By Edinah Masiyiwa
On the 20th of January, the day that Donald Trump was sworn in as the president of the United States of America, I was really moved by the title of an article on the Safe Abortion Action Fund site which read, “We Wish US Politics Didn’t Have a Big Impact on Global Abortion Access, But it Does.”
I agree. Since 1984, every U.S. Republican president has introduced the “global gag rule” which restricts funding for organisations which support or provide abortion. The Global Gag Rule, also known as the Mexico City Policy, denies U.S. funding to organizations who provide any abortion related services, including counselling, even when such services are legal in a national context.
This is short sighted for so many reasons, including one stated in the SAAF article: “Sometimes we need an abortion to survive.”
One can’t help but remember the impact the Global Gag Rule had in 2017 when Trump began his first term. As a leader on reproductive rights and health, I was part of the documentation process for the Center for Health and Equity[1]project on the impact of the Global Gag Rule in 2018. The final report for this documentation was “Prescribing Chaos in Global Health”. The report highlighted the negative impacts of the GGR in Mozambique, Kenya and Zimbabwe. Overall, the GGR’s development and implementation was consistently associated with poor impacts on health systems’ function and outcomes. In Zimbabwe outreach programmes for family planning were stopped. Access to reproductive health care services including post abortion care was also affected. Organisations advocating for reproductive health services were demobilised as most organisations chose to drop the abortion agenda.
Today we are back in that position where the same effects will be experienced because of this policy.
When President Biden came into power, he repealed the Global Gag Rule, a decision which was welcomed by many throughout the world. In welcoming the repeal, the International Planned Parenthood Federation’s Director-General, Dr Alvero Bermejo stated that there was a need to take steps to permanently repeal the Global Gag Rule as without a permanent repeal this policy would remain a threat to women and girls, youth and marginalised communities. He was right.
Today we are faced with the uncertainties that are coming with the implementation yet again of the Global Gag Rule. But this time, there are even more concerns across the world, leading to many webinars to discuss the effects of the pause on USAID to different countries. The situation has brought about chaos and confusion as organisations are faced with uncertainties on their programmes. As the world grapples with this confusion, we need to focus on one of the final beneficiaries of the U.S. aid, the woman and girl.
Zimbabwe is one of the few African countries to achieve a milestone in HIV/AIDS diagnosis, treatment and suppression of viral load through support from the President’s Emergency Plan for AIDS Relief, or PEPFAR. These programmes have contributed in saving women’s lives in Zimbabwe. Women and girls have also benefited from the support given by USAID to family planning programmes. The pause on support to such programmes will result in unwanted pregnancies which in turn will result in unsafe abortions. All the gains that had been made in reproductive health issues might be lost during this period.
However, the “pause” on USAID funding also provides an opportunity for countries to review their funding to the affected sectors, particularly the health sectors. Yes, the aid has been dropped before and then comes back with a democratic president, but given that lives can be lost in between, countries need to ensure they provide enough aid for critical services, not rely on the U.S.
Over the years there has been calls for Zimbabwe to allocate 15% of the national budget to health. In an article published by the Health Times, the Community Working On Health had this to say about the 2025 budget, “The inadequate financing of the health sector perpetuates overreliance on out-of-pocket spending and external donor support, both of which are unsustainable. No country can achieve Universal Health Coverage (UHC) without prioritizing public investment in health.”
Barely six months after this analysis, Zimbabwe is facing the withdrawal of funds by the U.S. This is the time for Zimbabwe to set up domestic funding to the health sector through a national health scheme, and quickly. This scheme would provide basic health care services to 90% of the Zimbabwean population that is not paying for private health insurance.
Also, at an individual level, people should plan for their health through contributing to different health insurance options. In Zimbabwe, people tend to prioritise funeral insurance compared to health. It is high time we change that mindset, bearing in mind that “my health is my responsibility.”
[1] New Report About the Impact of the Global Gag Rule - Giving Compass
