Wait…Trump is Expanding the Global Gag Rule Again?

Note: Check out our introductory episode on the Global Gag Rule to learn more. You can also access our episode on the Global Gag Rule Two Years In: What Are We Seeing?

The Global Gag Rule has interfered with HIV prevention and contraceptive access and has increased unintended pregnancy and abortion rates. The Trump administration has engaged in unprecedented expansion of this rule (endangering the health and lives of millions around the world) and is looking to further expand who the gag rule applies to. Beirne Roose-Snyder, Director of Public Policy at the Center for Health and Gender Equity (CHANGE) talks to us about the continuation of these harmful expansions even though 70 percent of Americans oppose the Global Gag Rule.

In January 2017, Donald Trump issued a presidential memorandum that not only overturned Barack Obama’s previous memorandum repealing the Global Gag Rule, but drastically expanded it. In fact, this expansion was so far-reaching it went from impacting about $500 million to $9 billion in global health assistance. In March 2019, Secretary of State Mike Pompeo expanded the policy further by declaring “foreign NGOs that receive U.S. global health assistance should take steps to ensure that they are not providing financial support with any source of funds and for any purpose to another foreign NGO that performs or actively promotes abortion as a method of family planning.” Ultimately, this impacted organizations that don’t even receive U.S. funding due to their partnership with organizations that do.

There is now a new proposed rule to further extend the Global Gag Rule. This rule would extend the Global Gag Rule to all global health contracts, which has the potential to impact an entirely new set of global health organizations and programs. This would be the first time that the U.S. government has ever applied this rule to contracts.

Links from this episode

CHANGE on Facebook
CHANGE on Twitter
Global Gag Rule Podcast Episode
Global Gag Rule Two Years In: What Are We Seeing Podcast Episode
The Global HER 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/hers. So this week there's a lot going on. And while I could focus on talking about the confirmation hearings for Amy Coney Barrett and some of the wild things that happened there and her reluctance to say that Roe is the precedent that needs to be adhered to, throwing some question on if she would uphold Griswold, which allowed married women to get birth control, I'm not going to do that. I think that there's enough stress right now. Let's talk about something much more fun than focusing on how nerve-wracking all of this is. I'm sure we'll come back to it at some point, but right now I think we should do something a little lighter, so we can talk about some of the other things I've been getting up to. I talked about recently that I have been really stressed and was having stress dreams and having trouble sleeping. So that's much better now I'm thankfully sleeping better and not really having the weird dreams that I was having, which is nice. I feel much more refreshed. So one of the things that I started doing recently that I haven't done for a very long time is I started knitting. Again. It seems to be one of those things I do in the fall and winter, and then quit doing it for a long time. But it's one of those things that, it keeps your hands busy. And it's just this de-stressing thing I can do while I'm watching TV and then not feel like I'm doing nothing. It's nice. So one of my friends, Nina, who has been on the podcast before, has her own Etsy shop, where she dies wool and creates this beautiful yarn. It's called Flock Dyeworks, shout out to Nina, and it's gorgeous. And so I had ordered some from her. And as soon as it came, I was like, Oh my God, I need to start a project. I need to use this and start knitting again. So it was nice. It was nice to start a new project and remember how relaxing I find knitting. And that'll be my new winter project is a bunch of knitting projects. Also. I tackled another thing that I had been intimidated by. I know I talked about this a long time ago, but my goal this year was to try more things that intimidate me or that I'm scared of. And so one of those things was tackling breads that I’ve been intimidated by. So, I saw this recipe for a harvest apple challah, and challah has been one of those things that I've been wanting to try, but have been too intimidated to try. So this finally pushed me over the edge. So I made it last weekend and it turned out amazing. It was so good. I will absolutely make it again. And I'll try some other challah recipes. It was very delightful and I don't know why I've been so intimidated. It's so weird. The things that you're like, I'm really nervous to try this. Then you try it. And you're like, what? Get out of your own way thing. That's where I'm at. I need to get out of my own way and just try things. So I think that's where I'm at right now. I'm really relaxed and peaceful to have found my knitting hobby again. That is something that is very de-stressing to me. I still been reading a lot and baking bread. It's nice to bake bread. Cause then I have something for breakfast in the morning and I don't have to think about it. So it has been really helpful to get me through quarantine.

Jennie: So with that, I think we'll go ahead and turn to this week's episode. I'm really excited to share this conversation with you. I talked to Beirne Roose-Snyder at the Center for Health and Gender Equity. And we did a check in on the global gag rule. I had her on way back at the beginning of the podcast to talk about the global gag rule, but a lot has changed since then when she was on, we talked about the original expansion of the global gag rule that happened under the Trump administration. And we haven't checked back in to talk about some of these new expansions that have happened since then. And we already knew it was terrible and it's just gotten worse. So it's a wonderful conversation. I hope you enjoyed my talk with Beirne.

Jennie: Beirne, thank you so much for being here.

Beirne: Thanks Jennie. It is always a pleasure to be here with you at rePROs Fight Back. I am Beirne Roose-Snyder. My pronouns are she/her/hers and I'm the Director of Public Policy at change the Center for Health and Gender Equity, a sexual and reproductive health and rights organization doing advocacy in Washington, DC.

Jennie: I'm so excited to have you back here today to talk about the global gag rule again, because one, it takes up a lot of our lives, but two, a lot has happened since you were last on… so much. So I guess before we get into what's happened just in case people haven't listened or haven't heard of it before, maybe we should do real quick, what is the global gag rule?

Beirne: So Jennie and I will be calling it the global gag rule, but it was previously formally titled the Mexico City Policy and the Trump administration now calls it Protecting Life in Global Health Assistance. And it's a presidentially enacted policy that restricts who can receive U.S. global health assistance. And it restricts it to foreign organizations who agree to not provide, refer, counsel, or advocate for abortion as a method of family planning. So that's any foreign organizations. So, not based in the U.S. who received global health assistance from the U.S., they have to agree to be gagged and no longer talk about, counsel, refer, or provide, or do any advocacy around abortion as a method of family planning. So what we've seen in previous Republican administrations, because this started with Reagan and has gone back and forth with each Republican and Democratic president, is generally that it has applied to international family planning programming, which is about on average $500 million a year during all these times. And it sort of goes on day one of a Republican administration, and then it's bad in a contained way and a pretty consistent way. We know it's interfered with HIV prevention, with contraceptive access. It increases unintended pregnancies and it's caused an increase in abortion. Um, and we have really good data on that at this point, but what we've seen in the Trump-Pence administration and what we'll be talking about is the fact that we've seen this unprecedented drum beat of expansion driven by ideology for political gain by this White House and State Department sort of pretty consistently since it first went into place in January of 2017.

Jennie: Yeah. So there was the really big expansion that was immediate.

Beirne: Yeah. So this policy goes into effect with a presidential memorandum. And what happened in January of 2017 was a presidential memo from Trump that immediately overturned Obama's presidential memorandum about it and directed the secretaries of state Health and Human Services and the head of USAID to expand it as far as possible. And that direction has been taken up by those different agencies in different ways over the last couple of years. So we saw an immediate expansion sort of the end of that directive in May of 2017, when then Secretary Tillerson announced Protecting Life in Global Health Assistance. And that was the point in which there was clarity. And there were sort of frequently asked questions and different standard provisions for contracts that were all released to find any organizations receiving global health assistance. So well beyond international family planning to all of global health assistance. As I said, that went from about 600 million a year to close to 9 billion a year. So all of a sudden in May 2017 it extended to all of our HIV funding, our malaria funding, nutrition, maternal newborn, child health, all of these new domains were being touched by this policy for the very first time. So that was the May, 2017 expansion sometimes called the Beginning of Protecting Life and Global Assistance, sometimes called Tillerson's expansion. But that was that massive expansion right out of the gate. We also saw an expansion in March of 2019-- buckle in for some really it's both very boring and dramatically devastating all at the same time--but in March of 2019 Secretary of State Mike Pompeo, that's the current secretary of state, the second that we've had under the Trump presidency, and it's important to note someone who's ideologically aligned with Mike Pence, in March of 2019 Pompeo expanded the policy further by unilaterally declaring that, and this is a quote “foreign NGOs that receive U.S. global health assistance should take steps to ensure that they're not providing financial support with any source of funds and for any purpose to another foreign NGO that performs or actively promotes abortion as a method of family planning.” Now that sounds incredibly sort of wonky and not very dramatic, but it is because what it is effectively doing is requiring that a foreign NGO that receives U.S. money for any kind of global health assistance now has to attach a U.S. funding restriction, the global gag rule, to all of their subrecipients of any project. Even if those sub-recipients receive no U.S. funding of any kind, this is extraordinary groups that receive no U.S. money, can nonetheless be forced to comply with this U.S. antiabortion policy based on who their prime partner is. So this isn't very much how global health assistance and global development in general are structured. And it's not necessarily how we think of grantmaking or in how we talk about grantmaking in the United States all the time. So, for U.S.-based actors, it might be a little higher than usual, but in global health assistance, there's usually a prime partner. This is oftentimes international nonprofit organization, not necessarily sometimes based in the U.S., sometimes not oftentimes based sort of in the context of the global gag rule considered a foreign organization. They're generally pretty large to be a prime partner on a U.S. project. You have to have internal capability to do project management and financial management of really massive amounts of money compared to what a small NGO might be used to. So prime partners made the prime partners on lots of different projects. They're going to be large. Sometimes they're universities or specific health programs out of universities. That's true in the U.S. as well. They may be a large organization that just has the institutional capacity to manage these big projects. That might be a five-year HIV prevention project. That is a $20 million five-year project. Now they sub grant to smaller organizations and the people doing the services for most global health projects are smaller NGOs local, but a prime partner may have 10 projects that they're prime on. So after this very nerdy aside explaining why prime partners and subprime partners matter, it's really important to go back to thinking about the Pompeo expansion, because what he was saying is that if you're a foreign NGO, and let's call you Jennie’s NGO, and you are based in Kampala in Uganda and your Jennie’s NGO, and you are a prime partner on a big maternal newborn child health project for the U.S. government. And you might have 10 sub-recipients that receive that U.S. money from you. Now, all of those subrecipients are going to be gagged. And that means everything they do with anybody's money is restricted by the gag rule because they receive us funds through you. That is how the policy has worked. That is how insidious it is that you and your sub partners on this U.S. project are all restricted in what you can do and say at any point with anyone's money, as long as you're receiving U.S. funds, what Pompeo’s expansion did is said, Jennie’s NGO, you're gagged, as well as the organizations that receive money from you. But Jennie’s NGO, you are also the prime partner on a project for the Swedish government. You're also the prime partner on a project for the Gates Foundation. You're also a prime partner for a project for the WHO.

Beirne: Now you are going to have to enforce the GGR on all of your sub-recipients, no matter what project it is. So even though a small NGO or a local organization might be receiving Swedish money from you, you are now obligated to also make sure they're complying with U.S. policy. That's wild-- pause for a second. If you use that as outrageous, it really is. And I think this policy is really tough because it's tough to talk about you're talking about different types of actors. I just had to do a five minute aside to explain prime and sub grantees. But when you get to the core of it, it is so extraordinary that with Pompeo’s expansion, groups that receive no U.S. money, can nonetheless be forced to comply with a U.S. policy. That is an extraordinary thing to see within the realm of funding, the donor landscape, the fact that it impacts so broadly, what people who do not receive us money are doing really can't be emphasized enough. And it's by design. This is what Pompeo’s worldview and Pence’s worldview very much are, is that they do want to divide the world into people who do anything, who advocate, who provide, who counsel, who referred, who engage in any way around reproductive health. They want to divide them away from other organizations. And they want to create a set of organizations that is too scared to do anything around abortion. And they want these expansions to go as far as possible. They want to create as big of a divide as possible within the global health response. So it's not by accident. It is very much by design the idea that this is such a broad overreach and touches donors, money and organizations money that aren't connected to the U.S. that is absolutely something that Secretary Pompeo and Pence are very comfortable with being an outcome.

Jennie: We have the first wild expansion. We have this one that goes even further. So they're done, right? There are no more shenanigans they can get up to with the global gag rule. It just can't go further, right?

Beirne: Oh, Jennie. Oh, damn. So I'm here mostly today to talk about a new proposed rule to further extend the global gag rule. Last month, the Trump administration published a new proposed rule that would extend the global gag rule to all global health contracts. And this is the first time that the global gag rule would ever apply to contracts as opposed to grants and cooperative agreements. So everything we've been talking about up to now, the harm, the wrecked relationships, the increase in abortion, the increase in the unintended pregnancy, all of those things we've seen across this administration and previous administrations has been in applying the global gag rule to grants and cooperative agreements, which are two ways that we do funding mechanisms in order to attach it to contracts. It has to go through an actual rulemaking, which is restricted and sort of, there's a very clear way that rule making has to happen in U.S. law. And that is what we're faced with for the very first time here. And it potentially can impact a whole new set of global health organizations and programs. The Kaiser Family Foundation sort of identifies that potentially up to 40% of global health funding is done through contracts. So while we can't say that means, you know, we're going to see a 40% increase in impact because many of those organizations that receive contracts may already be gagged with a cooperative agreement. We can say that's a, still a lot of money, and that's potentially going to gag new organizations in ways that are really harmful. And because of the mechanism may be going on for much, much longer. I don't want to take this incredibly nerdy side trip down to sort of different funding mechanisms we use. I think the most important thing to know is that this would be the first time that the U.S. government has ever applied the gag rule to contracts. They've never sort of published the rule, finalized the rule, et cetera, and any previous administration and applying it to contracts. It just requires more work just because of the vagaries of U.S. regulatory law advocates have expected that they would try to do this as well. There's no reason to think they wouldn't leave a potentially disastrous expansion on the table. They've been going as far as they can. And so what we're facing is now this rule making process, and it would both expand it to this sort of new set of contracts, but it's also much slower to undo. And that's what we're faced with right now in the fall of 2020.

Jennie: I just… so much always happening. It is unreal to me that they keep finding more ways to make this already terrible rule that we know had devastating impacts when it applied to $500 million, reach so many more people and affect so many more people.

Beirne: I think you can't really overstate how bad the impacts were when it was $500 million a year, and we have more data on it. There's really good research published in the Lancet last year by Stanford University, really looking at you can track the number of abortions in highly impacted countries. So these are countries that receive a lot of U.S. family planning money, or now the methodologies would also include global health assistance. But at the time it was like, you can look at countries that are highly impacted by the gag rule, and you can see an increase in abortion when the gag rule is in place. So it increases abortion. When Obama comes into office and removes the gag rule, you can see abortions drop, and we're talking about a context in which abortions are for the most part, illegal and unsafe. They're happening outside of sort of safe medical settings, in part because of the U.S. is meddling in countries, abortion laws, and the gag rule intends to impede advocacy to make abortion safe and legal. And so we know that the gag rule increases abortion. We know most of those abortions are unsafe and to think about what we're doing as a country, as a foreign policy, by expanding it further and further and further, disrupting health services, disrupting contraceptive access, disrupting advocacy of countries and governments that may be trying to plot their own course towards laws that make sense for their own country. And the U.S. is disrupting all of that. And we don't seem to have any interest in pausing this election season. I am saying we on purpose because as much as you and I have fought against this policy, and we're working with Congress on this policy, it is U.S. taxpayer money. It is our government; all of this is being done in our names. And so as much as I oppose it and can talk about how harmful it is, I can't lose sight of the fact that my government is doing it in my name and harming so many people and civil society and other countries in the name of abortion ideology.

Jennie: That's all very, very right. And I think maybe worth taking a quick aside to be crystal clear on something, because it's something that to you and me is like, yeah, obviously, but maybe explain why when the gag rule is in place, there is a big increase in abortion.

Beirne: When the gag rule is in place, we cease to give money to some of the most effective family planning and reproductive health organizations. And we do that because they can't sign the gag rule. They cannot sign a rule of saying we won't counsel and refer on abortion. We won't provide abortion. We won't do advocacy on abortion. It may violate their core principles. It may violate their mission. It may violate other projects that they're doing. So we ask people to do something that's impossible and we lose them as grantees. And when we lose some of the most effective family planning, international family planning and reproductive health organizations, the two most named are International Planned Parenthood Federation, and Marie Stopes International. When the U.S. stops working with them and withholds our money, they are then in a position where they've lost a huge amount of funding, and they can't necessarily find alternative sources of funding. And so those organizations may need to close down some clinics. They may need to reduce hours. They may need to let go of staff. And I mean, this is the most common mechanism for impact, but what that means is the most expensive clinics to run are oftentimes in rural areas where it's harder to get to what that means is that people, women, and girls and people who can get pregnant, who really want contraceptive access, may no longer be able to get it because their clinic closed down or their clinic hours are reduced, or they're no longer able to procure the same number of contraceptives pills, depo, IUDs that they were able to before, because they lost funding from the U.S. The U.S. makes a big deal out of the fact that the funding stays consistent. It just goes to different organizations. In reality, those organizations aren’t ever going to be one to one, they're not going to be direct analogies to each other. So you may say, well, we're just taking away money from this group, but we're still giving the same amount of money for family planning in that country. But if all of your alternative organization’s clinics are in the city, those rural women are still losing complete access to all reproductive health services. If you are rerouting all your money to an organization that doesn't provide IUDs, then that changes the contraceptive choice and women and girls and people who can get pregnant may make different decisions. And it may just mean that money goes to a different country, or it goes to a religious organization that isn't going to provide the same set of contraceptive services. So it's really important to note that U.S. structures this in a way to make it seem like, well, we're not cutting any funds. It's just these “bad” guys who refuse to be gagged. And so they're choosing not to take U.S. money. It's not our fault, but we are the one creating this sort of false choice in our policies, our ideological driven policy. It means that organizations are having to make tough choices and may have to close clinics. That means women and girls and people who can get pregnant are losing access to contraceptives. Unintended pregnancy goes up, abortions go up, and to say, Jennie, in this context, the global context and the context of the data, when we're talking about unsafe abortion, we're not talking necessarily about self-managed or medicated abortion. We're talking about abortions done by people without the necessary skill or in an environment that doesn't have any of the minimal medical or safety standards. And so talking about increases in abortion and unsafe abortion in this context is really different than the conversations we're having in the U.S. right? Now that answer to your question, Jennie. Yes. I think it was just really important to talk about the impacts on the lives of the people, because often it gets caught up in the policy world, but these policies that we are making in DC that are being made in our name are having real detrimental impacts on people's lives.

Jennie: Yeah. And we're expanding. I mean, we are expanding how many people, it will impact how many people will not be able to access contraception. I mean, that is the choice that the White House is making and the Secretary of State is making, every time they expand, this is they want a political win. And so they are going to do something without understanding or caring what the potential impacts might be.

Jennie: Obviously, global gag rule is terrible. Pompeo hasn't been getting into a whole bunch of other shenanigans too, right?

Beirne: Pompeo’s shenanigans could be its own title of the episode. Yeah. I mean, I will loop back. Right. Pompeo is very much from the same ideological bent as Pence. He is a Christian. He is very explicit about his worldview and what world view he's bringing into foreign policy that includes extreme anti-choice views and extreme anti LGBT views. And I feel really confident in saying extreme because they try hard to normalize this and make it sound like, well, this is what we voted for. This is what you wanted. But the vast majority of Americans support abortion rights. And we know from a really recent PPFA polling that 70% of Americans oppose the global gag rule. So they are doing all of this and all of these expansions in the face of overwhelming support for abortion rights and abortion access and opposition to the global gag rule from the actual American public. And so it is ideologically driven. It is not what we expect or want from our government. And Pompeo is unfortunately being pretty across the board on it. I know you just did a really amazing episode about the Unalienable Rights Commission and how he's sort of trying to redefine human rights in a way that strips them from you and me and many of your listeners. And that's really sort of consistent with how he's operating in a lot of different spheres, both in diplomatic spheres, but also in policy. So, unfortunately it's not a surprise that the Trump administration is still pressing to deepen and widen this policy even in October of 2020. And I think it's important for everyone to know that even if they're voted out in November, there's still going to be an enormous amount of political and practical work that has to happen to remove the policy from contracts, grants, cooperative agreements, and to rebuild all the programs and relationships that were harmed by it. We want to believe that that switch can flip back, but the amount of harm that we've caused clinic closures programs ending, that's very hard to undo. And so they're sort of reckless disregard for coherent global health responses will have ramifications no matter what happens in November, it'll have ramifications for months and years.

Jennie: Yeah, I think that's so important is the policy does get talked about as the switch that is just flipped on and off one day, it's there the next day it's gone. But the damage it does is so much beyond that the relationships severed in communities, people not trusting those clinics that had to close. It's not like a clinic can just reopen the next day. Those clinics might be gone forever. So the damage is really, really much bigger than just the simple on off switch that it gets portrayed as.

Beirne: Absolutely. And governments and organizations remain really nervous. We often talk about this as the chilling effect of the policy and the chilling effect of us, of anti-abortion policy in general, it creates this sense that if you want to work with the U.S. government on global health, you can't do anything on abortion. And it is all of our jobs to disrupt that as much as possible, and also to overturn all of the legislative and presidential actions that make that reoccurring and true narrative in some cases. But the chilling effect means that people will stay nervous. If you just went through the experience of having to lay off half your staff and doing line editing of all of your comprehensive sexuality education materials to erase any mention of your national laws on abortion, if you just had to go through that three and a half years ago, you're going to be very, very cautious about adding back in that information or in a case of an organization that's been defunded. You may not have the opportunity to hire back half your staff. They may have gone to work for other organizations. You're not a reliable employer anymore because you are subject to the vagaries of one of your funders, which far exceeds even what a lot of people in the NGO world are used to ups and downs, but the level of disruption and disruption caused by something that's not, evidence-based really can't be overstated.

Jennie: So we've talked about all of this horrible stuff. So maybe we should go to where I'd like to end on something a little more positive, what actions can listeners take? What can we do?

Beirne: Well, the rule is open for a 60-day comment period. And that comment period closes on November 13th. Advocacy colleagues from lots of organizations will be preparing and sharing template comments. I think that's a great opportunity for folks to chime in, even if it's a short comment, even if it's just expletives, we would understand, but we do have the chance to draft comments and submit them up until November 13th. And I think it's a good opportunity to ask some real questions of the State Department and HHS and the other implementing agencies, asking them more about what the financial burden is of this. What is the impact? How are they going to measure the harm caused the U.S. has paid attention to the impact on funding and money and organizations that hasn't done any monitoring on the human cost? This is a good chance to ask those questions. So it listens should sort of, if you're having a rage-fueled letter writing night, I know there's a lot of opportunities for what to write and to whom, but it is a great chance to contribute during this comment period. The number of comments received matters and making them unique matters. And then you can urge all of your national level elected officials, even before they take office to really prioritize immediately and permanently ending like global gag rule. This doesn't have to be the way it is. We could take this off the table by legislation that says, this is simply not something that presidents get to do anymore. We could not have to deal with this in the future. So there's currently a bill in the house and the Senate called the Global HER Act. It will be reintroduced in some form in the next Congress. And again, you don't have to wait for folks to take office. You can really urge all of this sort of federal level of elected officials to make this a big priority to end it permanently as soon as possible.

Jennie: Thank you so much for being here as always. It was such a pleasure to talk to you about such horrible and kind of wonky things.

Beirne: I feel like today was very overly wonky, got into sort of contracts, regs prime, and sub partners, but I really appreciate the chance to talk to you every time. And I do think it's important that everybody knows all the ways that the administration is trying to overwhelm us with all the bad that they're doing, but this is something very specific that they're doing globally in our names. And as if we all think it's good and right, and they're continuing to push these expansions right up to the 11th hour. So thank you so much for inviting me back on, and hopefully we won't have any more expansions to talk about. Hopefully fingers crossed, right?

Jennie: Fingers crossed.

Jennie: 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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