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gag rule

Global Gag Rule

The Global Gag Rule

The Global Gag Rule
$0,000,000 lost funding

Waiting room at ABUBEF clinic in Ngozi, Burundi.

At the time of the reinstatement of the Global Gag Rule (GGR) in January 2017, IPPF had 53 projects operating in 32 countries in Latin America and the Caribbean, Sub-Saharan Africa, and South Asia. These projects were managed by our Member Associations (MAs) and provided essential and life-saving healthcare to underserved and marginalized communities. In some MAs, service delivery decreased by up to 42% from 2016 to 2017 – part of this loss in services is attributable to the GGR.

Donor support provides emergency funds to help “plug the gap” created by GGR, but there are marked differences in the scale of projects, availability of technical assistance, sustainability of small healthcare enterprises, and most of all, communities have suffered a significant disruption in the availability of safe, comprehensive and rights-based healthcare provided by IPPF.


What is the Global Gag Rule?

The Global Gag Rule (GGR), or Mexico City Policy, denies US funding to organisations like IPPF if they use non-US funds to provide abortion services, counselling or referrals in accordance with national law. It blocks critical funding for services like contraception, maternal health, and HIV prevention and treatment. Evidence from previous policies shows that eliminating access to contraception leads to more forced pregnancy and unsafe abortions.

32 countries and 53 healthcare projects worldwide are affected by the Global Gag Rule

ADV Advocacy • CON Contraceptives • CSE Comprehensive Sexuality Education • FP Family planning • FSW Female sex workers • GBV Gender based violence • HIV HIV healthcare • KP Key populations • MAL Malaria • MCH Maternal and child health • NUT Nutrition • OUT Outreach • SF Social franchising • STI STI services • TB Tuberculosis • OVC Orphans and vulnerable children • YG Young girls • YP Young people • Zika VC Vulnerable children

African countries affected

  • Botswana $1,444,503 (HIV, Orphans, Vulnerable Children, Young People)
  • Burkina Faso $1,026,000 (FP, Commodities, Outreach)
  • Burundi $2,137,146 (HIV, ART, PMTCT, Outreach)
  • Cote d'Ivoire $600,000 (Social franchising, FP)
  • Ethiopia $8,500,000 (HIV, ART, Young People, PMTCT, STI, Key Populations FSW)
  • Kenya $1,500,000 (Outreach, Key Populations, HIV, GBV)
  • Lesotho $2,137,932 (HIV, ART FP, Outreach, Young People, Young girls, CSE)
  • Liberia $1,340,000
  • Malawi $3,342,915 (HIV, Outreach, Key Populations FSW)
  • Mali $1,414,500 (FP, contraceptives)
  • Mozambique $3,100,000 (FP, Outreach, Young People, HIV, TB, Malaria)
  • Senegal $1,440,000 (Maternal and child health, Nutrition, HIV, STI)
  • Swaziland $1,490,000 (HIV, ART)
  • Tanzania $900,000 (CSE, Outreach, FP)
  • Togo $880,449 (FP)
  • Uganda $2,597,130 (Advocacy, FP, Outreach)
  • Zambia $3,827,007 (HIV, Key Populations)

South Asia countries affected

  • Afghanistan $900,000 (Young People)
  • India $2,160,000
  • Nepal $3,300,000
  • Pakistan $146,521 (Maternal and child health, Commodities)
  • Sri Lanka $1,040,802 (HIV)

Western Hemisphere countries affected

  • Barbados $700,000 (HIV)
  • Belize $250,000 (GBV)
  • Colombia $1,200,000 (Zika, HIV, Key Populations)
  • Dominican Republic $500,000 (Zika)
  • El Salvador $500,000 (Zika)
  • Guatamala $600,000 (Zika, HIV, Key Populations)
  • Honduras $500,000 (Zika)
  • Panama $60,000 (HIV, Key Populations)
  • Trinidad & Tobago $219,000 (HIV)

The services affected

Advocacy (ADV) At Planned Parenthood Association Zambia (PPAZ), advocacy activities through two projects raised demand for family planning and contraception to prevent HIV transmission among two key populations, female sex workers and vulnerable young people. Without funding and technical assistance from USAID, the projects were forced to close. Replacement funding has now enabled project staff to retain jobs and start new health projects with young people, particularly around peer educator networks. PPAZ suffered preventable disruption to operations and services because of the GGR. Contraceptives (CON) Across South Asia, including Sri Lanka and India, contraceptives and commodity distribution chains have been affected by GGR, in addition to the defunding of UNFPA. It is more difficult to source affordable, modern, and safe contraceptives for clinics and communities. Family planning (FP) Family planning is at the core of IPPF’s projects worldwide. We believe women should be free to decide if and when to have children, without fear of violence or coercion. Family planning is an integral part of our package of services. The Global Gag Rule restricts the US’s family planning budget, around USD 600 million, as well as restricting other global health assistance amounting to USD 8 billion. Female sex workers (FSW) As part of Family Guidance Association Ethiopia’s (FGAE) USAID funding, 10 clinics provided specialist services to female sex workers. They served around 15,000 women annually with HIV and STI prevention and treatment and family planning. They built trust in the community in previously underserved populations. These clinics have been put at risk by the GGR. Other donors have stepped in to ensure the clinics to do not close, but Ethiopia and FGAE are feeling the strain of reduced funding access and technical assistance. Gender based violence (GBV) At Family Health Options Kenya, USAID funded research into gender-based violence and clinical referrals, training staff to identify and counsel for GBV as part of family planning healthcare. Formative research found that 40% of clients surveyed had experienced reproductive coercion in the past year, a strong indication of the importance of this work. The Hewlett Foundation provided emergency funds to allow this research to continue after the GGR. HIV healthcare (HIV) Around 20% of IPPF’s service delivery worldwide is healthcare for HIV and STI prevention and treatment. We serve key populations such as those in rural areas, sex workers, young women, adolescent girls and communities displaced by violence. The expanded application of the GGR to PEPFAR funds has restricted USD 6 billion, and IPPF is no longer eligible for awards from PEPFAR. Key populations (KP) In different regions, key populations designate different groups: ethnic minorities, sex workers, transgender persons, men who have sex with men, young girls, adolescent women, refugees, migrant communities and much more. For example, Zika awareness projects were tailored to key populations of very poor women and men in Guatemala and Honduras. Projects in Colombia served communities displaced by conflict. This investment in reaching out to the most sporadic communities makes IPPF projects unique. Without funding to carry out projects, MAs risk not being about to reach these key populations with essential healthcare. Malaria (MAL) Amodefa in Mozambique offered tests and treatment for malaria in 12 districts across 3 provinces. Due to GGR funding restrictions for static and mobile clinics, malaria treatment and prevention services are no longer easily accessible as part of a wider set of sexual and reproductive health and rights services, including HIV, STI and family planning healthcare. Maternal and child health (MCH) FPA India had successfully won an agreement to deliver training and capacity building to clinical staff such as midwives and nurses in health centers across 10 extremely deprived districts. The project would have improved health providers’ clinical skills and implemented family planning services, outreach and comprehensive sexuality education for women, men, girls, and boys. Due to GGR, funds could not be disbursed to FPA India and the project did not move forward. Nutrition (NUT) In Senegal, ASBEF was part of a large-scale USAID program in West Africa to improve maternal and neonatal health and prevent unnecessary death. ASBEF implemented nutrition programs in 4 clinics in rural areas, but due to the GGR, a fifth clinic will not receive funds to open. Two of the original four clinics closed, in addition to a third clinic in the suburbs of Dakar. Emergency funds have now enabled some services to resume but they will have less technical support without the large-scale USAID project. Outreach (OUT) Outreach programs are key to many projects. Through mobile services, community-based distributors and peer educators, MAs create strong ties with disparate, rural, and marginalized communities where services may not otherwise be available. With GGR blocking funding for vehicles, clinics, medical supplies and training programs, it is more difficult to build sustainable and strong health networks in these isolated regions and it is harder to reach key populations. Social franchising (SF) To widen networks and build sustainability in communities, social franchising projects operate like social enterprises to encourage small ventures to provide sexual and reproductive healthcare. For example, condom vending machines in Latin America or franchised community clinics in Ethiopia. As each small enterprise grows, it becomes more independent and sustainable, serving the health needs of the local community. Without UNFPA funding or subsidies for commodities due to the Global Gag Rule, it is harder to source modern, affordable contraceptives that are essential for these social franchise operations. STI services (STI) Preventing and treating sexually transmitted infections is a key priority for MAs as part of integrated healthcare for HIV prevention and treatment, contraception, and family planning. Following the Global Gag Rule, integrated healthcare projects have been forced to close, losing both clinics and staff that may have been the only access point for STI healthcare for people in rural and disparate communities. Tuberculosis (TB) In Mozambique, Amodefa responded to the risk of HIV-linked tuberculosis with an integrated healthcare project. Training for healthcare workers included testing, treatment and counselling. Staff cared for nearly 15,000 clients with tuberculosis until the Global Gag Rule blocked funding. Clinics were forced to close and staff laid off in September 2017. Orphans and vulnerable children (OVC) The Botswana Family Welfare Association ran a project to provide care for orphans and vulnerable children until the Global Gag Rule blocked funding and forced the project to close early. Skilled staff cared for out-of-school children in 9 isolated rural communities and 12 schools with a focus on adolescent girls, young women, children and adolescents living with HIV and HIV-exposed infants. Young people (YP) Young people are at the heart of IPPF’s work worldwide. 82% of Member Associations have at least one young person on their governing body. Youth Action Movements and Youth Representatives deliver messages about rights-based sexual and reproductive healthcare to peers in communities as well as to policymakers and governments. Of approximately 70 million people who receive healthcare worldwide from IPPF, around 42% are under 25 years old. This means that, with the GGR in place and IPPF projects being forced to close, young people will be significantly affected and have reduced healthcare access. Zika (ZIKA) In Guatemala, APROFAM implemented a family planning project with USAID funds during the Zika outbreak. A significant investment was made in personnel, recruiting, and training for over 230 technical staff and 6,000 volunteers and youth advocates. They sought to reach 130,000 women to provide information on family planning and Zika prevention, counselling and contraceptive healthcare. With the Global Gag Rule blocking funds, the project ended a year early in May 2018, leading to staff lay-offs and reduced access to healthcare for women in marginalised, at-risk communities.

The Global Gag Rule and its impact in Kenya

Single mother of five, Mary Mukuhi, is a businesswoman and family planning volunteer in one of Nairobi’s biggest slums, Kibera. Over the last two years she has seen first-hand the impact of the Global Gag Rule (GGR).

“At the end of the day, the quality of service is compromised.”



The Global Gag Rule - two years on

Since the implementation of the Global Gag Rule, IPPF's Member Association Association Sénégalaise pour le Bien-Être Familial (ASBEF) were forced to close three of their five clinics. Clinics based in rural and hard to reach areas. Communities that relied on the ASBEF clinic for healthcare, were left without quality and affordable care. ASBEF knew how important it was to keep services open in rural areas, so with funds from IPPF's GGR Emergency Grant, they created pop-up health clinics to help try and bridge poor and marginalzed communities with the quality healthcare.

“Quality of life in the suburbs is low and unemployment is high. People struggle to make money to eat, let alone to access proper healthcare.”



Integrated HIV testing and sexuality education for students in Burundi

Collaborating with schools, ABUBEF has been offering both medical care, HIV testing and sexuality education to students in Bujumbura. These clinics are now due to close because of Global Gag Rule.

“if there are not regular visits by the medical staff from the clinic, then we will have no one to seek information and advice from.”



The Global Gag Rule (GGR) cuts deep into sexual and reproductive healthcare in Mozambique

Albertina's story - People from different countries have come to learn from Albertina and her ground-breaking project that has changed the culture around HIV in Maputo. Despite its success, GGR will cut funds to the project.

“We estimate half million people across their HIV, tuberculosis, malaria and family planning projects will be affected.”



Case studies from around the world



“I’m a sex worker and peer outreach worker for the Nkaikela Youth Group. We reach the other sex workers because we are the ones that know them. We go to their houses, we go to the hotspots like clubs and the street; we reach them and encourage them to come here [to the Youth Group],” says Jackie Selelo, 34, sitting in one of the temporary office buildings at the Nkaikela Youth Group in Gaborone.

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Access to family planning is limited in Uganda and the contraceptive prevalence rate stands at only 30%. In remote communities, the situation is far starker and most women rely on mobile clinics or Village Health Teams (VHT) to manage their sexual and reproductive health. Now, as a result of the reintroduction of the Global Gag Rule, many of these services are now facing funding cuts and thousands of women, like Grace, have been put at risk.

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Bordered by Lake Malawi, one of Africa’s largest and longest lakes, Malawi in southern Africa is home to around 18 million people, Tanzania lies to the north, Mozambique to the south and west, Zambia to the east.

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Burundi is landlocked between Democratic Republic of the Congo, Rwanda, and Tanzania. Of the estimated 10.72 million population, 67% live below the poverty line.

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An introduction to the Global Gag Rule from PAI


Tanzania: Fighting back against the Global Gag Rule


How we are working on closing the funding gap?

We are grateful to our donors that have come forward to make emergency GGR funding possible, including the governments of Belgium, Canada, Denmark, Norway, Sweden, and the Hewlett Foundation. IPPF is determined to continue to find ways to close the funding gaps and provide short term and long term support to ensure that life-saving sexual and reproductive healthcare providers can continue operating.

To date, we have successfully provided grants to MAs that have been affected by GGR. The US remains the biggest donor of family planning and health assistance worldwide, and although emergency funding helps keep our clinics open and our MAs functional, it is difficult to develop scalable and sustainable projects without long term technical assistance, as well as continually responding to the disruptive effects of GGR and a shifting socio-political landscape.


Why we will not sign the GGR

IPPF believes reproductive health is a right and everyone should be able to make choices about their well-being. Therefore IPPF will not support policies which actively restrict or violate an individual’s right to choose.

The Global Gag Rule not only undermines but violates these rights and therefore, IPPF cannot and will not support it.

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