The Advocacy Committee of the Council on Anthropology and Reproduction (CAR), an interest group of the Society for Medical Anthropology, seeks to ensure that anthropologists have a voice in public conversations about reproductive and sexual rights and health. Our collective expertise provides research-based commentary and critical perspectives on parenting, childbearing, infertility, obstetrics, midwifery, contraception, abortion, adoption, and reproductive technologies. In addition, CAR takes a special interest in women’s and men’s lived experiences of policies, both domestic and foreign. On this occasion, CAR joins other activists and public health advocates in opposing the Global Gag Rule, a policy that has undermined reproductive health and security around the world.
CAR is a U.S.-based organization whose members come from and work in a variety of countries and settings. Our membership holds that sexual and reproductive health is fundamental to the health of societies around the globe. Our global orientation makes us sensitive to and knowledgeable about women’s and men’s fundamental need for reproductive and sexual health services. CAR members contend that the U.S. government, as the world’s largest donor of foreign assistance funding, has a special responsibility to use its leadership and resources to ensure fair and equitable reproductive and sexual health security wherever and whenever it can. CAR members support only those U.S. policies that enhance reproductive health, promote democratic values, and save lives. The Global Gag Rule has had deleterious effects on reproductive health, resulted in tyrannous global reproductive disparities, and increased maternal and infant mortality.
CAR supports policies that provide evidence-based, informed, and fair health education and services, and we find it deeply troubling that some recent U.S. foreign policies targeting reproductive and sexual health have put moral agendas ahead of public health. In recent years, the US has frozen funds to the United Nations Population Fund (UNFPA), hijacked the agendas of international health policymaking conferences, ignored the advice and evidence of prominent health scientists, appointed moral extremists to key policy positions, turned a blind eye toward regressive reproductive health policies passed in other countries, and stifled free speech by making foreign aid contingent on adherence to policies such as the Global Gag Rule.
The Global Gag Rule prohibits foreign NGOs that receive U.S. family planning assistance from offering abortion, counseling about abortion services, or lobbying to change abortion laws, even if they do so with non-U.S. funds. The policy was first enacted by President Ronald Reagan in 1981, rescinded by President Bill Clinton in 1993, and reinstated by President George W. Bush in 2001. The Global Gag Rule puts the United States at odds with global agreements on reproductive rights, including those reached at the International Conference on Population and Development (Cairo, 1994), and the ICPD+5 conference (New York, 1999).
The Global Gag Rule Impact Project was convened by a consortium of organizations devoted to documenting the effects of the Global Gag Rule on “the availability of life-saving family planning services, as well as efforts to address other major threats to public health, including HIV/AIDS and maternal deaths due to unsafe abortion.” The consortium of organizations behind the project includes Population Action International, Ipas, Planned Parenthood Federation of America, and the International Planned Parenthood Federation, with fact-finding assistance from EngenderHealth and Pathfinder International. Their website <globalgagrule.org>, includes detailed reports of the effects of the Global Gag Rule in Kenya, Zambia, and Nepal.
Critics of the Global Gag Rule point out that it harms women’s health and undermines US foreign policy. If the goal is to prohibit U.S. funds from being used to provide abortions overseas, The Global Gag Rule is clearly unnecessary, because laws to this effect have been in effect since the 1973 Helms Amendment. In fact, the Global Gag Rule was promoted by parties that oppose not only abortion but contraception, and one effect of the policy is to harm women’s health by restricting access to family planning and reproductive health services. Such services reduce unwanted pregnancy and the demand for abortion. Ironically, the Global Gag Rule may increase, rather than decrease, the number of abortions by limiting access to contraception. Unsafe abortions, in turn, compounded by lack of access to medical and family planning services, contribute to maternal mortality.
Health and family planning clinics have been forced to shrink and in some cases to close as a result of cutbacks in funding. Supplies of contraceptives and condoms, used to prevent sexually transmitted diseases including HIV infection, have been disrupted. In the wake of the Global Gag Rule, Population Action International reports that “shipments of U.S.-donated condoms and contraceptives completely ceased to 16 development countries, primarily in Africa.” The Global Gag Rule undermines U.S. foreign policy goals by increasing the risk for sexually transmitted diseases and unwanted pregnancy.
The Global Gag Rule also set the stage for another U.S. foreign policy restricting freedom of speech: the Anti-Prostitution Loyalty Oath. The anti-prostitution loyalty oath was passed by Congress in 2003 as part of the Global AIDS Act. It requires foreign organizations to pledge their “opposition to prostitution” to receive US funds for their HIV-prevention activities. In 2005, Justice Department extended the oath to U.S.-based organizations, a provision that was quickly ruled unconstitutional (in May 2006) for two reasons. “First, it forces private, U.S.-based organizations to espouse the government’s point of view on a controversial social issue in order to remain eligible for government grants. Second, the requirement restricts how organizations use their private funds to engage in speech or programs related to prostitution.” Even though the policy is now inapplicable (because unconstitutional) in the U.S., it still applies to foreign NGOs even when they use private funds. In the words of EngenderHealth President, Dr. Ana Langer, “While the decision is good news for U.S. public health organizations committed to implementing life-saving HIV prevention and care services, we are still deeply concerned about the policy’s negative impact on foreign organizations working hard to combat the epidemic in the world’s poorest and most desperate nations.” Foreign organizations and subcontractors of U.S. public health organizations continue to be bound by a rule that hinders the ability of public health workers to implement effective interventions to prevent the spread of AIDS.
The impact of this pledge ironically undermines the values that it claims to promote, by denying funds to organizations using proven public health prevention methods, and as a result putting more people at risk for HIV/AIDS. According to the International Women’s Health Coalition, the anti-prostitution loyalty oath cost Brazil $48 million when the National AIDS Commission refused to sign the pledge because it would hinder their ability “to work effectively with sex workers.” In January 2006, the BBC World Service Trust, “which uses media to promote development goals, was forced to abandon a 3-year, $4-million, USAID-funded HIV-prevention campaign in Tanzania because it refused to comply with policy.” Although the BBC did not work directly with sex workers, its program “was deemed incompatible with U.S. guidelines because it might have included ‘nonjudgmental’ portrayals of sex workers in its programs.”
Both the Global Gag Rule and the Anti-Prostitution Loyalty Oath are motivated by politics, not science. There are uncomfortable parallels between the so-called First and Third Worlds, because the same politicians who supported the Global Gag Rule and Anti-Prostitution Loyalty Oath also oppose reproductive health services in the U.S. The Hyde Amendment, for example, has been in effect for more than 30 years. It excludes abortion from the services provided to low-income Americans through Medicaid. In the 1980s, the Hyde Amendment was extended to other groups that receive taxpayer-funded health care, including all federal employees and their families, Native Americans, Peace Corps volunteers, low-income residents of Washington, D.C., federal prisoners, military personnel and their dependents, and disabled women on Medicare.
CAR members study all facets of reproduction the world over. Our interests and expertise encompass topics ranging from miscarriage to midwifery to menopause to medical technologies to masculinity. Some of us conduct research in humble homes and impoverished rural clinics, while others work in high-tech laboratories and wealthy medical institutions. Some of us have first-hand evidence of the untenable circumstances that force people to choose (for example) between starving and exposing themselves to HIV. The hallmark of anthropology is ethnographic research, including our ability to listen carefully, observe closely, and always attend to local context. CAR members are committed to participatory approaches, to working together with advocates in the United States and elsewhere around the world to acquire unique insights into how people understand and practice reproduction. CAR members are further committed to documenting the effects of governmental policy, including misguided policies of the US government, and to providing research results that will help create respectful, accurate, policies that are based on sound social science.
A comprehensive list of US policies that affect reproductive health can be found at the International Women’s Health Coalition’s web page, Bush’s Other War: http://www.iwhc.org/resources/bushsotherwar/index.cfm