Access to affordable, quality healthcare is a fundamental human right. Yet around the world, hundreds of thousands of women and girls die each year from a lack of access to healthcare, particularly a lack of access to reproductive healthcare.
The World Health Organization estimates that more than 800 women and girls die every single day of pregnancy- or childbirth-related complications. The overwhelming majority of these maternal deaths happen in developing countries, and many are preventable.
When Donald Trump took office in January 2017, he reinstated the Mexico City Policy (also known as the “Global Gag Rule”) restricting healthcare funding and making it even harder for women and girls to access adequate reproductive healthcare in developing countries that rely on US foreign aid. In response, the Dutch government launched SheDecides — a global initiative that calls on governments, businesses, and private citizens to step up and fill the funding gap to safeguard women’s health.
Take Action: Sign the She Decides Manifesto
What is the Global Gag Rule?
Over the last 34 years, the Global Gag Rule has been alternately suspended by Democratic administrations and reinstated by Republican ones, and millions of people have suffered in the process.
The original policy, established in 1984, prohibits NGOs from receiving US foreign aid funding — from the State Department and the US Administration for International Development (USAID) — if they perform abortions, provide information about abortions, refer patients to other services for abortions, or even advocate for policies that support access to abortion.
This affects medical services offered through clinics run by NGOs, particularly in low-income countries and rural areas where such clinics may be the only form of healthcare available to communities.
How Is Trump’s Global Gag Rule Worse Than Previous Administrations’?
President Trump not only revived the original policy, but expanded its scope.
To be clear, US federal funding generally cannot be used to fund abortion services either within the US or overseas — and this has been the case since the 70s — even when the Global Gag Rule has been suspended.
The Global Gag Rule was last enforced under President George W. Bush’s administration and, as in previous administrations that used the policy, only applied to US family planning funds provided by the State Department and the US Administration for International Development (USAID) — about $575 million. Under the Trump administration, the Global Gag Rule’s restrictions have been extended to all US global health assistance (roughly $8.8 billion), affecting programs that provide HIV/AIDS support, maternal and child healthcare, and prevention and treatment for diseases like malaria and tuberculosis.
This greatly impacts healthcare providers in countries like Kenya, where NGOs operate 15% of clinics, and Nigeria — where 70% of contraceptives were provided by the UN Population Fund, from which Trump has withdrawn US funding, and 25% were provided by USAID in 2015.
What Is SheDecides?
SheDecides is not about changing or influencing domestic policies, it’s about governments, businesses, and individuals stepping up to support these healthcare programs in developing countries in the sudden, devastating absence of US funding support.
It’s also not about abortion.
Above all, SheDecides is about making sure girls and women around the world have access to vital reproductive and sexual healthcare and that they are treated as people with the power and agency to decide what to do with their own bodies.
And that’s about more than just abortion — it’s about access to contraceptives and testing that help prevent HIV/AIDS, obstetric care that improves maternal and infant survival rates, it’s about keeping girls in school.
“Evidence shows that by blocking funding to the world’s largest NGO providers of modern contraception, unintended pregnancies and abortions go up,” Marjorie Newman-Williams, vice-president of Marie Stopes International, an NGO that provides contraceptives and safe abortions through clinics in 37 countries, said in a statement. “As a result, women and girls are less likely to complete their education, have a career, or pursue their dreams for the future.”
Every girl and every woman has the right to decide if, when, and with whom she wants to have children.
Why Do Women Need Access to Sexual and Reproductive Healthcare?
Hundreds of women die every day from complications linked to pregnancy and childbirth, but access to prenatal and postpartum healthcare can save the lives of both mothers and children.
According to the UN Population Fund, “214 million women who want to avoid pregnancy are not using safe and effective family planning methods.” Many of these women lack access to safe contraceptives — which can help prevent sexually transmitted infections like HIV/AIDS — while others lack the information about such resources.
A lack of information, reinforced by gender discriminatory norms, can strip girls and women over the power they should have over their own bodies, putting them at greater risk of sexually transmitted infections, unwanted pregnancies, early marriage, and unsafe abortion.
To date, SheDecides has raised around $400 million, contributed by governments — including Belgium, Canada, Denmark, the Netherlands, France, Norway, and Sweden — as well as organizations like Bill and Melinda Gates Foundation, and individual donors.
The funds are being managed by Rutgers, a Netherlands-based sexual and reproductive health rights NGO, and will be distributed to organizations impacted by the Global Gag Rule so that they can keep their clinics open and provide necessary sexual and reproductive health services without restrictions.
You can join Global Citizen by taking action here and calling on world leaders to support SheDecides to protect the health of girls and women everywhere.