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U.S. policy led to rise in abortions in Africa

A U.S. policy prohibiting federally funded agencies abroad from providing abortions has had an unintended effect: It actually contributed to a substantial increase in the number of abortions among women in sub-Saharan Africa. That's the conclusion of a new study by School of Medicine researchers, who looked at a policy that originated in 1984 under the Reagan administration.

The so-called "Mexico City Policy," named after the city where it was first announced, prohibits NGOs operating abroad from using U.S. dollars to provide abortions or abortion counseling. The controversial policy has been very partisan in nature: It was rescinded under the Clinton administration, restored by President George W. Bush and rescinded again by Barack Obama in January 2009.

In taking a closer look at the policy, researchers Eran Bendavid, MD, and Grant Miller, PhD, found that the number of women in sub-Saharan Africa who had induced abortions more than doubled during 2001 and 2008 in the countries most affected by the policy. The study included some 261,000 women living in 20 countries.

"We wanted to see how funding decisions impact health outcomes," Bendavid said in an Inside Stanford Medicine story out today. "We had no idea what the effect would look like, and what we found surprised us: This policy seems to have unintended consequences."

The researchers surmise that women in the affected countries lost access to family planning services and thus were using abortion as a form of birth control. Because abortion is illegal in most of these countries, these women were taking a great risk with their health. Among women worldwide, unsafe abortions and bleeding are the number one cause of death after pregnancy, Bendavid noted.

Bendavid told me:

Everyone, regardless of their persuasion, wants abortions to be rare and safe.  The disagreements are not about the ultimate goal, but about the path - and policies -  that lead there.  Until now, the link between the policies and the ultimate outcomes was not known, and our hope was to inform policy-makers on how to best achieve their goals. 

The study (.pdf) was published online in the Bulletin of the World Health Organization.

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