Quantifying the Impact of the Global Gag Rule: What 2020 Candidates Should Know

By Anna Bernstein

Abortion has not been a top issue raised in Democratic debates so far, despite the growing number of threats to access across the country. But with strong support of abortion rights among the long list of candidates, the 2020 election provides an opportunity to eliminate federal funding restrictions on abortion. Notably, these restrictions go beyond funding within the United States, with the Global Gag Rule playing a key role in U.S. aid abroad.

U.S. taxpayer dollars have been prohibited from being used for abortion care since 1973, through the Helms Amendment, which states that no foreign assistance can be used to pay for abortion services as a means of family planning.

The Global Gag Rule takes this type of restriction even further. Formally called the Mexico City policy, the rule places strict limits on U.S. global health aid by preventing U.S. aid-funded organizations from providing information or services about abortion. It requires foreign non-governmental organizations (NGOs) to agree that they will not “perform or actively promote abortion as a method of family planning” with any funding—regardless of whether the United States is the source of those funds—as a condition for receiving U.S. family planning assistance. The rule was first announced by the Reagan Administration and has subsequently been revoked and reinstated by Democratic and Republican presidents, respectively.

But the Trump Administration went even further in enacting the policy. The Global Gag Rule was expanded by President Trump in 2017 to include most other forms of U.S. global health assistance, rather than just family planning funding from the U.S. Agency for International Development (USAID) and the Department of State. This extends the rule to affect a funding pool 15 times larger than that of the George W. Bush-era policy.

Work is being done to document the effects of this iteration of the Global Gag Rule. The policy has led to diminished reproductive health and humanitarian aid services, disruption to non-U.S. donors, reduced advocacy work, and high costs for organizations attempting to comply with the policy. Qualitative research has demonstrated exacerbated barriers to health care, funding gaps, and overall confusion and misunderstanding among the global health community.

In addition to this evidence, a few studies have examined past implementations of the Global Gag Rule to measure the effects on fertility and other outcomes. These studies provide estimates of the impact of the policy on a range of countries in sub-Saharan Africa, allowing researchers to quantify what impact this rule has had in the past—and providing insight to what may be occurring with the latest iteration of the policy.

Bendavid et al. (2011) evaluated whether the gag rule was associated with changes in the inferred abortion rate in 20 African countries. The authors compared the periods of 1994 to 2000 and 2001 to 2008, around the 2001 reinstatement of the rule by George W. Bush. Countries that received higher assistance for family planning and reproductive health when the policy was not in place were classified as high-exposure countries.

The analysis found that the inferred abortion rate significantly increased for women in those countries once the Global Gag Rule was implemented: after adjusting for a number of related factors, women in highly-exposed countries were over two and a half times as likely to have an abortion. So even though this policy is put into place by politicians opposing abortion, the abortion rate goes up while it is in effect. This is likely due to reduced access to contraceptive services caused by the rule’s limits on U.S. family planning aid.

Jones (2011) took this type of evaluation further by examining actual abortion data within one country—Ghana—and using actual woman-level data rather than estimations. Unlike Bendavid et al., Jones analyzes the effects over three changes in the policy’s implementation rather than just 2001.

The findings are once again counterintuitive to the stated goal of the Global Gag Rule: no demographic group reduced use of abortion. Instead, women in rural areas actually increased their abortion use when the policy was in effect.

Jones is also able to quantify why this increase in abortion use occurred. She finds that the lack of contraceptives available during the years of the policy caused a 12 percent increase in pregnancies to rural women.

More recent research by Brooks et al. provides even more evidence that the Global Gag Rule increases abortion prevalence in sub-Saharan Africa. Again, a reduction in contraceptive use is found, paired with an increase in abortion rates in countries with high levels of exposure to the policy.

These rigorous evaluations provide evidence that the Global Gag Rule not only reduces access to contraceptive services—it actually increases use of abortion. Forty-five percent of abortions are unsafe, with the proportion even higher in countries with more restrictive abortion laws. By cutting off access to safe abortion services, while also reducing access to contraception, it may be pushing even more women and girls to seek unsafe abortion.

This research illuminates some of the important, and often overlooked, effects of U.S. policies. Not only will the 2020 election determine access to reproductive health services in the United States, but it also has the potential to impact the health of women and girls around the world.

Read recent research on the economic effects of access to abortion and contraception from IWPR’s Center on the Economics of Reproductive Health.

Reproductive Health and Community College Students: Building Momentum toward Holistic Approaches to Student Success

Reproductive Health and Community College Students: Building Momentum toward Holistic Approaches to Student Success

by Tessa Holtzman, Anna Bernstein, and Lindsey Reichlin Cruse

On July 8-9, 2019 in Washington, DC, the Institute for Women’s Policy Research (IWPR) hosted a convening on expanding reproductive health access for community college students. The convening brought together reproductive health and higher education experts, program leaders, community college representatives, and students to share their strategies and consider new opportunities to improve reproductive health access for the community college population. With over 40 people in attendance, the convening offered a powerful opportunity to discuss the need for greater attention to students’ reproductive health, the role that improved access to family planning information and care could play in students’ outcomes, and how colleges and communities around the country are working to close existing access gaps. This post describes highlights of the convening and foundational principles that emerged from the discussion that can guide future efforts to expand access to reproductive health for community college students.

The Case for Reproductive Health Access for Community College Students

In the absence of supportive services pregnancy and parenthood can diminish a college student’s ability to attend college and succeed once enrolled. Providing students with the resources, including access to affordable contraceptive options and information they need to decide if and when they want to start a family, is key to supporting their postsecondary success. Yet, just half of community colleges have health centers, and, according to IWPR’s research (here and here), many do not provide supports to help students meet their reproductive and sexual health needs.

Recent efforts to improve community college outcomes have increasingly focused on taking a holistic approach to student success. Holistic or wraparound supports can take many forms, from individualized coaching that refers students to on- or off-campus services, such as campus food pantries, emergency aid programs, or child care. As holistic approaches to improving student outcomes are increasingly seen as best practice, ensuring that access to reproductive health services is included in the suite of supports provided to students, either directly or indirectly, is essential.

As holistic approaches to improving student outcomes are increasingly seen as best practice, ensuring that access to reproductive health services is included in the suite of supports provided to students, either directly or indirectly, is essential.

One study estimates that unplanned pregnancy accounts for 10 percent of dropouts among female community college students and 7 percent of dropouts among community college students overall.

College-aged young adults are likely to be sexually active and many do not use birth control or other forms of contraception regularly, or do not have access to the form of contraception they prefer. Community college students want to prevent pregnancy, but often hold misconceptions about birth control and are at higher risk for unintended pregnancy than college students overall. Unmet need for contraception is high among women in community college, with cost and insurance often getting in the way of their ability to use their preferred contraceptive methods. The legacy of reproductive coercion can also effect the ability of community college students of color to access their preferred method of contraceptive care.

 

When students have access to family planning support, however, success is more likely. For example, legal access to contraception and abortion has been historically shown to improve a range of economic outcomes for women, including educational attainment. A 2007 study estimated that by 2000, more than 250,000 women over the age 30 were able to obtain bachelor’s degrees as a result of access to contraception. Ensuring students can access a range of family planning services, including contraception and abortion, and that campuses are family friendly for students who have children, is key to supporting community college students’ health needs and educational aspirations.

Increasing Access to Reproductive Care on Community College Campuses

To move the needle for community college students’ access to reproductive health supports, campuses need a better understanding of the link between reproductive health and student outcomes, along with more information and examples of approaches that help students with their reproductive needs. The convening included programs that are working to increase reproductive health access for college students, including:

  • BAE-B-SAFE, a partnership between Healthy Futures of Texas and Alamo Community Colleges in San Antonio, Texas,
  • The Women’s Fund of Omaha’s Adolescent Health Project, which serves students at Metropolitan Community College in Omaha, Nebraska, and
  • G.I.R.L. (Gathering Information Related to Ladies), a student advocacy group led by African American women from Jackson State University.

A number of community colleges were also represented at the event, including Austin Community College, Miami Dade College, and Pasadena City College, in addition to national groups, such as Power to Decide, National Women’s Law Center, and Young Invincibles.

Several principles emerged from discussions among convening participants and IWPR’s research to guide efforts to integrate reproductive health into colleges’ holistic approaches to student success:

  • Building college & community partnerships. Knowing that many community colleges do not have the capacity to provide direct reproductive health services to students, colleges should build partnerships with community reproductive health providers to facilitate students’ access to care that can meet their reproductive health needs. Referrals to outside services and information on pregnancy and family planning would play an important role in allowing students to plan when, and whether, they want to become pregnant while in college.
  • Providing access to inclusive, safe, and culturally-competent care. As colleges think about how to connect students with reproductive care, they should ensure that the care offered is centered on the needs and preferences of students, and that it is confidential, consistent, accessible, and inclusive of all students, including current parents, students who want to become parents, students who do not want to become parents, and LGBTQ+ students. Services must also be culturally conscious, taking into account disparities in access to reproductive health supports, existing biases in the provision of sexual and reproductive health care, and the impact that the legacy of reproductive coercion may have on the perceptions and experiences of students of color.
  • Making the case for new investments. Messaging about the importance of increasing students’ access to reproductive health services must resonate with students, faculty, staff, and college leadership. For example, explaining the link between access to reproductive health services and improved student outcomes will help make the case to college administrators that investing in greater support for students’ reproductive health needs is worthwhile. More research is needed on students’ needs and the availability of services on community college campuses to strengthen this case and to clarify how colleges can make a measurable difference.
  • Peer-to-peer learning & information sharing. Connecting community college leaders with others who are already working to increase student access to reproductive health care on college campuses can demonstrate the potential for success. Greater communication of current practices in the field can also exemplify the benefits of this work and provide a roadmap for institutions interested in learning more.
  • Building awareness & support. Greater attention to the importance of students’ reproductive lives for college success, and advocacy to increase access to services, is essential to moving the needle forward. Cultivating high-level champions would help raise awareness and build momentum toward integrating reproductive health into holistic support models. The philanthropic community should dedicate their convening power and funding to share best practices and build capacity in the field. Partnerships between student groups on four-year and community college campuses, reproductive health organizing networks, community and reproductive justice activists, and other stakeholders would also help broaden the call for action.

As colleges and higher education experts increasingly understand the role of students’ non-academic lives in their success in higher education, students’ reproductive desires and access to care must be brought into the conversation. By doing more to address the reproductive health needs of community college students, colleges can achieve better and more equitable educational outcomes and contribute to the economic success of students and families.

By doing more to address the reproductive health needs of community college students, colleges can achieve better and more equitable educational outcomes and contribute to the economic success of students and families.

July’s convening was funded by the William and Flora Hewlett Foundation, as a part of a project designed to raise awareness of the need for reproductive health access as an integral component of community college student success, and strategies that can promote progress. Through this initiative, IWPR is conducting research to: understand efforts to connect community college students with reproductive health care and resources around the country; =identify gaps in access and opportunities to meet existing need; and share promising strategies for expanding community college students’ access to reproductive health information and care. This work is intended to inform and inspire higher education leaders, philanthropists, policymakers, and others to improve access to reproductive health services in community college settings and encourage integration of reproductive health and economic and community development initiatives more broadly. Learn more about this work on IWPR.org.