At the Marie Stopes Health Clinic in Mazar-i-Sharif, women can get advice and help with, for example, contraception and maternity care.
Photo: Sandra Calligaro
Sida defends the right to abortion
Sida defends women’s and girls’ sexual and reproductive health and rights (SRHR) by not compromising on the right to abortion. Sida has developed a position and guidance document on how to deal with the United States government’s decision to cut off aid to organisations working with abortion, even with their own, or others’ funding.
The Mexico City Policy (MCP) was first enacted in 1984 by the United States’ president at the time, Ronald Reagan, and has since been reinstated through executive order by all Republican presidents. MCP prohibits foreign civil society organisations that receive US aid for global family planning assistance (contraceptives and contraceptive counselling) to work with abortion.
President Donald Trump’s decision in January 2017 to reinstate the MCP and expand its scope means that the United States will not provide assistance to foreign civil society organisations that work with abortion, even with its own, non-US funds (including other donor funding). This applies regardless of whether it concerns health care services, information or advocacy related to abortion.
What is “Protecting Lives in Global Health Assistance?”
The expanded policy is called Protecting Lives in Global Health Assistance (PLGHA). Instead of the policy being applied only to USAID’s global family planning assistance, as previously, it will now be expanded to cover nearly all United States’ global health assistance of around USD 9.5 billion annually.
Since both healthcare and global health assistance have developed a great deal in the past decade, the expansion of the policy risks having significantly more far-reaching consequences than before.
Previously, global health assistance was often earmarked for a certain intervention and went, for example, solely to fighting HIV or to contraceptives and maternal care. Today, governments, donors and implementing organisations have moved towards a more integrated health system. This means that a woman who lives with HIV can go to a single clinic for maternal health care, contraceptive counselling, HIV treatment or abortion care.
The MCP and the PLGHA risk breaking up the integrated approach, affecting many operations that were not previously affected by the MCP. This could, in turn, contribute to reduced effectiveness and greater costs in countries that already suffer from shortages of educated healthcare staff and weak healthcare systems.
The organisation Marie Stopes International estimates that the decision could lead to an increase of 6.5 million unwanted pregnancies, 2.2 million unsafe abortions as well as another 21.700 cases of maternal death.
Sida’s support to reproductive rights
Sweden has a long history of prioritizing sexual and reproductive health and rights (SRHR) as a key issue in its foreign and development cooperation policies and support. SRHR – including the right to decide over one’s own body, sexuality and development - is emphasized in both the government’s Policy for Global Development in the Implementation of Agenda 2030 and Policy Framework for Swedish Development Cooperation and Humanitarian Aid.
A key factor in reducing maternal mortality is to increase women’s access to, and use of, contraception. At the same time, increased efforts are required to secure access to safe abortions since unsafe abortions account for 8-18 per cent of global maternal mortality.
For Sweden and other like-minded countries, information about, and access to, safe abortion is an integral part of SRHR that may not be compromised. This means that there is a clear conflict between Sweden’s development assistance policy and the MCP/PLGHA. For Sida, it is important to ensure that organisations working with SRHR, comprehensive sexuality education, reproductive rights and the like do not exclude information about abortions or stop activities that comprise abortion care.
What will happen now?
Sida is currently reviewing its collaborations where partner organisations receive funds to implement SRHR programmes. If a Sida partner within SRHR decides to comply with the MCP/PLGH, it could lead to the organisation not being able to carry out all or some of the activities agreed with Sida. Sida may then be forced to phase out the SRHR funding for the organisation and consider whether funds may be reallocated to another partner that can implement the planned activities. No agreement will be terminated automatically, but activities will be phased out in a responsible manner and over time, based on a dialogue with the organisation in question.
The current assessment however is that very few of Sida’s partner organisations will comply with the MCP/PLGHA.
Sida and USAID have a close dialogue on these issues in order to create an understanding of their respective positions as well as to share experiences.
Through the initiative #SheDecides, Sweden and other like-minded governments have manifested both political and financial support for SRHR in light of the MCP/PLGHA.