FEATURE: She Decides!!! A global initiative to challenge the hegemony of the US government in funding family planning and abortion

The story to date

On 22 January 2017, the Global Gag Rule was reinstated by Donald Trump the day after he took office. (See the Campaign newsletter report of 27 January which outlines the history of the Gag Rule, which goes back 32 years, the consequences it had for NGOs in the past and the current picture.)

Six short weeks later, on 3 March 2017, as reported in the PAI Washington Memo of 7 March, USAID had inserted a new section Mexico City Policy (March 2017) into the guidance governing USAID funding to NGOs outside of the USA that is “applicable to all awards that include family planning funds”.

A notice to USAID headquarters and field staff stated that this new section will be inserted into all new USAID family planning assistance grants and cooperative agreements, and also into existing agreements “when such agreements are amended to add incremental funding”. Thus, it will not be applied to already existing grants, but only if new funding is added to them or for new grants. The notice emphasises that the Gag Rule does not apply to agreements with foreign governments or multilateral organizations, consistent with implementation during the previous Bush administration. However, the US government has other policies with similar restrictions for the governments and inter-governmental agencies it funds, such as UNFPA. And unlike the Gag Rule, which was rescinded under Clinton and Obama, these other policies have been operative non-stop for decades.

USAID is the largest donor in the world to family planning services, and many, many NGOs will also lose these grants unless they sign. Two of the largest international NGOs with USAID family planning grants had already announced on 23 January that they would not sign the Gag Rule – International Planned Parenthood Federation and Marie Stopes International.

Implementation with regard to the rest of US global health assistance, e.g. affecting HIV care and services, remains unclear but appears to be moving forward through a US government inter-agency process. PAI says to expect recommendations to be presented to the US Secretary of State in the next several weeks.

The amount of funding at stake for family planning programmes is estimated at US$ 575-600 million. However, if as threatened all HIV and other SRH services are also included, then the estimate jumps to as high as US$ 9 billion. How much is lost, however, depends on how many NGOs refuse to sign the Gag Rule. If they sign, they will keep their FP grants but have to give up their abortion-related work. If they refuse to sign, they will lose their FP grants and both their FP work and their abortion-related work will either have to stop, continue without funding, or be funded some other way.

Trump recently announced he will use the money saved to, among other things, re-build US military might.

Q: What is the Gag Rule really about?

The answer is dead simple. It is about US Republican Party politicians, who are (all but one, I am told) anti-abortion, imposing a funding policy on USAID grantees that aims to stop their provision of safe abortion information and care. If groups do not sign, it also de-funds the family planning services they provide. The Trump iteration of the policy is wider; it is also aimed at any non-USA-based NGO that provides any SRH services that include safe abortion. The policy predates the ICPD Programme of Action 1994 but it is enshrined there too, in language that says: “abortion may not be promoted as a method of family planning”.

FACT: The vast majority of abortions are for “family planning”. To reject “abortion as a method of family planning” is just a linguistically devious way to say you oppose almost all abortions.

FACT: This policy also results in the loss of funding for “family planning”. It is therefore a backdoor form of anti-family planning policy too.

The fightback began the day after the announcement

What distinguishes this iteration of the Gag Rule over previous ones is that even as the USA has moved steadily backwards into the dark ages in its policy on abortion, many positive changes have been taking place in much of the rest of the world, where there has been greatly increased support for sexual and reproductive health and rights. This includes growing acknowledgement of the need for safe abortion information and services, and a growing number of calls for the decriminalisation of abortion, even if most have not yet resulted in actual law reform.

Thus, when the Dutch government announced on 25 January that they would launch an “abortion fund”, which was later broadened in scope and form and named the “She Decides Initiative”, as many as 20 other governments wrote to them within a very short space of time to say they too supported the initiative. This is nothing short of incredible. Nothing like it has ever happened before as far as safe abortion is concerned – because in most global forums, usually in the UN and its agencies, governments supporting safe abortion have had to broker harsh compromises with those who support unsafe abortion, from ICPD to the SDGs.

On 14 February 2017, a large majority (93%) of MEPs in the European Parliament backed an amendment calling the Global Gag Rule a “direct attack on the progress made in the field of women’s and girls’ rights” and supported the setting up of an international fund to improve access to abortion services. The authors of the amendment – Constance Le Grip of the European People’s Party and Marie Arena from the Socialists and Democrats – called on the EU to “significantly increase” funds for “sexual and reproductive health and rights” and to launch an international fund to “finance access to birth control, legal and safe abortion, using both national as well as EU development funding, in order to fill the financing gap left after the Trump’s administration’s moves”. The amendment was to a report being prepared for member countries ahead of the UN Commission on the Status of Women that starts on 13 March in New York. (SOURCE: Politico, by Maïa de La Baume, 14 February 2017)

Then, days later, faster than anyone would have thought possible, four European Ministers for Development Cooperation – Dutch (Lilianne Ploumen), Swedish (Isabella Lövin), Danish (Ulla Tørnæs) and Belgian (Alexander De Croo) jointly called a High Level International Conference in Brussels for 1-2 March 2017.

The high level conference

Over 400 people attended the Conference, including representatives of as many as 50 governments, some of whom included NGOs on their delegations, plus many other donors and NGO representatives. The meeting had three main parts: (1) an introductory event on 1 March at the Belgian Parliament, where half a dozen speakers gave presentations on the background to the Gag Rule and what was happening; (2) an NGO meeting that evening, and (3) on 2 March, the day began with a crowded press conference, followed by the main event – a session in which the governments and others present pledged funds to the Initiative and/or made strong statements of support, some of which have led to pledges since.

The NGO meeting

The NGO meeting was organised by EuroNGOs and IPPF Europe Region. It was a 3-hour meeting, to which about 150 people came. Among the range of SRHR issues represented by groups in the room, my impression was (but there was no participants list) that most NGOs were involved in family planning, development and gender issues, plus a few in sexual rights work and a few in HIV work, and also fewer than I had hoped whose focus is primarily on safe abortion. The large majority were from the USA and Europe, but there were also several from Latin American, Africa and Asia.

In the opening presentations, it was explained that the new Initiative was not a fund. Contributors to the Initiative will each decide for themselves how they will allocate the funds they pledge. This, it was said, raised both questions and opportunities, and it was too early to expect any details. EuroNGOs reported that they had initiated some crowdfunding themselves and had raised €200,000 in 2 weeks, mostly from people in the Netherlands, for “affected organisations”. But criteria were still needed as to who these and any other such monies will be given to. More time is needed, so process remains to be determined. Who will make these decisions is also unknown.

The question was asked whether the funding that would be pledged was in fact really “new money” or not. The complexity of the answer to this will become clear as you read further but it does not diminish the enormous value of what is taking place. As far as the Initiative’s organisers knew at the time of the meeting, almost all pledges referred to new, additional funding commitments.

Some NGOs reported, however, that funding for national NGOs in their countries had been cut in recent years, and was cut this year too, by several of the very same governments who were going to pledge new money. It was also reported that ODA spending overall had been falling in Europe for some years, which was affecting the government departments involved as well, who were themselves complaining that their own budgets had been cut by their governments. Indeed, just 3 months earlier, a number of European government donors, at a meeting on abortion priorities for the future, had said they had no new money for the field, even though they knew it was needed. So the picture is, to say the least, quite complicated and not surprising either.

It was also reported to the NGO meeting that during the meeting in the Parliament, one view expressed, though I am told it was expressed in the corridors rather than from the podium, was: “We can’t join this if it’s only about abortion”, because: a) it is important to position this so as to bring in countries like Germany, and b) governments do not want to appear to be anti-USA.

The NGO meeting in turn acknowledged that many governments depend on the USA – for other funding, for trade, through defence agreements, and much more. We agreed that they cannot be expected to give up those ties in spite of Trump. The same was said for many global South NGOs, who will probably be forced to sign the Gag Rule in order to survive at all.

On the other hand, several of us said that while this is clearly not only about abortion, it definitely is about abortion. Otherwise, it wouldn’t be happening at all. We hoped that among the NGO community, at least, there would be a consensus not to “push abortion under the bus” yet again, as had happened under the last Gag Rule – and since then as well. Under the previous Gag Rule, the whole thing became very divisive and accusatory between those who signed and those who didn’t sign, precisely because of disagreements like these. As a result, the Gag Rule won and all our countries were the losers. This time, we agreed, we need to try to avoid blame and stick together.

Overall, the sense of the room seemed to favour not backing down on abortion, though there was not a vote on anything that was proposed, and it would have been tough to stand up and express support for backing down, so my perception is really a hope, not a certainty.

There were calls for accountability on the part of the governments who were offering money as to how they will spend it, and that spending should focus on the most serious negative outcomes from the Gag Rule, e.g. the effects on youth and those in humanitarian settings. It was agreed that we need to maintain a human rights perspective in our campaigning, and also that it was not just donor governments in the global North who must take responsibility but also in the global South.

Others stressed the need for one global voice and pushback against conservative forces. We were reminded that, under the last Gag Rule, many NGOs were attacked by anti-abortion forces and had to spend a lot of time, money and energy defending themselves. These attacks are a highly distasteful part of many of our lives anyway, but they are certainly becoming more horrible in the US by the day. The question of whether the US government would give the money it “saves” to anti-abortion NGOs was asked, but no one knew the answer.

One person called for NGOs who were going to sign the Gag Rule to shift their abortion work to others, where the work could continue, before they sign. What a great idea, if/when it is feasible.

But in addition to the call for unity among us, perhaps the most important recommendations were the need to reduce dependence on the USA for funding and indeed, dependence on foreign money in general. People in the meeting wanted their own governments to step up and take responsibility too – and felt this was the right time to demand that they do. Finally.

The pledges, 2 March

As many as 50 governments attended the meeting. This was a major accomplishment in an extremely short space of time, and it was an inspirational event, chaired with panache by Kate Gilmore, who spoke in tweets. There were not only governments from across Western Europe, Canada and Australia, but also a goodly number of global south governments, including Namibia, Cameroon, Cabo Verde, and Chad (those who spoke, again, there was no participants list).

In all, a total of €181 million was pledged in just a few short hours. Belgium’s deputy prime minister and development minister, Alexander De Croo, said he expected even more countries to make pledges in the coming months. “Not all countries are able to free up these amounts in three weeks’ time,” he told the press conference, “given the rapid organisation of the conference.”

Who pledged what, in the order they spoke

– Belgium pledged an extra €10 million.

– Sweden pledged an extra €21 million.

– Denmark will give an extra €9 million to Amplify Change + other additional money.

– The European Union will pledge extra money.

– Finland will give €20 million extra for SRHR.

– Children’s Investment Fund Foundation – a private individual foundation of Christopher Hohn – will give US$10 million.

– Canada will give $20 million for Ipas, MSI, IPPF.

– Luxembourg will give €2 million.

– Norway – Solveig Horne, Minister for Children & Equality – €10 million extra to UNFPA and money to ten NGOs who work on abortion who will be invited to apply.

– The UK did not pledge any money. Instead, they announced that they are already the second largest donor for family planning globally (£200 million), after the USA, and remain committed to funding both FP and abortion, and that they will organise a conference on family planning with FP2020 and the Gates Foundation in mid-2017. The focus will be on youth and FP, vulnerable populations, and humanitarian settings. This announcement was not popular.

– Portugal – supports the European Union stepping up. Will maintain support for UNFPA and other partners.

– World Health Organization, Flavia Bustreo – You can count on us to develop FP evidence and evidence on safe abortion care within the law and spearhead research on how health and human rights can be developed.

– Gates Foundation, Melinda Gates by video – US$20 million for FP.

– Australia – AUS$9.5 million for MSI, IPPF, UNFPA and for women & girls in humanitarian settings.

– An anonymous donor – at the last minute, US$50 million.

Other statements

  1. Canada – International Development Minister Claude Bibeau – We want women to have a voice and a choice.
  2. Minister of Health, Chad – We have to decide for ourselves our own destiny, and it is not easy.
  3. Belgium Alexander de Croo – We can inspire with words, but we lead with our actions.
  4. Laurence Rossignol, Minister, France – We cannot have women punished for illegal abortions.
  5. Minister of Foreign Affairs, Cabo Verde – We will make the cause of women an absolute priority.
  6. Cameroon Forums of Parliamentarians in Africa – Commitment to be careful about budgets and to preserve the progress we have already realised.
  7. Namibia – Maureen Hinda, Deputy Minister for International Relations – good words of support (I was not quick enough to record).
  8. European Parliament – there was a 93% majority support for the Initiative (see report below). They will discuss the Gag Rule in a meeting in March.

News reports since the meeting

Sweden and Mozambique

On 5 March 2017, it was announced that Sweden had given the government of Mozambique $5.2 million for a programme to make safe abortion accessible, giving women information about abortion and where to access it, and also about methods of contraception. (SOURCE: Africa Review, by Arnaldo Vieira, 5 March 2017)

At the end of 2014, Mozambique revised their law on abortion, which has been in effect since July 2015. It decriminalized abortion until the 12th week of pregnancy and up to 16 weeks in cases of rape. However, in their report for 28 September in 2016, the Coalition for Sexual and Reproductive Rights said there was more work to be done in order for the law to effectively reduce maternal mortality and morbidity, including increasing knowledge of the new law and improving access to safe abortions. The Ministry of Health had also recently approved new clinical norms on abortion, which must now be implemented. The Coalition was contributing by raising awareness within communities about the new law and advocating for the drafting of comprehensive abortion regulations to ensure access. (SOURCE: Campaign newsletter, Coalition for Sexual and Reproductive Rights, 6 October 2016)

Canada announces CAN$650 million for global SRHR and safe abortion

On 8 March 2017, the government of Canada announced new funding for sexual and reproductive rights, as an important step towards Canada’s global leadership on women’s rights. Leading Canadian civil society organizations welcome Prime Minister Trudeau and International Development Minister Marie-Claude Bibeau’s announcement made on International Women’s Day. The money will be invested over 3 years.

This announcement follows Canada’s $20 million pledge in Brussels to address SRHR funding gaps created by the Global Gag Rule, and was described as intended to go towards meeting Minister Bibeau’s mandate to ensure that “Canada’s valuable development focus on Maternal, Newborn and Child Health is driven by evidence and outcomes, not ideology, including by closing existing gaps in reproductive rights and health care for women”.

The announcement was also described as aligning with Global Affairs Canada’s recent international assistance review, which signalled a scaling-up of investments in sexual and reproductive healthcare and a feminist approach to development assistance. “By focusing on funding for contraception, safe abortion, sexuality education and advocacy for SRHR, Canada is filling the gaps in the Muskoka Initiative that many civil society organizations have been pushing to see rectified.”

Action Canada for Sexual Health and Rights, who attended the Brussels meeting as part of the Canadian delegation, is one of six Canadian civil society organizations that have been calling on the Government to take these commitments forward under the banner of the Future Planning Initiative, a plan to empower 18 million adolescent and young women with full access to SRHR. The Canadian Council for International Co-operation notes that there is a major shortfall in funding for SRHR, which existed before the re-enactment of the Global Gag Rule and will continue to persist if donors like Canada do not continue to make substantial increases to their development assistance budgets for these issues. The Future Planning Initiative is asking Canada to mobilize $4.25 billion over the next 10 years for SRHR. (SOURCE: Press release, Action Canada for Sexual Health and Rights, 8 March 2017)

A further news report in the Globe and Mail on 9 March notes that part of the support offered by Canada is for “removing judicial and legal barriers to the fulfilment of sexual and reproductive health and rights”. A federal official confirmed to the Globe and Mail that these barriers include the anti-abortion laws in many countries. “Advocacy is included in our initiative, so yes, we will support local groups and international groups who advocate for women’s rights, including abortion,” International Development Minister Marie-Claude Bibeau told the Globe and Mail in an interview on 8 March 2017. The new federal strategy would also aim to “reduce the number of unsafe abortions, through education, contraception, family planning,” Ms. Bibeau said. “All of this strategy is to empower women and protect them. They put their lives at risk when they go to clandestine abortions.” A spokesman for Ms. Bibeau said the $650-million will be financed from “unallocated funds” in the government’s existing budget for foreign aid. He said it won’t reduce the $3.5-billion allocated for maternal and child health by the previous Conservative government, which has three years remaining in its five-year budget.

Two foreign aid experts are quoted as saying the amount is not enough and that this was just moving existing money around, but it’s not clear where so much new money was expected to come from, nor did the criticism acknowledge the importance of why this is happening to begin with and how few other governments have come even close to putting this much money forward. (SOURCE: The Globe and Mail, by Geoffrey York/Michelle Zilio, 9 March 2017)

And now a reminder of the reality in the global South…

Malawi: “Trump abortion aid cuts threaten to send Malawi women ‘to the grave'”

A Sky News article with this headline, published online on 3 March, describes the outcome of the Trump policy in no uncertain terms. It says: “Backstreet abortions in Malawi are expected to increase dramatically if the US withdraws its funding to all foreign groups which give advice on terminations.

The poor African country already has one of the worst maternal mortality rates in the world and thousands of women die every year from illegal abortions. Its already fragile health service infrastructure is reliant on overseas funding and any drop in financial help is expected to have a big impact. The main hospital in capital city Lilongwe is already crowded with women seeking post-abortive care. A third of the beds in the maternity ward are filled with women requiring surgery and treatment after having illegal abortions. Hospital department head Dr Grace Chiudzu says:'[Women] use things to drink like Surf (washing powder) or quinine and things to poke themselves like a clothes hanger – even a knife – to try to poke that pregnancy. They come here very sick. About half lose their lives.’… We saw one abortionist mix his potion from a wild plant. He told us how a few sips would deal with the unwanted unborn baby within two days. But he said it would cause women who take it great pain and that they would bleed very heavily. ‘If it gets too bad, I tell her to go to the hospital but I tell her not to say she came to me,’ he said.”

A video with the article is worth watching. (SOURCE: Sky News, by Alex Crawford, 3 March 2017)

Mali: “Du coup, c’est vraiment une décision dure pour nous, c’est dur pour le monde du développement.”

The consequences of the Gag Rule are a very sensitive issue for many countries. In Mali, for example, family planning organizations would not receive the US$600,000 that they would have been able to receive from the United States. “To no longer have access to these funds will prevent the achievement of all our objectives. It has direct consequences for us and especially for the population, who through us have access to this information and these services. Imagine a little what these $600,000 would allow. For how many young girls, how many women to have access to contraception, to have access to information, to have the right and the choice to decide about their lives. Then, imagine a little, that this number of people will no longer have this choice. This is a blow. It is really a hard decision for us, it is hard for the whole developing world. (SOURCE: RFI, 2 March 2017, en français)