Repeal global gag rule

As one of his first acts in office, President George W. Bush issued an order reinstating the so-called "global gag rule" for international family planning organizations.

This order was first enacted by President Reagan in 1984, then repealed by President Clinton in 1993. It prohibits family planning groups that receive U.S. funds from offering abortion counseling or referrals for women overseas, even if the latter services are provided with non-U.S. funds.

In issuing the order, Bush stated that "taxpayer funds should not be used to pay for abortions." This statement misleads the public. Under federal law, no U.S. foreign aid has been used to provide abortions for nearly 30 years.

Indeed, the primary focus for international family planning groups is to expand access to contraceptives, thereby enabling couples to plan the number and spacing of their children. Through their efforts such groups have greatly reduced the number of unplanned and unwanted pregnancies and, consequently, the number of abortions throughout the world.

Reinstating the "gag rule" means that any organization that provides abortion counseling, referrals or services with its own or with non-U.S. funds is no longer eligible to receive U.S. support for family planning efforts.

By his action, Bush is using the leverage of U.S. funding to dictate how a health organization uses its own or other non-U.S. funding to meet local health needs. In the process, he is turning back the clock on reproductive rights in the poorest countries where women are most vulnerable and their health most precarious.

With U.S. government support, international family planning programs have been very successful. Since the 1960s, the percentage of women using contraceptives has risen from less than 10 percent to more than 50 percent.

The average number of children born to each woman has fallen from six to three.

In a perfect world, family planning would be universally available. Women would be empowered to choose when and with whom they have sex and whether birth control is used. No contraceptive method would ever fail.

In fact, every year:

8 million to 30 million women experience contraceptive failure;

350 million couples around the world have no access to contraceptive information and services;

80 million unplanned pregnancies result in significant health consequences for women and children.

As long as there are unplanned and unwanted pregnancies, abortion will be a fact of life.

It is unlikely that Bush's "gag rule" will prevent many abortions. Instead, family planning groups will be prevented from providing women with respectful counseling and referrals to trained health care providers. In desperation, women will put their own lives at risk.

Every day, 55,000 unsafe abortions take place, 95 percent of them in developing countries. Worldwide, an estimated 80,000 women die every year from complications of unsafe abortion. Thousands more suffer serious long-term health consequences. In the developed world, the risk of dying from an unsafe abortion is one in 3,700 procedures. In Africa, it is one in 150.

The "gag rule" forces an unconscionable choice on international family planning groups. Accept U.S. funds for needed programs and remain silent as thousands of women take desperate measures to end unwanted pregnancies. Or refuse the funds that will enable more women to prevent unwanted pregnancies in the first place.

Bush's decision is not grounded in sound public health or medical policy. It is a political decision that barters the health of women in the developing world for the support of a conservative constituency in the United States and will contribute to the growing inequity in health between rich and poor countries.

Christopher J. Elias, M.D., is president of Program for Appropriate Technology and Health, Seattle.