In a new commentary in the New England Journal of Medicine, two Stanford scientists make a case for lifting the ban on U.S. aid to international groups that support abortion-related activities, saying the policy harms women and ultimately could hurt U.S. economic and security interests abroad. They argue that scientific evidence, not ideology, should guide policymaking in global health.
The so-called Mexico City policy bans funding to nongovernmental organizations that provide abortion counseling or referrals. The policy, initiated by President Reagan in 1984 during a U.N. conference in Mexico City, was reinstated by the Trump administration in January.
"The reinstatement of the Mexico City policy is a stark example of 'evidence-free' policy making that ignores the best scientific data, resulting in a policy that harms global health and, ultimately, the American people," write Stanford's Nathan Lo and Michele Barry, MD.
Barry, director of the Stanford Center for Innovation in Global Health, had worked with the Obama administration to lift the restrictions in 2009. She said she was particularly disheartened to see the Trump administration take the policy one step further, banning funding to groups that promote maternal and child health, as well as HIV prevention efforts.
"It's very unfortunate to see all that good work unraveled," Barry told me. "It not only impacts reproductive services, but the health of women and their children."
In the commentary, the authors note that even when U.S. aid is provided to groups supporting abortion-related activities, the money is not used to directly pay for abortion services, as this is restricted by the so-called Helms Amendment of 1973. Rather, the funds are used for reproductive counseling, education and contraception. When these services are cut, the result is more women become pregnant and abortion rates rise. Moreover, without health and reproductive services, more women suffer pregnancy-related complications and engage in unsafe sex, putting them at risk of HIV, the authors say.
In fact, a 2011 Stanford study found that women living in countries most affected by the ban had 2.6 times the odds of having an abortion, compared to those in countries not affected by the policy. This means the policy has the opposite of its intended effect. Similarly, a 2011 study in Ghana found a direct link between the policy and a rise in abortions in rural areas, as well as a decline in child nutrition.
"When the rule is imposed, children become more malnourished because there is a gap in food supplies and in nutritional information to children," Barry told me.
The authors say global health programs serve American interests abroad by building health care systems that promote economic stability and protect U.S. markets while helping minimize possible security threats. These programs also help contain the spread of infections, such as Ebola and influenza, which can threaten the health of U.S. citizens. But these initiatives have to be based on scientific data, they say.
The new policy is centered in ideology, without regard to scientific evidence, and could have potentially damaging and costly consequences, the writers say. Lo cited the example of the President's Emergency Plan for AIDS Relief, which required that some HIV prevention funds be devoted to promoting abstinence and marital fidelity. After a decade and $1.4 billion investment in these prevention programs, a 2016 study by Lo and his colleagues found that they were ineffective in changing behavior related to HIV risk.
"These are not benign consequences," Lo, a Stanford MD/PhD candidate, told me. "The PEPFAR program illustrates the danger of ignoring scientific evidence. By rescinding or changing the Mexico City policy and considering scientific data in future decisions, we can fix these mistakes and help the American people and many across the world at the same time."
Previously: New ban on U.S. aid to family planning groups could have unintended consequences and Study shows that promoting abstinence, fidelity for HIV prevention is ineffective
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