Family Planning Makes A Comeback
On the 20th anniversary of the Supreme Court's Roe v. Wade decision, President Clinton issued a set of executive orders that had a profound and immediate impact on the health of women and families in this country and abroad. The lifting of these restrictions, most notably the "gag rule," signals a sharp and decisive departure from 12 years of destructive and myopic public policy regarding abortion and family planning.
The "gag rule" was by far the most egregious of the Reagan - Bush litany of reproductive rights restrictions. It mandated that any clinic which received federal funds (Title X) to help subsidize health care for low-income people, could not counsel or refer or give information on abortion to their clients.
The "gag rule" not only undermined access to abortion, censored speech, and re-placed medicine with politics - it blatantly and unabashedly discriminated against less economically privileged women. We must remember that despite the successes of the right-wing during the last decade, abortion did remain legal. Women who could afford to go to private practitioners could still hear of all their legal, medical options. Women who depended on federally funded clinics for the bulk of their health care needs may have been denied accurate and complete information.
The repeal of the "gag rule" is a tremendous relief to family planning clinics and the women they serve. What is less well known is that the United States has been exporting the "gag rule" abroad for nearly a decade. Indeed, Reagan and Bush's anti-choice legacy ultimately may prove to be more devastating abroad than it is at home.
Beginning in the 1960s, the United States took on a leadership role in providing funding and technical assistance to the family planning efforts of "developing" countries. Due to increasing pressure from anti-choice forces at home, our government acceded its leadership on population policy.
In 1984, then-President Reagan announced that the spiraling population growth in the world was a "neutral" phenomenon undeserving of public attention. Reagan then dealt a serious blow to the existing programs with the announcement of what carne to be known as the "Mexico City Policy." Without hearings or congressional activity, Reagan declared that the U.S. would no longer give any money to organizations that provided any abortion-related services abroad.
This policy went way beyond the existing restrictions in the law that prohibited the use of U.S. population funds specifically for abortion services, lobbying or research. According to numerous audits, no violation of these restrictions ever occurred (the same was true for the national Title X program).
The U.S. government cut off its 17 years of support to the International Planned Parenthood Federation (IPPF), the world's largest private voluntary provider of family planning services. A federation of independent family planning associations in about 120 countries, the IPPF had never dictated policy to its affiliates. Thus the IPPF was unable to accept the U.S. condition that it refuse funding to a member involved in legal abortion-related activities in its own country, even with non-U.S. funds.
At the same time that our government was effectively dismantling the family planning programs, the Human Life International, a U.S. based anti-choice umbrella group, set up camp in 18 countries. Their goal was to restrict abortion. Significantly, this effort was not coupled with providing people with means and education to reduce their fertility.
It will take a lot of work and resources to repair the damage to international family planning efforts by the policies of the previous administration. While our government adopted its short-sighted international family planning strategy, the demand for access to quality reproductive health care skyrocketed.
In many "developing" countries, at least half of the married women want no more children and many other women are asking for help in more effectively spacing their pregnancies. Of the 370 million women in need of contraceptives, only 124 million use an effective method. This leaves about 250 million who need access to birth control. The rapid spread of sexually transmitted diseases and HIV infection, the lack of contraceptive choices and diminished access to safe abortion puts women in intolerably dangerous medical situations. It is estimated that in parts of the world, reproductive-related health problems account for more than 50% of deaths to women in childbearing years.
Both the international and national version of the "gag rule" underscore the tragedy of the anti-choice polemic in our country. These restrictions are direct results of a rhetoric that reduces abortion to a Manichean debate between a fetus and a woman. The so-called "right to life" movement ignores the role that abortion plays in the health of women and their families. The World Health Organization attributes 200,000 annual deaths worldwide to iIlegal abortion. Not surprisingly, the countries with the highest rates of deaths from iIlegal abortions also have the least availability of contraceptives.
Because of the anti-choice climate, officials have willingly sacrificed successful public health programs like Title X and its international counterpart for political gains. Although President Clinton has taken an important step in repealing both the "gag rule" and the "Mexico City Policy," we still lack a global commitment to and understanding of reproductive health care needs.
It would be naively optimistic to expect that the Clinton administration alone will offer us an immediate solution. Nor will Clinton's tenure offer us a reprieve from the heated politics of abortion. Yet we must begin to translate the extraordinary energy of pro-choice activists in this last election into a campaign for an expanded reproductive rights agenda. This agenda must include improving family planning services, sexually transmitted disease treatment and prevention, cancer screening, pre-natal care, and much more. And the agenda must include women and their families here at home as well as abroad.
Eileen Spring is the Public Affairs Coordinator for Planned Parenthood of Mid-Michigan.
We must begin to translate the extraordinary energy of pro-choice activists in this last election into a campaign for an expanded reproductive rights agenda.