Reflecting on a Year of International Family Planning Under the Trump-Pence Administration

Who Bears the Brunt of President Trump’s “Successes?” Women and Girls.

President Trump is no wallflower when it comes to touting his accomplishments. On his 100^th day in office, he denounced the media via tweet for refusing to cover his “long list of achievements” and the “great optimism” surrounding his presidency. At a televised cabinet meeting in June 2017 he proclaimed, “There has never been a president… who’s passed more legislation, who’s done more things than what we’ve done.” And, we read the White House fact sheet—released three days before Christmas—boasting about the various ways in which President Trump is Making America Great Again.

The facetious side of me wants to simply stop right here with some of the one- and two-word exclamations that ended President Trump’s tweets over the past year:

• Sad!
• No way!
• Try again!
• Pure Fiction!
• Desperation!
• Very dishonest!
• Exactly opposite!
• Highly overrated!

Unfortunately, there is some truth to the President’s claims. In addition to the total pieces of legislation passed during Trump’s term (which includes bills under the Congressional Review Act—a measure allowing Congress to overturn regulations promulgated by a president, in this case President Obama), we must add the number of harmful executive orders and memoranda he has signed to grant him the “most accomplished” title he so desperately wants from the media and American public.

The sad reality is that President Trump’s list of “successes” harm women and girls—especially those in the developing world—the most:

Imposition and Expansion of the Global Gag Rule

President Trump and members of his administration—especially Vice President Mike Pence—like emphasizing their efforts to “protect life.” However, on January 23^rd, 2017, two days after millions of women around the world rallied in opposition to his administration’s anti-woman rhetoric and the policies of likeminded politicians, Trump imposed and dramatically expanded the Global Gag Rule (GGR) to include all of U.S. global health assistance. This expansion targets the most effective, qualified and trusted health organizations in the more than 60 low and middle-income countries that benefit from U.S. global health assistance.

The Global Gag Rule threatens the work of health care providers who ensure access to needed and comprehensive services. There is no evidence that this policy has ever reduced the incidence of abortion globally. We know from previous iterations of the policy that unintended pregnancies and deaths due to unsafe abortions increase when it is in effect. While we are in the early stages and full impact of the policy will not be known for some time, we have already seen signs of the GGR’s impact. These include, but are not limited to, health care providers being forced to cut services, increase fees and even close clinics altogether.

Defunding the United Nations Population Fund

There were several humanitarian crises in 2017, including the continued flow of Syrian refugees into Jordan and other nearby countries; famine in Nigeria, South Sudan, Somalia and Yemen; hundreds of thousands of Rohingya fleeing persecution in Myanmar to Bangladesh; as well as countless natural disasters. These crises did little to prevent the Trump-Pence administration from eliminating the U.S. contribution to the United Nations Population Fund (UNFPA), nor did they motivate Congress to reverse this decision. The U.S. is one of the largest contributors to UNFPA, the principal multilateral organization working to advance sexual and reproductive health and rights around the world, as well as the primary supplier of reproductive health supplies globally and provider of health services to women and girls in humanitarian settings. Eliminating UNFPA funding jeopardizes the world’s most vulnerable girls and women, particularly those in crisis situations.

During conflict, natural disasters and other emergencies, displaced women and children experience heightened vulnerability to unwanted pregnancies, rape, sexual exploitation, and early and forced marriage. In response, UNFPA sets up safe spaces; ensures the availability of emergency reproductive health kits, which include supplies for safe childbirth, rape management, and prevention and treatment of sexually transmitted infections—including HIV; and trains staff to provide care to crisis-affected women and adolescent girls. There is no question that the elimination of U.S. funding for UNFPA puts the health and rights of millions of girls and women at risk.

Decreased Global Health Leadership and Funding

The United States serves as the linchpin of global health, development and humanitarian assistance. Continued U.S. leadership in providing strong global health funding and supportive policies plays an essential role in incentivizing action on health for developing countries with competing development priorities. We know that U.S.-funded programs interface with domestic politics in developing countries to create incentives for governments to take action and ownership on health issues. These programs also protect U.S. citizens by helping to reduce the spread of pathogens such as Zika, influenza, and Ebola, and ultimately increasing global health security.

Although U.S. foreign assistance accounts for less than one percent of the federal budget, it saves millions of lives every year and has far-reaching impact through economic growth, democratic governance and improved gender equality. Yet, President Trump’s first budget included massive cuts to global health and a complete elimination of all funding for one of the most effective interventions in the history of public health—family planning and reproductive health programs. An estimated 303,000 women in developing countries die each year from pregnancy-related causes, and unsafe abortion continues to be a major cause of these unacceptably high maternal mortality rates. If the funding cuts to global health assistance proposed by the Trump-Pence administration were enacted, there is no question that the lives of millions would be put at risk, global poverty will increase exponentially, and incalculable goodwill towards the US will be lost (provided President Trump’s own gaffes don’t eviscerate that goodwill first).

What’s Next?

With his illogical funding proposals and ideologically-driven policies, President Trump is paving “the way to a diminished role for America—not out of necessity, but out of a want of vision or understanding of what America stands to gain from global leadership.” U.S. investments in global health are effective, efficient and contribute to a more secure world for the United States. The policies and funding levels advanced by the Trump-Pence administration will negatively impact integrated, comprehensive health systems strategies and programs—the consequences of their actions undermine both the cost-effectiveness and efficacy of our aid dollars.

With President Trump at the helm, the United States is no longer seen as a convener, a strategist, or as a source of leadership—and the rest of the world has already begun to turn away. The United States should not shy away from its legacy and leadership in supporting global health assistance. It is a vital plank of any strategy to keep America safe, but the developing world also cannot afford it. It is morally unjustifiable to cut and restrict access to health providers and health programs that save millions of lives around the globe—but given the 2017 accomplishments hailed by both the President and the conservative Congress, morals and compassion don’t carry much weight.

There is an opportunity to be had in this failure of U.S. leadership. PAI is leading efforts to document and communicate the implications (and eventual impact) of policies like the GGR and defunding UNFPA. We are working to strengthen and expand the network of civil society advocates championing progressive policies that support women’s health in their own countries, including government action to improve domestic resources for global health. This work is not easy. But in the absence of a strong U.S. administration, we must shift our focus and rely on local civil society organizations to create positive change and build country ownership. This will ensure that we will be all the more ready to combine our resources, strength and reach when we once again have a U.S. administration that believes that in order to uplift women and girls, you must support their sexual and reproductive health and rights.