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House Committee Holds Hearing on “Mexico City” Policy

On October 31, the House Foreign Relations Committee held a hearing, “The Mexico City Policy/Global Gag Rule: Its Impact on Family Planning and Reproductive Health.” The policy bars overseas nongovernmental organizations (NGOs) that receive U.S. aid from using their own money to provide referrals for, or perform, abortions, or to lobby their government on abortion policy.

In his opening statement, Chair Tom Lantos (D-CA) advocated ending the Mexico City policy. He noted that “an estimated 67,000 women die each year as the result of complications from those unsafe [abortion] procedures let me repeat that: 67,000 women dead from unsafe abortions each year, often leaving many children behind. Given these staggering statistics, the United States should be actively supporting NGOs which are fighting to get rid of unjust laws banning or severely limiting abortion, not shunning them.” Rep. Lantos urged his colleagues to support making contraceptives more readily available to women in the developing world, thereby reducing the number of abortions. He concluded, “[S]ince 2001 the United States has stopped shipping contraceptives to 20 developing countries in Africa, Asia, and the Middle East and many leading NGO family planning providers in other countries have stopped receiving contraceptives. While the Global Gag Rule is being promoted as anti-abortion, it remains at its core anti-family planning…The Global Gag Rule is bad policy and it is doing enormous harm to women around the globe. The sooner we change it, the better for everyone concerned.”

Ranking Member Ileana Ros-Lehtinen (R-FL) refuted claims that the policy has harmed family planning providers: “[I]t has been asserted that [the] Mexico City [policy] has led to cuts in both funding for, and delivery of, vital family planning services, and therefore has led to an increase in the number of abortions in developing countries. This is untrue…Funds which were denied to groups that promote abortion as a means of family planning have been diverted to other implementers, which have proven both willing and able to deliver quality family planning services.” The policy “also allows organizations to provide compassionate care to women who require post-abortion services” even where abortion is illegal, she said. Rep. Ros-Lehtinen urged her colleagues to uphold the Mexico City policy, because “[t]o fund an organization engaged in lobbying efforts to legalize abortion even when that organization uses private resources to do so effectively subsidizes that lobbying effort…To eliminate this policy would devalue the importance of other preventative methods of family planning, if not replace them with abortion…As a pro-life woman and human rights advocate, I urge members to seriously consider the ramifications of any policy change which would compromise our ability to promote respect for innocent human life and human rights worldwide.”

Rep. Nita Lowey (D-NY) opened the first panel by focusing her remarks on the policy’s limitations: “It forces our foreign partners to relinquish their right to free speech, a foundation of our democratic government, in order to participate in U.S.-supported family planning programs. We must stop exporting this policy not only because it would be unconstitutional in the United States, but because it threatens the health of millions of vulnerable families worldwide.” She noted that better access to contraceptives could “prevent 52 million unwanted pregnancies, 29 million abortions, 142,000 pregnancy-related deaths, and 505,000 children from losing their mothers every year.” Rep. Lowey discussed her efforts to modify the Mexico City policy in the FY2008 State and Foreign Operations spending bill (H.R. 2764) (see The Source, 6/22/07). She concluded, “The global gag rule is unconstitutional, immoral, unsubstantiated, and dangerous. I urge your cosponsorship of the Global Democracy Promotion Act [H.R. 619], which I authored, to repeal this terrible policy. Until it is passed, I hope we can all agree that we must provide contraceptives to the world’s poorest men and women through the FY08 State and Foreign Operations Appropriations Bill.”

“According to USAID, since reimplementation in 2001, the Mexico City policy has not had a negative impact on U.S.-funded family planning and reproductive health,” said Rep. Marilyn Musgrave (R-CO). She continued, “If anything, this policy is positively impacting family planning programming and reproductive health. For example, there is evidence that closing clinics run by international organizations in Kenya resulted in the re-direction of funding and training going to government and local non-government organizations that resulted in increased local capacity and sustainability of programming two key goals of U.S. foreign assistance.” Rep. Musgrave said, “The issue of maternal mortality should be addressed with life-affirming policies that help women have healthy pregnancies and deliver healthy babies. This can be best achieved by providing international aid for essential obstetric care, such as safe blood and delivery assistance…Mr. Chairman, as a nation, we must not export policies that are harmful to women. Our foreign aid tax dollars should be spent assisting developing countries with their needs and preserving lives. We must stand up for a culture that promotes life and continue to protect the great number of American taxpayers that ethically oppose abortion from having their tax dollars spent on encouraging the practice overseas. We need to export a life-saving policy that provides poor women with food, housing, and medicine not policies that are destructive to women and children.”

Joana Nerquaye-Tetteh, former executive director of the Planned Parenthood Association of Ghana (PPAG), testified about the effect the Mexico City policy has had on her organization and on other family planning organizations in her country. She began with the history of PPAG, noting that prior to the policy’s reinstatement, the group received a $2.8 million USAID grant that allowed the implementation of “an innovative community-based services project to reach the most vulnerable groups in rural areas. PPAG grew to include over 1,800 trained community-based volunteers and 13 staffed clinics.” In 2001, when the policy was reinstated, Dr. Nerquaye-Tetteh said PPAG “faced a nearly impossible choice. We had to choose between losing our 30-year partnership with USAID, which helped us reach the poorest and most vulnerable people in Ghana with family planning services and supplies, or to violate the trust we painstakingly built with these same people and communities.” Ultimately, PPAG decided not to sign the Mexico City policy. She detailed the effects of PPAG’s refusal to sign, including contraceptive shortages, a 40 percent decline in condom distribution, and the loss of community-based staff. She told the committee, “In my country the Global Gag Rule has had the exact opposite effect of its stated intent. It did not reduce abortions. Indeed PPAG began to see a sharp rise (almost double) in post-abortion care services in our clinics, especially in the rural areas, which is a reflection of the worsened access to reproductive health care and supplies…We will never know the real cost of this harmful policy because we can never know the total number of lives that have been irreversibly altered. It is the lives of poor and rural women, men, and young people who were denied the right to make choices that could have improved their living conditions: an STI [sexually transmitted infection] or maybe HIV infection that could have been prevented, a poor, rural mother that could have received quality prenatal care to help her survive a pregnancy and deliver a healthy baby, a woman that could have avoided an unwanted pregnancy and therefore no need for an unsafe abortion and its related complications.”

Jean Kagia, chair of the Protecting Life Movement in Kenya and an obstetrician-gynecologist, said that the Mexico City policy has not undermined her country’s family planning efforts. She said, “The NGOs that have been affected by the Mexico City policy do not seem to be conversant with the social, cultural, and religious practices of the African woman. In order to attempt to reduce maternal mortality, one has to propose remedies that do not conflict with her social-cultural and religious practices; otherwise they will be met with a lot of resistance. Remedies need to take into account the realities and faith of the African woman and not focus only on family planning (when she is not assured of the survival of her children or if she does not have consent from the husband) or abortion (which not only risks her health and the life of the unborn baby, but would also make her go against her faith and conscience).” Dr. Kagia shared the results of several opinion polls in Kenya that found that more than 80 percent of the country’s population opposed abortion. She asked the committee “why Congress wants to fund organizations that work against the will of the majority of the people of democratic countries.” Rather than fund organizations that provide referrals for, or perform, abortions, Dr. Kagia argued that USAID should be providing money to support economic empowerment of women, emergency obstetrical care, transportation to health care facilities for rural populations, and “artificial or natural” family planning services. She closed, saying “[T]he promotion of, and effort to, legalize abortion in Africa is a foreign agenda and a form of recolonization. The Mexico City policy, together with the government, public [and] private [organizations], and some NGOs, are going to lower maternal mortality within the African social, cultural, and religious setup. I would plead with you to support those local programs that are run by people who respect African babies and women within the context of African culture, faith, and real-life situations.”

During questions, Rep. Sheila Jackson Lee (D-TX) asked Dr. Nerquaye-Tetteh to describe the “toll of successive births” on women in Ghana caused by lack of availability of contraceptives. Dr. Nerquaye-Tetteh said that women who bore children very close together often suffered from nutritional deficiencies, birth complications, such as prolonged labor, and had generally poorer health. She said that the complications were especially acute when the pregnant woman was age 15 or younger as this could lead to obstetric fistula, a condition in which a hole forms between the vaginal wall and bladder or rectum. In areas without emergency obstetrical services, this complication can be fatal, Dr. Nerquaye-Tetteh said.

Rep. Bob Inglis (R-SC) asked the panel to explain the problem of availability of contraceptives in the developing world. Specifically, Rep. Inglis asked why NGOs that voluntarily refuse to sign the Mexico City policy were upset about the effects of the policy. Dr. Nerquaye-Tetteh said that she took full responsibility for refusing to sign the policy, but said that she felt it denied her and her practitioners rights available to them under Ghanaian law and the ability to fully care for clients. Dr. Duff Gillespie, former director of USAID’s Office of Population and a professor at Johns Hopkins Bloomberg School of Public Health, responded that the policy has a “chilling effect,” both on recipients seeking unbiased medical information and on professional staff who feel they must censor themselves, thereby violating their professional ethics, or risk losing funding.

Also testifying were Dr. Gillespie and Dr. Ejike Oji, Nigeria country director for Ipas.

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