delay seeking care because they're really just kind of amassing resources, financial, informational, and other resources to figure out what to do. So, in our work, you know at IPAS, we've heard stories of young women who have used-- ingesting ground glass to end the pregnancy, they've inserted sticks, you know, in their cervix, bicycle spokes, other sharp objects to end an unwanted pregnancy. So, you know, people will take really extreme measures in order to end the pregnancy. And it's really important to keep in mind that, you know, women have been ending pregnancies for thousands of years. And so, when a woman is motivated and doesn't want to be pregnant, she'll do what it takes to end that pregnancy.

Jennie: Yeah, I think that's really true. You know, I feel like we often talk about that in the context of banning abortion, that you may make it illegal, but you're just going to make it unsafe. You're not going to end it.

Anu: No. And that is very clear from the experience in other countries, including also in the United States. I mean the legal restrictions on abortion really change nothing around the practice of abortion. So, what they do change is where women can go for safe care. What they do change is how providers are able to provide care, whether they can do that openly and safely and with the resources that are necessary or whether they have to do that clandestinely in a hidden way. You know? So, the legality of abortion that has actually made very little impact in terms of the numbers of abortion that take place, but it makes a huge difference on the safety and the health and lives of women.

Jennie: So the U.S. government has a role to play in the way people access abortion overseas. And it's not necessarily a positive one. Do you want to tell us a little bit about what is the Helms amendment?

Anu: Absolutely. Yeah, so the Helms amendment is an amendment to the U.S. Foreign Assistance Act which was passed in 1961. And then it was amended by Jesse Helms in 1973. And the Helms amendment states that the U.S. government funds, foreign assistance funds cannot be used for, and this is a quote, “the performance of abortion as a method of family planning.” And so, this language exists not only as a statute, as an amendment to the Foreign Assistance Act, but it's also reiterated year after year in the Department of State and Foreign Operations Appropriations bill. So that has been in place now for 47 years. And I have to say that this is a bill that has a lot that IPAS and our organization is deeply connected to because we were started in 1973, when the Helms amendment actually prevented the U.S. government from supporting the final design and distribution of the manual vacuum aspirator, or the MBA, which is a medical device that's used for abortion and other procedures. And Jesse Holmes is a Senator from North Carolina where IPAS is so we have a really strong connection to the Helms amendment cause it's really rooted in our history, but it's been around for 47 years now and it's become just normal. It's just part of the background. A lot of people don't even think about it anymore. I think a lot of everyday Americans don't even know that it still exists periodically. We have the gag rule, but we sell them really think about the Helms amendment. It's kind of the hum in the background.

Jennie: So what does it mean for abortion care?

Anu: So as written, the Helms amendment allows for the provision of abortion information counseling and post abortion care, and even allows for abortion in cases of rape and incest and if a woman's life is in danger, however, there is no clarity around the restrictions. And so it's actually been over interpreted over the years and it's been interpreted as a total ban on abortion related services and information. So that has meant that U.S. foreign assistance funds have not been utilized in any way for the provision of abortion care information, anything, and any organization or government that's getting a U.S. foreign assistance fund does not work on abortion, even post abortion care. And if I could just take a minute to explain what post abortion care is, it's an emergency treatment for complications due to spontaneous abortions, whether they're spontaneous as in a miscarriage or an induced abortion, post abortion care also includes family planning, counseling, and services that none of that is occurring as well with the Helms amendment in place.

Jennie: So I think one place to maybe dig in a little bit is you mentioned the global gag rule, and I think this is one place we see, like in reporting and often, and sometimes even with members of Congress, Helms and gag get conflated or confused, and they think gag is Helms and Helms is gag. And do maybe we just want to talk a quick bit about like, what's the difference?

Anu: Really great point. Yes. They often get confused. Okay. So, the global gag rule is an executive order, which is issued by Republican presidents since Ronald Reagan. It's generally repealed by democratic presidents; the global gag rule restricts foreign nongovernmental organizations that receive U.S. government funds from using their own private funds to engage in abortion related work. So it's called the gag rule because it doesn't allow organizations to use their own money that they've raised from other non U.S. sources for abortion care, referral information advocacy under the Trump administration, the global gag rule has been expanded, and it actually now applies to all global health funding by the U S government, which covers about $9 billion in aid. So that's the gag rule. The Helms amendment, which as I mentioned, is applied as a total ban on abortion limited services and information. The Helms amendment applies to all U.S. funding for governments, nonprofit organizations, pooled funding mechanisms, and it includes humanitarian funding. It covers a total of nearly $40 billion of us funding and aid. So, the gag rule actually broadens restrictions that have already been in place under the 1973 Helms amendment. So, while the Helms amendment restricts U.S. funded programs, the gag rule restricts foreign organizations.

Jennie: So now that we have a better clarity on what exactly Helms is, how does this impact people who are in countries that receive U.S. aid?

Anu: So I think it's really important to remember that unsafe abortion is one of the five leading causes of maternal mortality. So maternal mortality is when a woman dies in pregnancy or childbirth and in all of the five causes of maternal mortality causes, unsafe abortion is the only one that's entirely preventable and has been essentially eliminated as a cause of maternal death in Europe. And for the most part in the U.S. as well. So, this is an area from a public health point of view that we can definitely tackle and address simply and easily. So, by not allowing U.S. funds to be used in this manner, we are essentially contributing to the needless deaths and suffering of women overseas. The other really, I think important point about the Helms amendment is that it applies mostly, and it impacts mostly Black and brown women around the world, right now in the United States and across the world, we're having conversations about racial justice and racism and in our society and in other parts of the world as well. But when you think about it at its root, the Helms amendment is a fundamentally racist policy. Racial justice and reproductive justice are very closely intertwined, both Black and brown communities in the United States and overseas have been denied access to healthcare and denied access to services really due to racism and white supremacy.

Jennie: Yeah, that's absolutely true because you have the similar amendment affecting domestic spending with the Hyde amendment-- not to get off track, but just, it would be wrong to not mention it.

Anu: Exactly. I was going to mention the Hyde amendment as well. I mean the Helms amendment actively discriminates against poor Black and brown women that live thousands of miles away that we don't see and who are not in the U.S. right. And every day that this policy exists, the U.S. is essentially tacitly contributing to maternal deaths and injuries from unsafe abortion. The Hyde amendment, you're absolutely right, applies to the United States. And it prohibits federal funding for Medicaid coverage for abortion, except in cases or the pregnancy is a result of rape or incest or when the pregnancy is dangerous to life. But that policy also hinders abortion through discrimination because it denies women insurance coverage for safe, legal, necessary abortions because of their income level. We know that restrictions on Medicaid coverage are discriminatory against women of color, particularly Black and Latino women. And those are the women that are more likely to face financial hardships. And we also know that maternal mortality is three to four times higher among Black women in the U.S. than white women. So just like the Hyde amendment is a racist policy, so is the Helms amendment. In the case of the Hyde amendment, you know, we, as voters can actually do something about it, but in the case of the Helms amendment, we're actually going after really disenfranchised women and girls living, as I say, you know, thousands of miles away from us and who do not have any say in U.S. policy.

Jennie: Yeah. And I think all of this becomes even starker when you think about, we're seeing all of these racial injustice, health disparities being heightened with the COVID-19 pandemic. And so now you're talking about all of these restrictions on top of this pandemic that is disproportionately affecting Black and brown people.

Anu: Yeah, absolutely. I think COVID has really uncovered so many of these disparities, but truthfully those disparities have always existed. They have just become visible to many people, but they have always existed. And certainly, in the public health community, race has been an incredibly important variable in determining health outcomes. So yeah, you're absolutely right. COVID has laid bare these disparities and made them incredibly visible to the rest of us. And unfortunately, now to the rest of the world for the United States, you know, where income inequality in the U.S. has become, I think, a national disgrace. And so that is really, I think, impacting again, Black and brown women, but also it plays out in the Helms amendment, for example, and really it exaggerates the negative impact of COVID-19 on reproductive health. We know that women and girls in crisis settings are at an increased risk of unplanned and unwanted pregnancy because they're essentially living in a situation of societal disruption just as we are right now, high levels and high incidents of sexual violence, a disruption of regular sources of contraception, lack of social support and family support. All of these things result in women and girls not being able to get the care that they need. And COVID exaggerating this. So, around the world, a recent report actually points out that a 10% decline in contraceptive use would leave an additional 49 million women without access to modern contraception because of the disruptions in supply chains and commodity supplies, et cetera. And we're finding that if 10% of safe abortions become unsafe, because women can access safe abortion, then there's going to be an increase of 3 million more unsafe abortions around the world and a thousand more maternal deaths. So COVID is really making a bad situation, even worse.

Jennie: Yeah. And that also just makes me think he knew you talk about access to services. You see a lot of inequities, even just thinking of rural versus urban access, especially in the global South where, you know, a rural area, the closest clinic could be a couple hours away. And that really has detrimental impacts on people's ability to access healthcare.

Anu: Absolutely. I mean, I think we actually underestimate the challenges that are involved in the physical barriers to accessing care that many women face, you know, we've heard about it in the U.S. and the recent court cases around abortion access, where there's been descriptions of the hundreds of miles that women have to travel in order to access care in Texas, for example, but not long ago, I was in Nepal and in Nepal where you literally have the world's highest mountains for a woman to access care, walking through these incredibly tall mountains on roads that are really just footpaths, you know, it can take days for her to actually get to a clinic. You know, I think there's the physical barriers to care are so great that we underestimate how challenging it is for women to get there. And then once she gets there, let's say a woman does actually make it to a health clinic in a rural area. Often those health clinics are not staffed regularly so she can show up and no one will be there to help her. And if she does show up and someone is there, they may not have the supplies that they need to actually give her the care that she needs. Nepal is really interesting actually, because Nepal is one of the places where there is legal abortion. And in fact, in all of the 70+ provinces in Nepal, there are legal, safe, abortion services and care available in a very poor country like Nepal.

Jennie: So that's great overview of what the global landscape looks like right now, the impact that Helms amendment is having now, I just wish there was something happening in the U.S. that could change all that.

Anu: Well, I'm glad you asked. Yes, we are. I'm so excited. The bill that has just been introduced is called the Abortion is Healthcare Everywhere Act. It's being led by representative Jan Schakowsky and she'll be joined by a small group of co-sponsors in the house. The bill is the first time that there has been discussion around striking the Helms language from the Foreign Assistance Act and replacing it with more proactive language around the necessity of having safe abortion. So, the bill will include a statement of U.S. policy that I think is really important because it's proactive and positive. The language in the bill will state that it would be a policy of the U.S. government that safe abortion is a critical component of comprehensive maternal and reproductive health care and should be funded by the United States government. That safe abortion is to be made widely available and integrated with other types of healthcare. And that the U.S. government should work to end unsafe abortion and promote safe abortion services. So, this bill would be a huge step to bringing the U.S. along with other countries. And that's, I think a really important point, I think, to emphasize that the U.S. opinion and views around abortion are really out of step with the global community. We have been out of step with the global community really, since Helms was started, but, you know, 40 plus years ago, for example, in the last 25 years over 40 countries have made abortion legal and expanded access to safe abortion care. And most of those cases, that effort was part of their efforts to reduce maternal mortality and promote human rights. So, for example, you know, in 2018, Ireland voted to decriminalize abortion, the Democratic Republic of Congo legalized abortion last year, South Korea declared its 66-year-old ban on abortion illegal, Rwanda legalized abortion. Mexico city has legalized abortion. The state of Oaxaca legalized abortion in his first 12 weeks. And this year on March 2nd, Argentina's president proposed the bill to legalize abortion, which if it's passed would be a significant breakthrough for abortion rights in Latin America. So, you know, the U.S. is so out of step in its approach to abortion, not only for American women, but also in its approach to abortion care and its international aid efforts. So, this bill would actually help bring us in line with other countries around the world. In 2017, a number of countries actually stepped up their pledge and their advocacy for the inclusion of safe abortion. In all aspects of maternal healthcare. We have a campaign that really mobilized resources and global commitment. So, countries from Canada, Denmark, Finland, France, Iceland, Luxembourg, New Zealand, the Netherlands, you get the picture, a lot of different countries signed on, but the U.S. did not. So, we are very isolated in our view about abortion. Most countries in the world think of abortion care is kind of an essential part of public health, but also essential for human rights. So, our views are very backwards.

Jennie: Yeah, I think this bill could be really big for people in the global south, too. Let's talk a little bit about what it would mean if this were to pass.

Anu: If it were to pass, it would mean that obviously the funding that the U.S. government allocates could be used for safe abortion care, including the purchasing of commodities and supplies for abortion care. So, let me give you a little bit of an example of what that would look like in a real world setting. I'm sure you've heard about the Rohingya refugee crisis in Bangladesh, where we now have a million refugees that fled Burma into Bangladesh and rely on U.S. assistance for healthcare. There is a very large part of the health budget that is being utilized to provide care for those refugees. In fact, the U.S. government is the largest humanitarian contributor to the Rohingya crisis and is providing $820 million for that effort, but not a cent of that is going towards safe abortion care. And I want to add that in Bangladesh, abortion is legal, so it can be legally provided. And in fact, the work of IPAS and partners on the ground, we are working with the Bangladesh government to provide safe abortion care to Rohingya refugees. In that setting the bill to repeal the Helms amendment would allow U.S. government funds in that setting to help the women and girls who need access to safe abortion care. You know, many of the refugees that fled Burma where young women, many of them experienced horrific violence includes sexual violence. I've read reports where nearly half of the women that fled Burma into Bangladesh, experienced violence of some sorts, and many of those women need access to abortion and contraception. So the repeal of Helms would allow us to finally meet the comprehensive reproductive health needs of those women and so many more women around the world.

Jennie: So this is really exciting and I'm sure the listeners are really excited to hear that there is positive legislation that is being introduced. So, what can they do? What steps can listeners take to help make this a reality?

Anu: So, first of all, of course, listeners can work for justice for all. People think about how they can demonstrate their own concern and care about human rights and how the United States could be a leader in that. So, you know, whether that's through advocacy, we've had a huge opportunity for activism in the United States over the last several months, that opportunity continues support reproductive justice organizations work for reproductive justice organizations, work for justice, period. Listeners can contact their representative and urge them to support the bill. Again, the bill is called the Abortion is Healthcare Everywhere Act and is being led by Representative Jan Schakowsky and other co-sponsors in the house. So, they can contact their representative and urge them to support the bill. We would really invite listeners to join our social media campaign by following IPAS and our Twitter handle is @IPAS. And to use the hashtag repeal Helms, we are doing a lot of media outreach and advocacy on that. And we would really appreciate amplifying that message and letting you know, letting people know that this bill is out there. We don't have to be passive. We can actually change this. And listeners of course can continue to educate themselves and learn more about it. They could go to this website called www.repealhelms.org, to learn more about the bill and to learn more about advocacy efforts. You know, I think particularly for progressive Americans who care about reproductive justice, these four years under this administration has felt really demoralizing and difficult. So, I think when we have opportunities like we have with this bill to do something proactive, to do something positive, to do something, to create the world that we want to live in, we all must seize that opportunity and make the most of it.

Jennie: That's a great place to stop. Thank you so much for being here. I really enjoyed talking to you.

Anu: Thank you so much. I look forward to hearing, well, I actually hate hearing myself talk, so I can't say I'll listen to it, but I hope other people will.

Jennie: Hey everybody. Thanks for listening everyone. And we'll see you on our next episode of RePROS Fight Back. For more information, including show notes from this episode and previous episodes, please visit our website at reprosfightback.com. You can also find us on Facebook and Twitter at RePROS Fight Back, or on Instagram at reprosfb. 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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