A mother’s day reflection: Trump’s threat to global maternal health

By Caitlin Haas, RN, BSN, MPH
Director, Safe Birthing Programme
International Women’s Initiative

Approximately 303,000 women die every year from pregnancy and childbirth-related causes, with 99% of these deaths occurring in the developing world.[1] That means 830 women die each day from preventable maternal causes, and yet, in today’s world, women’s health is becoming even less of a priority. In his first three months in office, President Trump has enacted three key policies which will have a devastating impact on maternal health worldwide: reinstatement of the global gag rule (also known as the “Mexico City Policy”), defunding of the United Nations Population Fund (UNFPA), and passing of the American Health Care Act (AHCA) within the United States Congress. On this Mother’s Day, it is essential to pause and reflect on the Trump administration’s recent actions and the direct effect it will have for mothers around the world.

On January 23, 2017, Trump reinstated the global gag rule and expanded it to an unprecedented level. With a stroke of his pen, Trump prohibited U.S. aid from being dispersed to overseas organizations which list abortion as an option for women. The funding is not just barred for abortion-related services. If a health centre mentions abortion as an option as part of care, funding is stripped to the organization completely, dramatically reducing maternal care services in the developing world. Three months later, the State Department announced it was ceasing all funding to the UNFPA, citing it “supports, or participates in the management of, a programme of coercive abortion or involuntary sterilisation in China,” of which there is no evidence and the UNFPA vehemently denies. Trump’s action will result in a $76 million loss for the UNFPA – 7% of its total budget – a critical loss for an international aid agency that promotes safe pregnancy and childbirth and works to end child marriage, gender violence and female genital mutilation in over 150 countries.

In addition to Trump’s war on maternal health worldwide, he is also declaring war on women’s health in the United States. Take the recent passing of the AHCA within Congress. Under the AHCA, pregnancy, Cesarean sections, postpartum depression, domestic abuse, and rape are classified as “pre-existing conditions.” This could result in higher premiums or complete denial of coverage. This will place women at an additional economic disadvantage in a country where women only earn 83% of a man’s wage for the same job.[2] The United States has the highest maternal mortality rate of all developed nations, and yet we are introducing legislation that would no longer require health plans to cover pregnancy. The reinstatement of the global gag rule, the defunding of the UNFPA, and the introduction of the AHCA are instalments in an overarching theme of misogyny in the Trump administration. The overall message: women are not worth it.

Ironically, the anti-abortion and “pro-life” policies of the Trump administration are doing the exact opposite of its intended outcome, resulting in a direct increase in abortions and maternal deaths. The facts are simple. The global gag rule and UNFPA defunding does not save lives; it causes lives to be lost. In a study by Bendavid et. al,[3] the global gag rule directly led to higher rates of abortion in sub-Saharan Africa due to the policy’s direct effect on contraceptive and family planning services. Women’s health centres in the developing world lose their funding, leading to the loss of critical health services. As a result, these health centres are no longer able to provide basic reproductive health care, including access to contraceptives, leading to an increase in unintended pregnancies, and consequently, an increase in abortions. Important to note, with an increased number of abortions, also comes an increased number of maternal deaths, with abortion-related complications accounting for approximately 8% of all global maternal deaths.[1]

It is estimated that the combined effect of the global gag rule and UNFPA defunding will result in an additional 24,040 women dying in pregnancy and childbirth, 7.5 million unintended
pregnancies, and 2.5 million abortions each year.[4,5] Post Mother’s Day, we are reminded that every woman should survive pregnancy and childbirth and go on to enjoy motherhood. A woman’s geographical location should not dictate her maternal outcome. Whether in South Sudan, Afghanistan, or the United States, women should have access to essential, comprehensive reproductive health care. The Trump administration’s recent acts and legislation are direct violations of women’s human rights worldwide. The international community must collectively safeguard motherhood, giving women access to critical, life-saving services. Without maternal health and women’s empowerment, the vicious cycle of poverty will continue for generations, inadvertently keeping girls and women from achieving gender equality and their ultimate potential on the global stage.

References:

[1] World Health Organization (2017). Maternal Mortality. Available at:
http://www.who.int/mediacentre/factsheets/fs348/en/
[2] Pew Research Center (2017). The narrowing, but persistent, gender gap in pay. Available at:
http://www.pewresearch.org/fact-tank/2017/04/03/gender-pay-gap-facts/
[3] Bendavid E., Avila P., Miller G. (2011). United States aid policy and induced abortion in sub-Saharan Africa. Available at: http://www.who.int/bulletin/volumes/89/12/11-091660/en/
[4] Marie Stopes International (2017). Re-enactment of the Mexico City Policy. Available at:
https://mariestopes.org/news/2017/1/re-enactment-of-the-mexico-city-policy/
[5] National Public Radio (2017). Citing abortions in China, Trump cuts funds for UNFPA. Available at: http://www.npr.org/sections/goatsandsoda/2017/04/04/522040557/citing-abortions-in-china-trump-cuts-funds-for-u-n-family-planning-agency