Global Gag Rule and the Political Economy of Sexual and Reproductive Freedoms
On January 23, 2017, only days after his inauguration and among a series of controversial executive decisions, President Donald Trump reinstated the Mexico City Policy.  More commonly known to its opponents as the ‘Global Gag Rule’ (GGR), the US policy places limits on US funding distribution by excluding overseas NGOs that perform or promote abortion and related services, such as public information campaigns and lobbying. It originated under the Reagan Administration and was spurred by the 1984 World Population Conference held in Mexico City. Since it was first introduced in 1984, it has been rescinded or reinstated based on party lines. The policy was revoked under Barack Obama and Bill Clinton both representing the Democratic Party, and reinstated under the Republican presidencies of George H.W. Bush and George W. Bush. According to Crane and Dusenberry, “throughout its history, the politics of the Gag Rule have been rooted in domestic political struggles over abortion, played out between anti-abortion and pro-choice factions of the Republic Party, between Republicans and Democrats, and between the Executive branch and Congress.” Indeed, prior to the creation of the GGR, abortion-related legal restrictions on the use of US aid had already been in place: from the 1973 Helms Amendment to the Foreign Assistance Act.
The effects of the GGR are far reaching. The policy primarily impacts NGOs from the Global South, which are most reliant on foreign aid, and will be forced to comply with this ‘gag’ rule or risk losing funding. This is particularly concerning as the US continues to be one of the largest donor countries for international family planning assistance and humanitarian aid. NGOs are also effectively prohibited from operating in abortion-related work using their non-US funds, even in countries where abortion is legal domestically. In addition, US-based NGOs are indirectly affected because they are prevented from implementing US aid development programs and other related partnerships with overseas NGOs unless they meet the GGR eligibility. The rule, therefore, as swiftly pointed out by others, will be disproportionately detrimental to women and girls in the Global South. Evidence shows the reinstatement of this policy in the past has been positively associated with increased abortion rates in affected countries. It undermines the full basis for bodily autonomy and integrity by denying the availability of comprehensive sexual and reproductive health and rights (SRHR) necessary for meeting different needs and preferences. Equally important, the reinstatement of the GGR runs counter to achieving key goals reflected in international security and development agendas such as the Women, Peace and Security (WPS) agenda and the 2030 Sustainable Development Goals (SDGs).
In this article, I situate the ongoing debate on the GGR reinstatement within prevailing global inequalities in SRHR that are enabled under a neoliberal global economy. First, I outline the confluence of neoliberal fiscal austerity and religious fundamentalist ideologies in undermining SRHR globally. Second, I examine the exacerbating impact of restrictive policies such as the GGR for bodily autonomy and integrity in crisis situations, particularly for internally displaced women and girls. By tracing the political economy roots that undermine sexual and reproductive freedoms in both crisis and everyday life, I deepen the case for promoting women’s health and wellbeing at the centre of global peace and development agendas. Increasingly, this project requires the broadening of critiques and political mobilisation against Far Right politics to ultimately include the depletive nature inherent to a neoliberal economy.
Neoliberalism, Religious Fundamentalisms, and Global Health Inequalities
The final report on the Millennium Development Goals (MDGs) noted that Goal 5 or ‘Improving Maternal Health’ remains an unfinished agenda largely due to the slow progress in stemming maternal deaths globally. Tables 1 and 2 demonstrate the staggering global health inequalities among countries from different income groups. Adolescent fertility rates are overwhelmingly high at 96 per cent in low-income countries compared to 13 per cent in high-income countries. Adolescent pregnancy severely curtails the capacity of girls to pursue education and therefore also limits their potential to pursue full political and economic participation and realise their human capacities. Girls that are forced into motherhood before their bodies are physically able to cope with the strain of childbirth have heightened risks to maternal death. Consequently, as shown in Table 2, maternal mortality remains most acute for women and girls in low-income or developing countries. According to 2015 data, 1 in 40 women from poor countries are likely to die from pregnancy or childbirth complications, compared to 1 in 6000 for women in high-income countries. However, maternal deaths are mostly preventable. The high concentration of such deaths among a particular group of women and girls powerfully reveal global inequalities in resource distribution mediated not just by gender hierarchies but also by class, race, ethnicity, religion, age and sexuality. As health activist and academic Alicia Ely Yamin points out,
No global health issue may more acutely capture the culmination of conspiring inequities within, as well as between, countries than maternal mortality. And it is likely that no global health issue more graphically illustrates the role of health systems, their potential both for promoting greater democracy and for reinforcing exclusion and discrimination along gender, class, racial, and ethnic lines, which further marginalises certain groups.
Restrictions to women’s and girls’ bodily autonomy and integrity, such as the GGR, exacerbate prevailing structural barriers to accessing health. At the same time, they reinforce the continued marginalisation and discrimination of women and girls on the basis of their sexual and reproductive identities. As a result, the wellbeing of households and communities reliant on the sustainable provision of care is undermined too.
Table 1. Fertility Rates by Income Group
|Total fertility rate||Adolescent fertility rate|
|births per woman||births per 1,000 women ages 15-19|
|Lower middle income||4.3||2.8||45|
|Upper middle income||2.7||1.8||32|
Source: World Bank, World Development Indicators: Reproductive Health, http://wdi.worldbank.org/table/2.17.
Table 2. Maternal Mortality by Income Group
|Maternal mortality ratio||Lifetime risk of maternal mortality|
|per 100,000 live births||per 100,000 live births|
|Lower middle income||533||251||130|
|Upper middle income||114||54||970|
Source: World Bank, World Development Indicators: Reproductive Health, http://wdi.worldbank.org/table/2.17
Global health inequalities, especially for SRHR, remain unmatched by foreign aid allocations and public health expenditures (see Table 3). The World Health Organisation (WHO) notes that while for many countries there is a need to mobilise and effectively use domestic resources, “only an increased and predictable flow of donor funding will allow them to meet basic health needs in the short to medium term.” However, UNFPA has persistently called out the inadequate financial and political support for SRHR from developed countries in the face of worsening conditions for women in and from developing countries. Thus, the reinstatement of the GGR serves as a litmus test for bodily autonomy debates within US politics. Nevertheless, in so far as a curtailment of the accessibility of SRHR globally, the GGR aligns with neoliberal policies of austerity that involve cutting back on state social welfare provisions and conditioning privatisation of service delivery including health.
In developing countries, civil society actors especially foreign and domestic NGOs have been crucial in ‘filling in the gaps’ and mitigating health inequalities. They do so by servicing particularly underprivileged communities and typically through short-term programs. For example, international organisations such as the International Planned Parenthood Federation and Marie Stopes International have long supported NGOs in the Global South in delivering vital SRHR services and supplies. Indeed, more recently they are among the key partner organisations named by the Netherlands in its pledge to create an international safe abortion fund as a direct response to Trump’s reinstatement of the GGR. Ultimately, however, these initiatives are stopgap measures that fall short of meeting all SRHR needs in the absence of guaranteed state allocation of resources. Importantly, as Nancy Fraser argues, their very presence inadvertently normalises state retrenchment.
Table 3. Public Health Expenditure (% of total health expenditure)
|Lower middle income||35.4||36.4|
|Upper middle income||51.5||55.2|
Source: World Bank, http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS
The GGR is particularly significant in helping unpack the prevailing material and ideological conditions that curtail sexual and reproductive freedoms globally. It reflects the alignment of neoliberal fiscal austerity and state retrenchment with religious fundamentalist ideology. Moreover, the ‘rolling back’ of the state allows for the ‘stepping in’ of conservative ideologies articulated through pro-life and pro-family discourses.  In the context of developing countries, the already weak infrastructures for sexual and reproductive health care are further weakened by globally promoted neoliberal economic policies that divest states of the primary responsibility vis-à-vis welfare provisioning. Religious fundamentalists have been able to leverage greater influence over the sexual and reproductive decision-making of many women and girls precisely as a result of these gaps. Presently, there is a growing body of research to unpack the relevance of interrogating the complementary role of religious fundamentalist forces in legitimising the gendered inequalities fuelled by neoliberalism including restrictions to SRHR. For instance, the US Christian Right embodies the confluence between neoliberal and religious fundamentalisms because it endorses both social and fiscal conservatism. They play a key role in shaping US politics especially in terms of domestic sexual and reproductive rights debates such as on abortion and same-sex marriage. Through measures such as the GGR, however, their capacity to make a global impact becomes particularly pronounced.
SRHR, unlike all other health components, remain deeply contested and constantly under threat of backsliding in terms of progress. The idea that sexual and reproductive health is fundamental to human dignity remains fiercely contested by religious groups and conservative governments at various levels of policy-making. Studies show that religious fundamentalist forces are increasingly present in every religion – Christianity, Islam, Hinduism, Sikhism, Buddhism and Judaism. Yet, they reflect a shared “conservative and patriarchal point of view on gender issues which come together under a rhetorical ‘pro-family’ rubric”. As Deniz Kandiyoti observes, they are characterised by a common intention “to establish the principle that matters relating to sexuality, to the control of female bodies, and to reproductive choice do not belong to the sphere of civic deliberation, public choice, or human rights but to a domain of non-negotiable morality defined by doctrinal imperatives.”
Another very recent example of the influence of religious fundamentalist ideology in backsliding from gender equality progress is in the case of decriminalisation of domestic violence in Russia, which was legitimised on the basis of returning to traditional ‘Russian family values’. At the global level, religious fundamentalists with representatives from two of world’s major religions (Christianity and Islam), and conservative governments from the Middle East as well as the US Christian Right, have mobilised transnationally to oppose SRHR. These ‘unholy’ alliances have solidified at UN conferences, Commission on the Status of Women meetings, and key international conferences on HIV/AIDS, population and development, and children. As a conservative lobby, they are increasingly organised and adapting to global and regional governance structures to question the universal applicability of SRHR. Indeed, religious fundamentalist forces constitute an expanding transnational network of political connections and financial resources.
SRHR in Crisis Situations: Neoliberal Policies Diverting Resources
Globally, the 10 countries with the highest maternal mortality ratios in the world are affected by, or emerging from, war. Over half of the world’s maternal deaths occur in conflict-affected and fragile states. From a human rights perspective, states have the responsibility under international human rights and humanitarian laws to progressively promote the health and wellbeing of all individuals regardless of crisis. In addition, UNFPA stress that “conflicts and disasters do not exempt any government or humanitarian actor from obligations, embodied in the Programme of Action of the 1994 International Conference on Population and Development, to uphold the right of the individual to sexual and reproductive health, including the right to decide freely and responsibly whether, when or how often to become pregnant.”
In situations of recurrent and escalating conflicts and disasters, health needs intensify. However, it is also during crisis and emergencies that the sources of such care, including the availability of comprehensive sexual and reproductive health, are destroyed. For example, in crisis settings where women and girls are highly exposed to various forms of sexual and gender-based violence (SGBV) they are also faced with limited reporting and protection mechanisms. This is particularly pertinent in protracted internal displacement situations. Because of reporting constraints, many victims of SGBV are effectively denied essential health treatment through the unavailability of sexual and reproductive health services including: post-exposure prophylaxis (PEP), emergency contraceptive (EC) pill, and abortion. Consequently women and girls experience compounded harms first through direct physical violence and second, by being forced to bear the long-term consequences of sexual violence such as unwanted pregnancy, STDs or HIV/AIDs.
Despite remarkable progress in targeting humanitarian services to women and girls over the past decade, large gaps remain in transformative actions beyond the crisis or emergency phase to address gender inequalities. Moreover, disparity persists in the gender-equitable distribution of resources during and after crises. And yet, studies show that global expenditures for military and internal state security continue to significantly outweigh global resources allocated for building lasting peace and sustainable development globally. According to the military expenditure database by the Stockholm International Peace Research Institute (SIPRI), global military expenditure in 2015 was an estimated $1,676 billion USD. In the crisis-prone region of the Asia Pacific where protracted conflicts and severe environmental disasters routinely intersect, military spending rose by 5.4 per cent in 2015 alone, and by 64 per cent between 2006 and 2015, reaching $436 billion in 2015. Militarism diverts resources away from long-term prevention of violence strategies and sustainable development. It aligns with, and exacerbates, neoliberal solutions such as fiscal austerity in response to economic crises thereby depleting resources for social welfare, and by extension, health service delivery during and after crisis.
Women’s and Girls’ bodily costs in crisis situations, and the effects of the GGR
The sustained growth in military spending alongside a surge in the frequency of humanitarian crises suggests that the deployment of crisis narratives leaves the neoliberal global economy intact. Such manoeuvres come at great bodily cost to women and girls. Feminists have shown that as a result of crisis, women’s unpaid care and domestic labour is more intensely relied upon by states as an ‘invisible safety net’ for the coping of families and communities. Gaps in crisis responses and interventions, particularly when they neglect SRHR, reproduce the assumption that this labour is elastic. That is, survival and recovery are contingent on women’s willingness to make the necessary sacrifices by means of subordinating their personal needs to that of the family, community and the state. However, without replenishing or sustaining the bodily autonomy and integrity of women and girls, then the very bodies that meet intensified care demands end up depleted. Deploying a feminist political economy lens to sexual and reproductive freedoms is vital in relation to assessing the GGR, because it shows how violence is enforced through material or structural factors as much as it is also ‘internalised’ and thus effectively invisible through women’s complicity and self-sacrificing practices. Stemming the root causes of bodily depletion extremely manifested in preventable maternal deaths requires eliminating both material and ideological barriers to SRHR, which are embodied by the GGR.
Additionally, faith-based groups have had a long history in humanitarian and development spaces. Their unique positioning as both rooted in communities while being global in reach, has translated in them being regarded as ‘privileged interlocutors’. Neoliberal public-private partnerships potentially enable both faith-based groups and conservative governments, such as those represented in the US and Russia presently, to propagate and fortify religious fundamentalist beliefs. There remains very little research on the contradictory outcomes engendered by empowering religious groups and how their presence might further normalise cultural norms and practices that deny women and girls of sexual and reproductive agency within humanitarian spaces. In the case of emergency crisis responses, a report by the Association for Women’s Rights in Development (AWID) suggests that “making religious organizations a default choice for partnerships can have negative implications for human rights, and especially for women, sexual and gender minorities, and other marginalized groups.”
While the quality of health care service delivery generally suffers as a result of conflicts, crises may also allow for vital health services and assistance to be made available through the influx of foreign humanitarian aid. However, the AWID study posits “there is some evidence that at least some religious organizations have used services and relief to introduce narrower interpretations of religion and adoption of rigid gender roles, heteronormativity, conservative dress codes and behaviour.” This finding is consistent with broader social science research that demonstrates how “in countries where political and ecclesiastical power are tightly linked, family law tends to discriminate against women.” Forms of gender inequality that are deeply embedded within institutional frameworks thus shape the provision of reliable health care before, during and after crisis. In the long-term, meeting the challenges of responding to multiple crises and their direct and indirect effects on health service delivery cannot be hinged upon states divesting more power to privatisation and financialisation.
Advancing SRHR within security and development agendas will require destabilising the pre-eminence of militarism and growing salience of religious fundamentalist ideologies within these spaces. This includes recognising how the reinstatement of the GGR sits squarely within these contemporary political and economic processes. For example, UN Women points out that a global humanitarian standard on the delivery of Minimum Initial Service Package (MISP) for both reproductive health and clinical management of rape has been in place since 1999, which has also been revised in 2010. In many crisis settings this standard has not been attained or implemented. This is because the effective delivery of MISP “assumes some level of pre-existing, functioning health infrastructure, disrupted due to conflict, that humanitarians can help patch up and reactivate.” In many conflict and disaster-prone regions however, public health systems are already weak or deeply eroded as a result of an enduring global health crisis manifested in egregious lack of access to health services and personnel. Future challenges for SRHR are evident in the marginalisation of SRHR within the pioneering World Humanitarian Summit held in Istanbul, Turkey in May 2016. A joint statement calling for countries to increase economic investments to address SRHR in humanitarian crises received minimal support with less than 10 per cent of member states in attendance backing the call for action. It is clear from the case of SRHR in crisis situations that promoting the full basis of human dignity for women and girls requires national and global structural reforms that overhaul unequal gender relations.
In this article, I examined the reinstatement of the GGR beyond representations of its ‘exceptionality’ associated with the rising global discontent against Trump to instead emphasise that it is intricately linked to the material and ideological conditions enabled by a neoliberal global economy. Certainly, the reinstatement of the GGR carries grave symbolic harms. As a form of restriction to sexual and reproductive freedoms globally, it was reinstated by the very same person who had also previously remarked that women who undergo abortion must be subjected to “some form of punishment” and confessed to grabbing women by the pussy. However, it is equally crucial not to lose sight of broader structural inequalities that perpetuate the progressive abrogation of SRHR in crisis situations and everyday life. Global health inequalities remain pervasive and underpin the normalisation of preventable maternal deaths in the Global South. These egregious forms of gendered violence severely undermine the health and wellbeing of women and girls, as much as of the households and communities, which rely upon their unpaid labour.
The rise of religious fundamentalisms in tandem with neoliberal global economic processes is not merely incidental, but in many contexts may increasingly play a central role in legitimising gendered inequalities that manifest at their most basic in the control of women’s bodies. They similarly reveal how economic systems continue to be built on rewarding “masculinist modes of control [that] pervade the practices of both financialization and militarization.” Indeed, in crisis situations especially, militarism and religious fundamentalisms may serve to mutually reinforce one another to close off substantive and broader participation for women and girls in political and economic decision-making precisely by enabling material and ideological barriers to bodily autonomy and integrity. And yet, from a feminist perspective, it is precisely these women and girls as most marginalised who are in the best position to promote comprehensive crisis and long-term solutions that attend to multidimensional experiences of insecurity, peace and development. Such a transformative project of gender inclusion, however, begins essentially when women and girls are able to take full control over their own bodies.
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 An important exception, however, is that it allows NGOs to provide or support post-abortion care. See Crane, Barbara B & Jennifer Dusenberry (2004) “Power and Politics in International Funding for
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 Crane & Dusenberry 2004, p. 129
 The Amendment stipulates that “[N]o foreign assistance funds may be used to pay for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortions.” See USAID (2017) “USAID’s Family Planning Guiding Principles and U.S. Legislative and Policy Requirements,”
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 See Bendavid, Eran, Patrick Avila & Grant Miller (2011) “United States aid policy and induced abortion in sub-Saharan Africa” in Bulletin of the World Health Organization. http://www.who.int/bulletin/volumes/89/12/11-091660/en/ (last accessed 31 January 2017); Schwerdtle 2017.
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 See for examples Tanyag, Maria (2016) “Peace, Sex and Violence in Mindanao,” in Australian Outlook, 15 August, http://www.internationalaffairs.org.au/australian_outlook/peace-sex-and-violence-in-mindanao/ (last accessed 31 January 2017); Garcia, Melissa & Sarah Rich (2017) “Emergency contraception is a simple part of post-rape care: Why is it not routinely provided?” in Sexual Violence Research Initiative, 16 January, http://www.svri.org/blog/emergency-contraception-simple-part-post-rape-care-why-it-not-routinely-provided (last accessed 31 January 2017).
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 See for example Schippa, Camilla (2016) “War costs us $13.6 trillion. So why do we spend so little on peace?” in World Economic Forum, 8 June. https://www.weforum.org/agenda/2016/06/the-world-continues-to-spend-enormous-amounts-on-violence-and-little-on-building-peace/ (last accessed 31 January 2017).
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 This joint statement was signed by UNFPA and the following member states: Australia, Central African Republic, Denmark, Finland, Iceland, Liberia, Netherlands, Norway, Philippines, Sweden, Switzerland, United Kingdom and Uruguay. The summit was attended by 173 member states of the United Nations, including 55 Heads of State and Government. See UNFPA (2016) “Accelerating efforts to save lives, protect rights and dignity and leave no one behind,” http://www.unfpa.org/press/accelerating-efforts-save-lives-protect-rights-and-dignity-and-leave-no-one-behind (last accessed 31 January 2017).
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Published March 27, 2017