Navigating the Global Gag Rule: How to Support Sexual and Reproductive Health Services Around the World

In remarks that Dr. Anthony Fauci shared with the World Health Organization’s executive board last week, he announced that the Biden administration will soon revoke the Mexico City Policy – also know as the “Global Gag Rule.”

The Mexico City Policy, originally instituted in 1984 by President Reagan, is a United States government policy that prohibits federal funding for non-governmental organizations (NGOs) that provide abortion counseling or referrals, advocate to decriminalize abortion, or expand abortion services.

Since its institution, the policy has been revoked by every Democratic administration and reinstated each time Republicans regained control of the executive. Most recently, President Trump expanded the policy to cover all US global health assistance, increasing the amount of funding affected from $600MM to nearly $12B. A 2019 study in the Lancet found that the Mexico City Policy actually increased abortion rates around the world, primarily due to a decrease in contraceptive funding and education.

The unpredictability associated with this order can make supporting sexual and reproductive health (SRH) services around the world difficult – but not impossible. Let’s look at how organizations continue to set up sustainable programs in the midst of the uncertainty surrounding one of the most controversial mandates in global development.

Effectively Navigating SRH Delivery

By essentially tying policy to the political party of the executive branch, the Global Gag Rule complicates how best to provide quality and complete reproductive health services across the continuum of care for girls and women of all ages.

While it is a hindrance that requires deliberate and thoughtful consideration in program design, the implementation of sustainable and effective reproductive health programs is still possible. 

Fundamentally, it requires making the most of the opportunities we have when the Global Gag Rule is not in effect, to ensure that women around the world have the information they need when it is. 

Dimagi has supported numerous SRH programs both with the Global Gag Rule in place and in its absence.  The flexible nature of digital solutions enables program teams to rapidly adjust content to be within the restrictions of the Global Gag Rule. Conversely, they also support the rapid expansion of content to include essential abortion-related information upon its revocation – without massive implementation disruption that can negatively impact beneficiaries. 

Dimagi supported one such implementation between 2015 and 2018, leading a women’s health program in Tanzania funded by the Human Development Innovation Fund. While the primary beneficiaries of the digital solution were pregnant women, the version of the mobile application in place prior to Trump administration included content on accessing abortion services. 

When the Global Gag Rule went back into effect, Dimagi was able to remotely hide abortion-related content and update all of the applications to be in accordance with the policy. With the Global Gag Rule in place, focus shifted to rapidly developing additional counseling content on the prevention of unplanned pregnancies, including emergency contraception, intrauterine devices (IUDs), and implants.

This additional educational content on family planning commodities led to a 20% increase in IUD uptake. Anticipating the Biden administration’s revocation of the Global Gag Rule, Dimagi will be able to unhide and remotely roll out an updated version of the application that once again includes abortion-related services – importantly, without any disruption to the frontline mobile users. 

Shifting Focus at the Right Time

When the Global Gag Rule is in place, the only effective way to prevent unplanned pregnancies (and therefore prevent abortions) is to actively promote family planning information and commodities.

Once it is revoked, organizations must do all they can to increase access to safe abortion services in order to ensure the knowledge and understanding of available options can spread within the community even once the Global Gag Rule is restored.

In another project Dimagi supported from April 2015 until September 2016, Pathfinder International worked to develop a comprehensive family planning program for women and adolescent girls in Tanzania and Mozambique that included referrals to local health centers to receive the family planning method of their choice. 

Tasked with improving linkages between the community and health facilities, community health workers (CHWs) equipped with a CommCare application would meet with adolescent girls and women at their homes to provide culturally-appropriate counseling on family planning and education on the various options available to them at their local health centers. CHWs could also then use the application to initiate a referral to the center for the client to receive the method of her choice. 

By leveraging the freedom that development organizations had to openly discuss and provide services related to comprehensive reproductive health in the absence of the Global Gag rule, more adolescent girls and women had a complete understanding of their available options even once the Trump administration reinstated the policy just a few months later.

Time for Evaluation

Anticipating the Biden Administration’s revocation of the Global Gag Rule, organizations around the world must start evaluating whether their services can incorporate SRH programming in a meaningful way. Weathering the unpredictability of the policy requires that organizations capitalize on the opportunities they do have as soon as they arrive.

Dimagi’s Solutions Delivery team can support this evaluation as well as any subsequent program updates, while regular CommCare subscribers can work with our Customer Success team to evaluate their own opportunities. If you would like to learn more about these resources, please contact us.

For more information on how Dimagi has supported reproductive health efforts around the world, click here.