The global gag rule -- officially known as the Mexico City Policy and rebranded by the Trump administration as Protecting Life in Global Health Assistance -- is a policy that prohibits foreign nongovernmental organizations that receive certain categories of U.S. foreign assistance from using their own, non-U.S. funds to provide abortion services, counseling, or referrals, except in the cases of rape, incest, or life endangerment. It also prohibits funding recipients from advocating for the liberalization of abortion laws in their own country.
It has been proven to be a failed, deadly policy that simply bullies reproductive health care providers into providing substandard medical care. By controlling what providers can and cannot say to their patients, it jeopardizes health care and is downright catastrophic for global health. It is particularly harmful to marginalized populations, and we have already seen how it has impacted the health and rights of LGBT persons.
A new report by the Center for Health and Gender Equity (CHANGE) traces the impacts of the global gag rule on marginalized populations. When the Trump administration attacks reproductive health providers with the global gag rule, by extension it attacks LGBT and other marginalized populations who may have nowhere else to access the health care they need and deserve.
In Mozambique, clinics that serve LGBT populations run by the Mozambican Association for Family Development (AMODEFA) have closed due to loss of U.S. funding. As a result, options for LGBT-friendly health care are now limited across the country. In turn, partner organizations that previously relied on this referral network for their clients are now unable to refer to AMODEFA for needed services. A representative of one organization said, "AMODEFA clinics were a unique space where we could refer our beneficiaries, who are [transgender] women, who are lesbian, who are gays, who are MSM [men who have sex with men], expecting if you are referred to AMODEFA's clinics, they were going to receive friendly attendance."
In a country like Mozambique with a high HIV prevalence, the closing of clinics that serve LGBT persons is especially alarming. AMODEFA's rural Xia-Xia clinic was forced to lay off both nurses and activistas (community health outreach workers); of 600 activistas, only 64 remain. This has resulted in a massive reduction in the number of young people receiving HIV testing and counseling. The loss of funding also means that AMODEFA has stopped -- and cannot scale up -- its program on parental disclosure of HIV to children living with HIV.
The impact of Trump's global gag rule on youth and their access to youth-friendly programs is equally disturbing, especially when it comes to young lesbians and young bisexual women. In certain regions, adolescent-age lesbians can experience higher rates of unintended pregnancy than heterosexual women, which may be due to lower condom use and sexuality education that is not inclusive of LGBT people. One stakeholder explained, "So there is often a self-selection or an exclusion of lesbians and bisexual women from mainstream youth programs that deal with family planning issues. Many reproductive health organizations fill a very important need by running youth programs that address the needs of lesbians and bisexual women. When funding is cut, these programs will be impacted."
And that is exactly what happened when AMODEFA was forced to close their clinics.
Health care providers, not politicians, know what is best for their patients and families. It is wrong for the United States to force health care providers in other countries to choose between restricting the care they can provide to patients and keeping critical funding.
If Secretary Pompeo and the U.S. government are really interested in "protecting and defending" the human rights of LGBT persons, they should start with ending the global gag rule.