Standing against the trampling of rights and health in a free world

In the past week, Donald Trump, the president of the United States of America, has been minaciously busy. First, he wrote a letter to the Director-General of the World Health Organization (WHO) and another one to the Secretary-General of the United Nations, demanding that any reference to abortion and sexual and reproductive health (SRH) be removed from the Covid-19 response because he is anti-abortion.

He also repeated his earlier threat to withdraw the USA from WHO because of the influence of China. Moreover, he circulated a statement against SRH/abortion at the (online) World Health Assembly this week. All in one week!

Furthermore, at a time when investing in multilateral health institutions is paramount, the Trump administration has chosen to withhold funding from UNFPA and to expand the global gag rule so far that it indirectly affects the work of the Global Fund to Fight AIDS, Tuberculosis, and Malaria. An initial analysis indicates that up to 12% of Global Fund resources (over $1 billion) could be subject to the gag rule. This harms relationships with other donors and recipients, as it is an imposition of regressive U.S. values on the taxpayer resources of other nations and infringes on the sovereignty of host countries.

Indeed, the global gag rule applies even in countries where abortion is broadly legal. The majority of countries that receive U.S. global health funding allow for legal abortion in at least one case not permissible by the exemptions of the gag rule (rape, incest, or the life of the mother). In these instances, the United States is attempting to override or disregard local laws and dragging health care providers back to a time when abortion had to be performed clandestinely.

All of us, as citizens of the global village, must be deeply concerned by these actions by the Trump administration. We are witnessing clear signs of the United States abdicating its role as a leader in supporting reproductive rights and global health programs more broadly. Other countries are stepping in to fill this void, but they cannot match the financial and technical contributions of the United States.

Moreover, with nearly 220 million women who want to avoid pregnancy not using a modern method of contraception, it would not be enough to merely maintain the status quo in terms of funding for reproductive health during this Covid-19 crisis, even if that were possible.

Since 1995, following the International Conference on Population and Development (ICPD, 1994), the global public health community has worked to ensure that essential, life-saving, and rights-fulfilling SRH services are a core element of the healthcare services provided in crisis-affected settings.

Years of evidence and direct experience have clearly demonstrated the acute need for SRH services in times of crisis and conflict including access to contraception, intrapartum care for all births, emergency obstetric and newborn care, post-abortion care, safe abortion care to the full extent permitted by law, clinical care for rape survivors, and prevention and treatment for HIV and other sexually-transmitted infections. Any effective global response to the COVID-19 pandemic must be embedded in an evidence-informed approach to public health and in line with existing international legal obligations and development commitments.

The evidence is unequivocal: the de-prioritization of SRH services during previous epidemics has led to stark increases in preventable suffering and death amongst girls and women in humanitarian settings. In fact, past epidemics have shown that shutting down or diverting funds from essential health services- including SRH - can result in more deaths than the epidemic itself.

During the 2014-16 outbreak of Ebola in West Africa for example, the number of women giving birth in safe conditions in hospitals and health clinics dropped by 30%, dramatically increasing the risk of medical complications, and tragically, maternal mortality increased by 75% during the epidemic.

Every day, more than 500 girls and women in countries with emergency settings die during pregnancy and childbirth, mostly due to the absence of skilled birth attendants or lack of emergency obstetric procedures, as well as from complications of unsafe abortions. Experience tells us that these devastating numbers will only increase in the context of the COVID-19 pandemic. In some crisis settings, 65% of women report experiencing either sexual or physical violence in their lifetime, two times higher than the global average and amongst the highest levels of violence against women and girls in the world. Recent country-specific research has already shown an increase in reported gender-based violence as movement restrictions and quarantine measures are put in place to reduce the spread of COVID-19. This type of violence is linked to increases in unsafe abortion, maternal and low birth weight, miscarriage, premature labor, and sexually transmitted infections for girls and women in humanitarian settings.

Eliminating, reducing or restricting essential SRH services in the global response to COVID-19 will violate international human rights, further harm girls and women, majority of whom are already at risk, and, in turn, undermine global efforts to respond to not only the pandemic but the existing emergencies in humanitarian settings.

Let us stand together and applauds the UN, the WHO, governments, donors and all public health advocates, who have committed to the inclusion of SRH services, including contraception and access to safe abortion care to the full extent permitted by law, in the COVID-19 global funding and response. In the face of a global pandemic, we cannot afford to derail what decades of research and humanitarian experience have confirmed: that SRHR are human rights, needed, wanted, essential and lifesaving in every emergency. Covid-19 pandemic is no exception!

The writer is a Ghanaian working as a Senior Public Health Advisor with the Royal Tropical Institute in Amsterdam. Email: jk@harvestmail.org