On 23 January, US President Donald Trump signed an executive order reinstating the Global Gag Rule. The rule will have global knock-on effects, in South Africa too, as institutions that receive funding from the USA are prevented from providing comprehensive family planning services.

Janet Walsh, the Acting Director of the Women’s Rights Division of Human Rights Watch, explains it succinctly. ‘[The policy] prohibits United State’s international aid to groups that engage with abortion in any way – providing it, offering counselling, advocating for abortion law reform, or providing referrals – even with non-US funding. Under this rule, organisations will be disqualified from receiving US assistance simply because they use their own, non-US, funds to provide abortion-related services and information that are legal in their home country and in the US.’

In South Africa, reproductive rights are protected and abortion is legal. Yet if a woman visits a clinic with US funding, she could be prevented from being informed that abortion is one of her options.

Marie Stopes is an international family planning initiative operating in South Africa and is the country’s largest non-profit provider of sexual and reproductive healthcare services. Marie Stopes operates 15 clinics in six provinces across the country. Whitney Chinogwenya of Marie Stopes SA told News 24 that their funding from USAID was cut during the (former US president George W) Bush administration’s implementation of the Global Gag Rule, causing them to close half their clinics at the time. They did not receive further funding under the Obama administration.

Marie Claire spoke to Andrea Thompson, Advocacy and Engagement Manager at Marie Stopes South Africa, and asked whether they would be affected by the Global Gag Rule.

Andrea said on Wednesday that they do not currently receive any funding from USAID or any US Government body. ‘Thus our operations will not be directly affected by the reinstatement of the Gag Rule. However, we stand with our global colleagues against what is very much a step backward for not only safe abortion care but women’s rights more broadly,’ she said.

Ripple effects 

Whitney clarified for us that the USA has never funded abortion at Marie Stopes clinics in South Africa directly, so that won’t change. However the Global Gag Rule prevents the provision of comprehensive family planning services that include abortion, or even discussion of abortion as an option, by any organisation that receives any US funding – this is the ‘gag’ effect. Without referrals to safe legal providers, more women will have to seek illegal abortions.

Andrea pointed out that the Global Gag Rule doesn’t technically prevent abortion from happening but that it will have negative effects nonetheless, particularly on vulnerable women. ‘[They] will be affected by what will become (including in South Africa) poorly integrated healthcare services, education and information. Service offerings and curricula that leave out abortion (and often as a result contraception) fail to provide women with the care and information they need to safely plan their futures and family.’

More deaths due to unsafe abortions

Ibis Reproductive Health reports that one in three South African women aged 15 to 24 experience an unintended pregnancy. Although the right to have an abortion is the law, accessing safe abortion remains a challenge. In South Africa, a woman can seek an abortion through public clinics and hospitals and private clinics, hospitals, or doctors. Researcher Christi van der Westhuizen reported in a 2014 article on Mail & Guardian Online that ‘only about 53% of the public health facilities designated to provide safe abortions are operational at present. Medical abortion, involving only pharmaceutical drugs, is available in five provinces in the public sector.’ She suggested that lack of access to safe abortions, stigma from providers in public health, and the proliferation of illegal providers were contributing to a rise in the number of deaths caused by abortion.

If half of the public health facilities reported in 2014 are still not operational, NGOs have an important role to play in providing safe, legal abortions for women who cannot afford private medical care. The reinstatement of the Global Gag Rule could mean less funding available for both new and existing organisations that provide family planning that includes abortion. This presents a difficult situation for organisations that receive US funding, who must either provide incomplete family planning services where they cannot include information on abortion, or lose US funding and reduce their operational budgets.