In January, 2020 the Rights Writers were asked to discuss an issue in the context of US political discourse (including public opinion, if desired) – is any relevant legislation being debated? How are different branches of US government engaged with your topic? Consider particularly the 2020 presidential race.

“Of all the forms of inequality, injustice in health is the most shocking and inhumane.” – Dr. Martin Luther King Jr.

While political discourse in the United States is not unfamiliar with discussions surrounding global health aid and its implications on human rights, these necessary conversations are far from common. The root of this problem perhaps lies in the dichotomy between widespread public support for aid and its lackluster implementation in federal politics.

US Aid being delivered
USAID delivery of critical health care supplies. Image sourced from the Defense Logistics Agency

On the whole, “food and medical assistance to people in needy countries” is favored by at an overwhelming 81% of Americans. And when asked to weigh different types of foreign aid against one another, the general public most adamantly supports “child survival programs, which includes prenatal care, immunizations, and nutrition”. When reminded of the federal government’s other spending priorities beyond improving the health of developing countries, pollsters remained supportive, with only 33% wanting to decrease it, 46% wanting to keep it the same, and 19% wanting to increase it.

Public opinion on foreign aid programs continues to trend favorably, despite its dissonance from the Trump administration’s recent policies. The Trump administration has recently proposed a 23% cut in foreign aid in its 2020 budget, including significant reductions to overseas AIDS and malaria intervention programs.

Within American politics, there is a growing mentality over the usage of aid as a “goody bag” to incentivize foreign leaders to fall in line with American policies. These effects can be seen in El Salvador, Guatemala, Honduras, Palestine and more, in which American withdrawal of aid has directly destabilized human rights protections and endangered lives. The most dangerous manifestation of this can perhaps be seen in the Mexico City policy, more commonly referred to as the global gag rule, which blocks federal funding for non-governmental organizations that provide abortion counseling or referrals, advocate for abortion decriminalization, or expand abortion services.

The global gag rule was first implemented in 1984 by the Reagan Administration, and was not only reinstated by President Trump in 2018, but also expanded to encompass all global health organizations that receive U.S. funding, rather than previously only applying to family planning organizations. A study of sub-Saharan Africa suggests the increase of unintended pregnancies and approximately double the rate of abortions since the policy went into effect. USAID estimates the accumulation of 6.5 million unintended pregnancies, 2.1 million unsafe abortions, and 21,700 maternal deaths in the last three years. When pro-life policies result in more deaths, something is clearly wrong. Ultimately, implementation of the global gag rule is a huge concern for advocates of both pro-life and pro-choice agendas.

The global gag rule limits open discussion of accurate reproductive medical information, at the risk of losing funding for all health care services.
Image sourced from Flickr

Beyond the face value of this policy lies much deeper implications on health rights and human rights. Numerous low and middle-income communities do not have the luxury of isolated family planning organizations aside from general health ones. Rural areas, in particular, often only offer integrated clinics that may offer everything from birth control to immunizations to anti-diarrheal medications. In these communities, the global gag rule may completely cut off all health care services. This not only inhibits the rights of women to make safe decisions over their own bodies, but further inhibits the ability for entire communities to access health information, resources, and services. The de-funding of generalized health centers that provide life-saving interventions not only endangers quality of life but ultimately, the right to life as a whole.

Opponents of the policy further argue that the global gag rule places restrictions on accurate medical information, and ultimately promotes the restriction of free speech (Figure 2). The increased anxiety and tension within such political climates limit open and informative discussions between providers and patients, fostering a shackled environment with limited open discourse. These violations further muddle the ability to advocate for health care rights.

The cumulative effects of the global gag rule and other policies that restrict the health rights of women are quantified through the Sexual and Reproductive Health and Rights (SRHR) Index, used to assess all US global health policies and funding that impact sexual and reproductive health rights. From 2017 to 2018, the USAID saw a drop in its SHRH score from 91.5 to 76. However, the Reproductive Rights Are Human Rights Act of 2019 was introduced by Massachusetts Representative Katherine Clark along with 142 co-sponsors earlier this month to reaffirm the goals of the 1994 International Conference on Population and Development. The Act would direct the State Department to re-include reproductive rights in its annual Human Rights Report, and potentially increase SHRH scores of significant US aid donors.

Within the global environment, research suggest that every additional $100 million in health aid is associated with a 6% increase in favorability of the United States. On the other hand, the significant reduction of international health aid by the Trump presidency may decrease American soft power over foreign governments that lack democracy and maintain poor human rights records. Pulling resources out of vulnerable regions can further cripple the stability of social climates and leave people without international advocates. The nature of political discourse, however, is always in flux, and some current cultural shifts in language differ from the present actions of the U.S. government, potentially as a response to these current events. Californian representative Karen Bass describes the slow cultural shift to a “trade not aid” mentality, in which the US should view African nations as trade partners, and to engage in more business, rather than treating the continent as solely a recipient of aid.

The future of US health aid can shift dramatically with potential changes in political leadership. Such shifts could further stifle the stable protection of human rights, particularly those of women. At its best, restrictions on aid deliver strong messages on strict protections of fetal rights to life. At its worst, these limitations can lead to far too many unintended, unsafe deaths, as well as perpetuate the human rights violations that have compounded over the long and complicated history of global health that will be discussed next month.

If you are interested in further engaging with current discussions about global health aid and its effects of human rights, consider registering to attend the Decolonizing Global Health Conference, scheduled to take place at Duke’s Levine Science Research Center on January 31st, 2020.