Health care is a human right, and abortion care is health care. Laws that restrict access to abortion discriminate against people who can become pregnant. They also deny our dignity and autonomy by taking away our ability to make fundamental decisions about our health and reproductive futures.

Some facts about barriers to abortion access in the U.S.:

• Not everyone who needs an abortion can get one. Over 75% of women who were denied abortions by a clinic because of abortion restrictions carried unwanted pregnancies to term.
• Being forced to give birth has long-term mental and physical health consequences. People denied abortion are more like to:
• experience pregnancy complications such as preeclampsia, hemorrhage, and death.
• stay with an abusive partner.
• suffer anxiety, stress, and loss of self-esteem after the denial.
• Abortion restrictions fuel the cycle of poverty and deepen social inequity. Compared to people who can obtain an abortion, those denied one have:
• three times higher chance of unemployment.
• four times higher chance of living below the federal poverty line.

In U.S. policy, there are two major abortion-related gag rules: the global gag rule (GGR) and the domestic gag rule (DGR). These rules literally “gag” or silence providers by preventing them from delivering certain abortion-related services and information to their clients or patients. The gag rules force health care providers to make a cruel choice: Accept restrictions that jeopardize the health of their patients and destroy the integrity of the doctor-patient relationship or lose vital funds that enable them to provide those patients with quality care.

The global gag rule does three things. It prohibits foreign nongovernmental organizations (NGOs) that receive certain U.S. funds from:

1. Providing abortion services except in the case of rape, incest, or to save the pregnant person’s life;
2. Counseling patients about, or referring them to, abortion services; and
3. Advocating for the liberalization of abortion laws.

The DGR:

1. Requires any clinic that gets Title X funds be totally physically and financially separate from any entity that provides or refers to abortion services. This will make it impossible for health care providers who provide abortion, like Planned Parenthood, to stay on the program.
2. Eliminates the requirement that Title X sites provide comprehensive counseling about pregnancy options.
3. Prohibits Title X health care providers from referring patients to abortion services.

The Trump Administration has expanded the scope of the GGR more than any administration before.

1. It extends to all U.S. global health assistance, an estimated $8.8 billion. Almost $6 billion, or about two-thirds, of the impacted funds are specifically dedicated to HIV/AIDS assistance.
2. NGOs can no longer use their own, non-U.S. funds to provide abortion-related services.
3. NGOs cannot receive U.S. global health assistance dollars if an NGO partner they’ve given money to engages in abortion-related work, even if that work is done with non-U.S. funding.

The GGR shows how the politicization of essential health care spills outside of U.S. borders to harm the life and health of women, girls, and trans and gender nonconforming (TGNC) people around the world. It has had a devastating impact on local health care infrastructure and makes it impossible for people to make informed decisions about their reproductive lives.

Trump’s expanded GGR is the most devastating in U.S. history. 92% of foreign NGOs directly impacted by Trump’s GGR would not have been impacted under previous iterations. Beyond applying to 15 times more funding than any previous administration’s GGR, ambiguities in the new policy and fear of lost funding has led organizations to err towards over-applying the terms of the rule.

Organizations have already reported:

1. Withdrawing from partnerships and shutting down operations in countries that receive U.S. global health assistance, causing weakened coalition networks, lost funding, and abandoned projects.
2. Forgoing U.S. funding, resulting in more clinic closures, reduced staff, disruptions in antiretroviral viral theory (ART) for people living with HIV, and the discontinuation of contraceptive services.
3. Discontinuing adolescent pregnancy consultations.
4. Taking information materials on abortion out of circulation.

For one organization alone — Marie Stopes International (MSI) — the GGR-related loss of funding is projected to result in:

1. 1.6 million fewer women with access to contraceptives
2. 6.5 million unintended pregnancies
3. 2.2 million abortions
4. 2.1 million unsafe abortions
5. 21,700 maternal deaths

The DGR would apply restrictions similar to the GGR to providers that receive Title X funds — and it is projected to have many of the same devastating impacts on sexual and reproductive health and rights. As of May 2019, the DGR was blocked in the courts, so the impact is not known. However, experts expect that it will:

1. Shrink the network of providers that offer reduced-cost family planning services through the Title X program
2. Reduce access to a broad range of contraceptive options for people with low incomes.
3. Violate patients’ right to informed consent and compromise the quality of Title X family planning care by forcing providers to withhold information about abortion.
4. Stigmatize sexually active minors and threaten confidentiality of care for minors.
5. Force people to travel further and pay more for abortion care or forgo that care entirely and carry an unwanted pregnancy to term.

Domestic Gag Rule

• Kaiser Family Foundation, “Proposed Changes to Title X: Implications for Women and Family Planning Providers”
• Guttmacher Institute, “What the Trump Administration’s Final Regulatory Changes Mean for Title X”
•  Family Planning and Reproductive Health Association (NFPRHA), Factsheet, “Domestic Gag Rule”

Global Gag

• Center for Health and Gender Equity, “Prescribing Chaos in Global Health: The Global Gag Rule from 1984-2018”
• Center for Reproductive Rights, “Factsheet: The Global Gag Rule and Human Rights”
• The Global Gag Rule Impact Project, “Access Denied: U.S. Restrictions on International Family Planning”
• International Planned Parenthood Foundation, “Global Gag Rule”
• Kaiser Family Foundation, “The Mexico City Policy: An Explainer”

Need Access to Abortion?

• ACCESS Women’s Health and Justice (CA)
• National Network of Abortion Funds