Trump is out. Let’s build back reproductive healthcare together.

The US government and their aid department, USAID, have long been viewed as a global force for good in family planning access. Yet, Trump's expanded Global Gag Rule has undoubtedly put this leadership - and reproductive healthcare and rights globally - into jeopardy. 

To mark the inauguration, we congratulate Joe Biden and Kamala Harris on their election and call on the US government and global community to ensure Trump's harmful policies don't outlive his presidency, by protecting access to reproductive healthcare.  

To re-establish the US as a global leader on family planning, and restore women's access, three key steps are needed: 

• Firstly, the President must follow in the footsteps of former Democratic administrations and revoke the Mexico City Policy, known as the Global Gag Rule, as one of his first acts in office.

• Secondly, USAID should begin to reverse the damage of the Global Gag Rule, which has led to a drop in contraceptive access and rise in maternal deaths, by reinstating partnerships with reproductive healthcare providers. At MSI Reproductive Choices, we are eager to work together again to protect healthcare access for women and girls. 

• Finally, we call on partners to not let the impact of the Global Gag Rule outlive Trump's presidency. Even if the Global Gag Rule is revoked, USAID funding would likely not be available in the near term to providers like MSI Reproductive Choices who took a stand against the Global Gag Rule, and any future funding would not cover safe abortion care. We still require support from new and existing partners who believe in a woman’s right to choose. 

Before Trump’s reinstatement and expansion of the Global Gag Rule, USAID were known for their commitment to equal access to healthcare, regardless of age, economic status or location. Working in partnership with USAID across our mobile outreach and public sector strengthening channels, we reached an estimated 2 million women with information and voluntary family planning services every year. These services prevented an estimated 1.5 million unintended pregnancies, 450,000 unsafe abortions and 5,000 maternal deaths annually. Most of these clients were women living in poverty, and women living in remote, rural areas who had no other access to services.  

MSI Reproductive Choices has never and will never sign the Global Gag Rule and in 2017, this meant we were unable to access USAID funding. For many of our programmes, in Uganda, Madagascar and Nepal, to name but a few, this led to service closures, a recorded rise in unintended pregnancies and unsafe abortions and a broader chilling effect, impacting partnerships and advocacy for women’s healthcare. Despite losing one of our most important partners, MSI’s work to improve equity in healthcare access continued. With the groundwork set by USAID, we have finetuned our delivery channels and innovated with digital health to deliver more services to the last mile: Of the 28,000 clients our teams serve every day, 1 in 4 are living under $1.90, 43% are first time adopters, and 15% are under 20 years old. 

Aware of the power that contraceptive access can have in enabling girls and young women to pursue their futures, we have rolled out a tailored adolescent strategy, reaching over 4 million adolescents since 2017. On mobile outreach, this has involved partnering with community-based mobilisers to harness the power of digital. For example, with our new Community.Connect mobile app, mobilisers can inform young people of their family planning options using short illustrated videos, before referring interested clients to their nearest, adolescent-friendly provider. 

During the pandemic, MSI’s contact centres also proved to be a valued resource for young people, providing confidential advice and service referrals over the phone, WhatsApp and social media. Under the first lockdown, our contact centres saw a 50% increase in clients interacting via social media, showing the need for digital and discreet sources of information. We know that under Samantha Power’s leadership, USAID will be committed to global COVID-19 recovery, and we hope to support this work with our insights from delivering services throughout the pandemic.  

We are so grateful to all our partners who stepped up to protect these services when the Global Gag Rule was re-instated, and ensure we were able to continue to serve women and girls around the world during the last four years. Yet, these were often short-term, emergency funds. As Biden and Harris enter office and this stop-gap funding subsides, reproductive healthcare faces a funding gap, and the future of these services hangs in the balance. 

For 2021 alone, MSI faces a $13.5 million USD shortfall, worsened by the long-term impact of Trump's expanded Global Gag Rule. In real terms, this is the equivalent of 650,000 reproductive healthcare services delivered by our mobile outreach teams, primarily for rural and low-income women with no alternative access. To protect access for these women, we will continue to require support from new and existing partners who believe in a woman’s right to choose. 

With the challenges facing healthcare and humanitarian settings globally, we believe that strong partnerships are paramount. With the new Biden and Harris administration in place, we welcome the return of a US government that supports women’s healthcare and rights globally. Now, we look forward to building back reproductive access for the better, together. 

You might also be interested in reading - MSI Briefing: The Impact of the Global Gag Rule on Frontline Reproductive Healthcare