Between Helms and Mexico City

(image by USAID Guatemala

Is the U.S. doing its part to achieve the reproductive goals of the SDG’s?

The UN’s Sustainable Development Goals (SDGs) have made a strong commitment to advancing the rights of women and girls over the next 15 years. The inclusion of reproductive rights as a part of a meaningful target marks a shift in the narrative of the UN’s official development agenda. Target 5.6 specifically aspires to universal access to “sexual and reproductive health and reproductive rights” as outlined in previous UN conventions. It also presents a significant question as to how the United States will reconcile its aid policy with the inclusion of these concepts.

Over the past several decades, the term “reproductive rights” has come to be strongly associated with a holistic approach to family planning. This holistic approach is often seen as including access to safe and legal abortion for women as an essential facet. The 1994 Cairo Programme of Action and the 1995 Beijing Platform, although both non-binding, have been interpreted by many advocacy groups as calling for the expansion of safe and legal abortion. In addition, Goal 3 of the SDGs  envisions, in part, a world with a lower rate of maternal mortality. Some observers have suggested that achieving this goal will necessarily require a reduction in the number of unsafe abortions, which make up 13% of maternal deaths worldwide.

There are two primary features of the United States’ international development policy which seem incompatible with achieving Goal 3 and Goal 5 of the SDGs— the first of these is the Helms amendment. This amendment to the Foreign Assistance Act was enacted in 1973, shortly after the Supreme Court’s decision in Roe v. Wade, as the counterpart to the better-known Hyde Amendment. Where Hyde prevents federal funds from going towards furnishing an abortion domestically, Helms prevents federal aid dollars from being used overseas in support of abortion services. Helms specifically precludes the use of foreign aid on the “performance of abortion as a method of family planning” and motivating or coercing anyone to perform an abortion.

Advocates of access to safe and legal abortion have pointed to Helms as a major impediment to the United States addressing maternal health or gender equality overseas. Some have gone so far as to accuse the policy of paternalism, highlighting the inconsistency between abortion being legal in the United States, while international aid to such services is outlawed. In fact, at the time that the Helms amendment was passed, USAID was vocally opposed to the legislation. The agency specifically cited the hypocrisy of the amendment, and criticized it as a form of undue meddling in the right of other nations to determine their own family planning laws.

In 1984, Ronald Reagan doubled down on Helms— introducing the controversial Mexico City Policy by executive order. Also known as the Global Gag Rule, the policy withholds U.S. government funding from organizations which provide abortion services, even if those specific services are not funded with US dollars. This policy essentially expanded the aid “black-out” that began with Helms— suddenly withholding funding from organizations which also provide essential contraceptives and health care as a result of their support for safe and legal abortion. While every Democratic president since Reagan has reversed the Mexico City Policy, every Republican president has reinstated it. The policy has not been in force since 2009, but depending upon the result of the upcoming election, we may see the return of the global gag rule in the near future.

In order for the U.S. to fully “pull its weight” in achieving the gender oriented SDGs and targets, we must reexamine our blanket opposition to holistic reproductive health overseas. In the same way that our aid policy has moved away from support for abstinence-only sexual health education towards comprehensive models, we must move towards support for access to safe and legal abortion overseas. Political and ideological considerations have long been given primacy over an evidence based approach. Each year approximately 47,000 women around the world die from complications resulting from unsafe abortion, the majority of whom live in the developing world. This problem constitutes the third leading cause of maternal mortality worldwide. We cannot hope to achieve our aspirations for reducing maternal mortality if we continue to turn a blind eye to the most obvious source of preventable maternal death. Moreover, as long as the Helms amendment remains in place, our commitment to the “reproductive rights” enshrined in Goal 5 of the SDGs can be no more than symbolic. Our current policies discourage NGOs and other organizations from delivering the services that women around the world need and that the SDGs claim to support.

There are several ways in which the United States could change its development policy to become a better steward of women’s health globally. The most obvious of these is repealing the Helms amendment. While many groups have called for the repeal of both Hyde and Helms, there has been significant reluctance toward political action on this front. In the eyes of many politicians, the current political climate and make-up of Congress does not allow for the dismantling of Helms. However, there is a degree of hope for the inclusion of more exceptions to the amendment— a position which is supported by Hillary Clinton. Should Clinton ascend to the Presidency in January, there is a good possibility that legislative action will be taken to lessen the impact of the amendment on the activities of USAID.

Of course, in the case of the Mexico City Policy, the outcome of the presidential election will be key. If history is any indication, Republican nominee Donald Trump would likely reverse the decision Obama made in 2009 to deactivate the policy. Meanwhile Clinton has specifically stated that she will follow in the footsteps of the Obama Administration in keeping the Mexico City Policy out of U.S. Foreign Policy. There is also room to improve USAID’s current stance on the Helms amendment without presidential authority. The amendment specifically precludes funds from supporting abortion “as a means of family planning”. Advocates for safe and legal access have pointed out that USAID could still disburse funds which support abortion in the case of threat to the life of the mother, incest or rape even with Helms as it stands. The responsibility for a policy change on this front falls on the Director of USAID, however a concurring view from within the executive branch would make this task easier.

If the United States is to fulfill its responsibilities under the SDGs it is essential that we consider all alternatives to our current stance on support for reproductive rights. Since abortion access was made available to women in the United States, we have seen a remarkable drop in the rate of maternal mortality due to unsafe abortion. Yet, we have failed to translate this principle of public health to our development agenda. What’s worse, our policies have created perverse incentives for organizations that might otherwise provide abortion care to discontinue their efforts. Our policies should be based on evidence and compatible with the rights of other nations to self-determination. As it stands, we have a great deal of work to do before American aid can be more useful in promoting the rights and health of women.

Daniel Aboagye is a 1st year MPP student at the College of William & Mary and an Associate Editor of the William & Mary Policy Review. 

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