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3.3 million more abortions. 15,000 more mothers dying. 8 million more unplanned pregnancies. Up to 26 million fewer women and couples acquiring contraception and family planning advice.
Those grim numbers from the Guttmacher Institute show the potential real-world impact of the Trump administration’s unprecedented proposed cuts to global family planning efforts; the budget the White House released Tuesday would basically eliminate those programs.
It also calls for gutting a key US famine relief program, slashing half the budget for the USAID’s internal disaster relief organization, and cutting $222 million from funds allocated to fight HIV, AIDS, tuberculosis, and malaria. The justification listed in the budget is a simple hope for others to fill the shortfall:
The United States has been the largest donor by far to global HIV/AIDS efforts, providing over half of global donor funding in recent years to combat this epidemic. The Budget reduces funding for several global health programs, including HIV/AIDS, with the expectation that other donors can and should increase their commitments to these causes.
If Congress were to agree to those cuts (and that’s a big if), advocates say the global impact of America’s abrupt departure from world health and disaster relief would be immediate — and devastating.
“The family planning elimination is the headline here,” said Rachel Silverman, a senior policy analyst on global health at the Center for Global Development. “It will have the most impact on people’s lives.”
But Trump’s proposed cuts to food aid and disaster relief would also deal a major blow to some of the world’s neediest and most desperate. Marilyn Shapley, a top official at the aid group Mercy Corps, said some 70 million people need emergency food assistance, while 20 million more are in famine-like conditions.
“This is going to take away food assistance from 33 million people in a year when famine risk is higher than in decades,” she said in an interview. “Before today I wouldn't have thought it possible.”
Funding family planning actually makes economic, not just moral, sense
This isn’t the first time the Trump administration has taken aim at global family planning and women’s health.
In January, Trump reinstated the “Mexico City Policy,” also known as the global gag rule, which literally bars family planning providers from mentioning abortion in their work. (The United States has long banned funds for abortion services.)
The policy is one that changes depending on the party of the president in power. Obama immediately rescinded the policy when he moved into the White House; Trump, like other Republican presidents before him, immediately reinstated it when he came into office. As I wrote in January, the policy has traditionally limited the ability of global family planning providers to give women and families comprehensive care if in any aspect of their work they recommend, discuss, or even mention abortions to clients, let alone provide abortion services.
But Trump went further than his predecessors. Previous Republican administrations limited the policy to family planning providers; the Trump administration extended the gag rule to all global health providers. That meant health care providers working on everything from maternal and child health to malaria, tuberculosis, HIV/AIDS, and vaccinations were now at risk of losing all US funding if they discussed abortion in their work.
The NGO PAI estimated that the extended gag rule would affect about 15 times more US funding than the gag rule had in the past. In mid-May, when the new rule went into effect, Suzanne Ehlers, president and CEO of PAI, said Trump’s move would do “unspeakable damage to integrated care efforts.”
That’s a problem. With integrated care, a woman can come to a single clinic for, say, vaccines for her children, then see a physician about her own contraceptive needs, and finally seek advice, or refill prescriptions. In other words, she can meet all her family’s health care needs in one spot. For families traveling long distances, an all-in-one clinic makes far more sense than one clinic for maternal health and another for child care and still another for other medical services.
The Trump administration spent the first quarter of 2017 signaling plans to undermine that sort of integrated care by reinstating the gag rule and beginning to reduce US funding for maternal and infant health around the world.
In April, the administration announced it would strip the United Nations Populations Fund (UNFPA), which works on reproductive health, family planning, HIV/AIDS, and infant and maternal mortality in more than 150 countries, of all US funding. The putative reason was a specious one.
“This decision is based on the erroneous claim that UNFPA ‘supports, or participates in the management of, a program of coercive abortion or involuntary sterilization’ in China,” a statement on the UNFPA website read. “UNFPA refutes this claim, as all of its work promotes the human rights of individuals and couples to make their own decisions, free of coercion or discrimination.”
A State Department memo obtained by the Associated Press found no evidence that US money had supported forced abortion or sterilization in China.
The decision costs the UNFPA $32.5 million in funding from the 2017 budget; the United States was the fourth-largest donor to the organization.
The new budget would hit global health even harder.
Silverman noted that there’s a “dissonance” between White House messages on women and families. Ivanka Trump, the president’s daughter, has claimed to be championing the idea of women’e economic empowerment. That sort of program, Silverman says, would be completely undermined by stripping global family planning from the budget.
“There is a lot of evidence that family planning contributes to women’s empowerment,” says Silverman, ticking off a list of things that planning, delaying, and spacing pregnancies allow women to do — like receiving an education, or even simply advancing at work. “When women have control over fertility, they have control over their lives.”
Silverman points out that USAID directly funds 28 percent of contraceptives and distribution in the developing world.
“If you cross-reference that with the number of women using contraceptives in those countries — a back-of-envelope calculation — that suggests that 10 million women are directly relying on USAID for contraceptives,” she said, adding that enormous numbers of women will “see a major disruption in their lives if this goes through and other donors don't step up in a major way.”
But there aren’t other donors looking to step in. Jonathan Rucks, who runs PAI’s advocacy efforts, says there is no other donor government that can make up the shortfall, and even major private family foundations, like the Bill and Melinda Gates Foundation, simply cannot replace the US on family planning. In February, Bill Gates told the Guardian that Trump’s proposed reinstatement of the global gag rule could “create a void that even a foundation like ours can’t fill.”
“If you are cutting maternal health funding, then you don’t care about survival of women,” Rucks says bluntly. “We are also going to be really frank and say this is not pro-life. This is undermining all your pro-life credentials.”
