In January 2017, the United States Government implemented and expanded a restrictive policy called the Global Gag Rule (GGR), also known as the Mexico City Policy. The updated policy is entitled “Protecting Life in Global Health Assistance” (PLGHA) and is designed to include all US global health funding, in addition to family planning funding.
The policy prohibits foreign/non-US non-governmental organizations that provide, counsel, refer or advocate for abortion services from receiving US global health funding excluding in the case of rape, incest or if a woman’s life is at risk. In March 2019, the policy was reinterpreted as a mechanism for barring any compliant non-US NGO from providing any financial support, even from non-US government, to any non-US NGO that conducts activities prohibited by the policy.
Sexual and reproductive health status in Nepal
In Nepal, laws and policies related to women have been progressive. The country legalized abortion in 2002 and since then the abortion laws have become more liberalized and progressive over time. In recent years, the health status of women and children has also continued to improve in Nepal. However, these improvements are not the same across all geographic regions, districts, wealth quintiles and social groups.
Although Nepalese government is committed to increasing access to sexual and reproductive health services including family planning and safe abortion, it has a limited financial capacity and technical human resources to provide the health care to all. Hence, a significant population, particularly disadvantaged, are left unreached.
The policy created gaps in sexual and reproductive health services
The US government has been providing financial assistance to Nepal for the last 70 years focusing on a range of interventions including maternal and child health, sexual and reproductive health, health commodities, sanitation and safe drinking water. .
However, the GGR put serious limitations on the support available for such programs. Organizations implementing programs supported by US government are compelled to either stop their works on safe abortion or risk losing their financial support if they do not comply with the policy.
One US government supported program, “Support for International Family Planning Organization –II (SIFPO-II)”, was terminated earlier because of GGR. This program further supported two organizations that were implementing a five-year program in 22 districts that provided training on family planning to government health workers, equipped public health facilities with necessary commodities and conducted demand generation activities in community. Because of GGR, they lost their resources and were compelled to stop their activities on family planning as they declined to comply with the policy.
Family planning service camps in hard to reach communities were stopped, government health workers could no longer receive training as well as mentoring sessions on family planning and public health facilities were left with no supply of family planning commodities and other support.
A representative from one of the implementing organizations shared:
“We used to conduct community level mobile camps to provide FP services and raise awareness on a frequent basis reaching marginalized and poor population. This has stopped. Now, FP services are available only at the health facility level, limiting access to services for all people. Women are shy and cannot go to the facility asking for services because of confidentiality issues. But, we could not continue these services because of the policy.”
As the comment above illustrates, the gaps in accessibility of family planning and other reproductive health care services have widened and women in marginalized communities now have limited access to such services.
US government funded organizations and organizations working on sexual and reproductive health, particularly abortion, were suddenly unable to visit and to work on a community level. Some had to lose partnerships and look for a new partner organization which is again a difficult task.
The silencing of voices on safe abortion has continued across US Government funded organizations, and has created a challenging situation for women to exercise their reproductive rights secured by Nepalese law and government.
Government losing its momentum
In Nepal —unmet need of family planning is high, a large number of unsafe abortions take place and a number of women die each year due to unsafe abortion —the GGR policy is restricting funds and adding difficulties in work for those organizations working for family planning and safe abortion. This reduces access to reproductive care for women, obstructing the ongoing progress of government on women’s health in future.
The policy has had major implications on organizations supporting the ministry of health and population and their sexual and reproductive health programs and added challenges to the ministry to expand sexual and reproductive services throughout the country.
Who are the actors to minimize effect?
The responsibility for minimizing effects of GGR in Nepal will have to be shared jointly by government, international donor agencies, NGOs and INGOs by filling funding gaps, minimizing gaps in service availability and accessibility, improving coverage of SRH services to the unreached population. There is a need for dialogue between government, donor agencies and civil society organizations on effects of the policy and identifying its mitigating measures.
Puri M, Wagle K, Rios V, Dhungel Y (2020). Impacts of protecting Life in Global Health Assistance in Nepal in its third year of Implementation. Kathmandu, Nepal.
Kusum Wagle is a Senior Research Officer and thematic team leader for adolescent and young people at Center for Research on Environment Health and Population Activities (CREHPA) based in Kathmandu, Nepal. At CREHPA she is involved in multiple research projects related to adolescence and women’s health. Her background is in Public Health and she has been working in this sector for more than six years. She graduated in public health from BRAC James P. Grant School of Public Health, Bangladesh as a WHO- TDR scholar. She has previously worked in the maternal and child health sector based in rural districts of Nepal.