While the Bush administration dropped plans to apply an abortion-related "gag rule" to international HIV/AIDS programs in response to concerns that such a restriction would impair service delivery, it refuses to demonstrate a parallel concern for health care services provided to women overseas through family planning programs, according to "Global Gag Rule Revisited: HIV/AIDS Initiative Out, Family Planning Still In," by Susan Cohen. New case study investigations by Population Action International and the Center for Reproductive Rights demonstrate that women's reproductive options are limited and their lives endangered by the restrictions placed on U.S.-funded family planning providers worldwide by the global gag rule.

Under the global gag rule, family planning funds administered by the United States Agency for International Development (USAID) may be transferred only to foreign nongovernmental organizations (NGOs) that pledge that they will not use funds from any source for abortion-related activities, including providing information about abortion through counseling or advocacy. President Bush claims that this policy does not have a major impact on the global provision of family planning services or on women's reproductive health. These new investigations show that it does.

Population Action International, in collaboration with other key U.S.-based NGOs, assessed the effects of the global gag rule on access to family planning and related reproductive health services in Ethiopia, Kenya, Zambia and Romania in "Access Denied: U.S. Restrictions on International Family Planning." They found that NGOs that had refused to be "gagged" were forced to close clinics, and thousands of women were turned away from former sources of care-not just for contraception, but also for prenatal, postnatal and well-baby care. In addition, in many countries around the world, already-inadequate supplies of contraceptives have become even more scarce because USAID's existing local family planning partner has been cut off from funding. Yet, the Bush administration acknowledges that one of the best ways to reduce the need for abortion is by providing quality voluntary family planning services. (For more on the role of contraception in reducing abortion, see "Contraceptive Use is Key to Reducing Abortion Worldwide" in this issue of The Guttmacher Report.)

In a parallel review, the Center for Reproductive Rights visited and researched NGO decisions regarding the gag rule in Ethiopia, Kenya, Peru and Uganda-all countries where abortion is severely restricted and unsafe. Illegal abortion is a significant contributor to high rates of maternal death and injury in these countries. "Breaking the Silence: The Global Gag Rule's Impact on Unsafe Abortion" found that NGOs acceding to the gag rule in exchange for desperately needed U.S. funding for family planning services and supplies have been severely hampered in their ability to effectively address the tragedy of widespread abortion-related maternal mortality.

The Bush administration, Cohen says, pulled back on expanding the global gag rule to its HIV/AIDS initiative because administration officials could not come up with a scheme that would not negatively affect the program's operations. The administration, she concludes, should place the same premium on the health and lives of the world's women.

Cohen's analysis appears in the October issue of The Guttmacher Report on Public Policy. Other analyses in this issue include: