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Davis is out front on family planning 'gag rule'

March 10, 2003 1:07 am

There are many reasons to be happy about a Republican-controlled Congress and White House, said Rep. James Greenwood, R-Pa.

"But one of them is not the area of reproductive rights," he said. "Unfortunately, our party has been co-opted by so-called religious or neo-conservatives."

Greenwood believes social conservatives are misguided on the issue of international family planning programs.

"They have persuaded themselves that if they cut funding to agencies that provide or counsel on abortions, that somehow that will actually reduce abortions. The fallacy of that argument is in places like Kenya, where self-induced abortions are very common," he said.

Greenwood, who visited Kenya last year to learn about reproductive-health issues, said his trip to the East African nation convinced him that the Mexico City policy--which denies U.S. population aid to groups that perform or counsel on abortions--"probably results in a net increase" in abortions because of reduced access to the full range of family planning services.

Fellow Republican Rep. Jo Ann Davis, whose 1st District includes the Fredericksburg area, strongly disagrees with Greenwood's assessment. She's been an enthusiastic supporter of the Mexico City policy, which was implemented by President Reagan during a population conference in the Mexican capital, rescinded by President Clinton, then reinstated by President Bush in January 2001.

During a May 2001 debate over the rule in the House of Representatives, Davis criticized "pro-abortion advocates" for "attempting to paint this policy as anti-family."

"The current misconception being spread that the Mexico City policy hurts family planning efforts overseas is simply not true," she said. "By withholding funds from groups that violate the Mexico City policy, the U.S. does not reduce the amount of foreign family assistance."

The rule, she said, "protects the desires of millions of Americans who ethically and morally oppose the federal funding of abortion."

Opponents of the policy, who refer to it as the "gag rule," counter that federal law has prohibited using U.S. funds for overseas abortions since 1973.

The real objective of the rule, they say, is to dictate what foreign nongovernmental organizations can say and do--even with money not provided by the United States. For example, to keep getting U.S. funds for contraceptives, a group cannot offer abortion counseling, even if the money for that counseling comes from the United Nations or some other source.

And clinics that do not even provide or counsel on abortions--such as the Ribeiro House in Nairobi, Kenya--can lose U.S. family planning aid if they are operated by an organization that refuses on principle to sign on to the rule.

Critics of the policy also contend it is antidemocratic.

"The gag rule would be unconstitutional in this country," said Rep. Carolyn Maloney, D-N.Y. "It's unconscionable that this would be forced on women overseas."

Last fall, Davis joined nine other conservative members of Congress in urging an extension of the Mexico City policy to cover U.S. assistance for HIV/AIDS programs, which currently are not subject to the rule.

In an October letter to U.S. Agency for International Development Administrator Andrew Natsios, Davis and the other signers wrote: "Even though the Mexico City Policy only covers population funding, the same principle of not wanting to support, or appear to support, abortion with taxpayer funds should apply to HIV/AIDS funding."

The Bush administration last month signaled its agreement with Davis and the others by announcing its intention to extend the Mexico City policy to the president's proposed $15 billion global AIDS-relief program.

A Feb. 11 briefing memo prepared for Secretary of State Colin Powell said the expanded policy would cover funds for HIV/AIDS programs and possibly other aspects of reproductive-health assistance, "such as those aimed at preventing and treating sexually transmitted diseases and gender-based violence, reducing maternal and infant mortality and morbidity, and providing reproductive-health education."

An exception to the rule may be made, the memo said, for foreign nongovernmental agencies that either perform or counsel abortions but "implement discrete HIV/AIDS projects."

That proposed compromise is absolutely unacceptable, said Joseph Giganti, director of media and government relations for the Stafford County-based American Life League.

"For a Republican president to propose such an exception and have it passed by a Republican-controlled Congress would be an insult to the pro-life taxpayers who gave them control of both houses of Congress and the presidency with their votes," he said.

Reproductive-health experts also are disturbed by the expected policy change. They say that in most parts of the world, family planning services and HIV/AIDS programs are integrated, and separating them would be extremely difficult for both logistical and financial reasons.

"It would be expensive for both the services provider as well as the clients," said Dr. Josiah Onyango, senior program officer for the Family Planning Association of Kenya.

"If [U.N. Secretary-General] Kofi Annan says the face of AIDS in Africa is a woman, why have family planning in one place and another for AIDS treatment?" asked Valerie DeFillipo, services director for Planned Parenthood's Global Partners program.

DeFillipo wonders how cash-strapped reproductive-health pro-viders will make family planning and HIV/AIDS programs separate. "If a service provider does family planning, can she do AIDS work, too?" she asked, adding that organizations in poor countries don't have the luxury of hiring more staff.

Davis, who declined repeated requests for comment for this article, has shown a keen interest in international population programs. Last year, the congresswoman and two other social conservatives in the House worked closely with the Front Royal-based Population Research Institute to persuade President Bush to withhold $34 million from the United Nations Population Fund (UNFPA) because of its alleged involvement in forced abortions and other coercive practices in China.

"This is about forcing women to do what they do not want to do. This is about the ultimate degradation of human beings. This is about right over wrong," Davis said at a January 2002 news conference urging Bush to cut UNFPA funding.

"The UNFPA plays an integral role in China's population-control program. So what does that say about U.S. tax dollars in the hands of the UNFPA?" she said.

PRI's campaign against the UNFPA combined lobbying work on Capitol Hill with harsh rhetoric designed to stir up grass-roots support. In solicitation literature obtained by the pro-family-planning group Population Action International, PRI told potential donors: "Your baby-saving gift is needed and it's needed now--before the UNFPA abortionists get their bloody hands on the $34 million they're counting on from the U.S. this year."

But the PRI campaign might never have gained traction in the nation's capital if not for the attention drawn to it by Davis and by Reps. Chris Smith, R-N.J., and Joseph Pitts, R-Pa.

"No matter where one stands on the issue of abortion, I think all would agree that no one should be forced to kill their child," Davis said at the January 2002 news conference.

The Bush administration would echo Davis.

"While Americans have different views on the issues of abortion, I think all agree that no woman should be forced to have an abortion," State Department spokesman Richard A. Boucher said in announcing the UNFPA cut last July. "We came to the conclusion that the U.N. Population Fund monies go to Chinese agencies that carry out coercive programs."

Davis thanked Bush after his UNFPA decision "for recognizing what we have been saying for some time now--that UNFPA funding goes towards forced-abortion programs in China."

But that assertion was reportedly refuted by a State Department fact-finding mission in May. According to news outlets including Knight Ridder and The Washington Post, an unreleased report by a three-member State Department team found no evidence linking the U.N. program to coercive practices in China.

Knight Ridder reported that the State Department inquiry found the U.N. program improved Chinese women's lives by helping them prevent unwanted pregnancies through education and family planning services, thus reducing the number of abortions under China's repressive population policy.

An inquiry by British investigators also found no smoking gun linking UNFPA to abuses in China.

It has been difficult to determine the overall impact of the Mexico City policy and the UNFPA cut.

Supporters of the president's UNFPA decision dismiss claims that the withholding of funds has hurt international family planning efforts. They note that the UNFPA money was diverted to USAID programs benefiting women's and children's health in Afghanistan and Pakistan.

But the U.N. program, which has a presence in dozens of nations where USAID population funds are unavailable, insists that poor women in various parts of the world are suffering from the funding reallocation. UNFPA says the lost U.S. assistance--12 percent of its annual budget--could have prevented 2 million unwanted pregnancies, nearly 800,000 induced abortions, 4,700 maternal deaths and more than 77,000 infant and child deaths.

In an e-mail response last month, UNFPA spokesman Abubakar Dungus said the loss of U.S. funds has forced the organization to eliminate a number of programs, including ones that helped ensure safe childbirth in Kenya and in Bangladesh, a country where one in 42 women dies during pregnancy or childbirth.

There are also questions about the aggregate effects of the Mexico City policy.

Barbara Crane, who worked at USAID on population issues during the Clinton administration, said "you will not necessarily see the drama" caused by funding restrictions when visiting family planning providers in Kenya or other parts of the developing world.

In an article published in Science magazine in October 2001, Crane and co-author Richard Cincotta said neither side in the gag-rule debate "is well informed by systematic research on the consequences of the policy."

Only two empirical studies have examined the policy's impact, and both looked at the Reagan-Bush period. The surveys collected data by interviewing family planning providers. They focused on the direct effects on organizations that had agreed to the policy's restrictions.

Crane and Cincotta concluded that the studies could not "fully assess the policy's broad consequences for access to contraceptive or abortion services, much less for women's health." They also asserted that the studies failed to look at the extent to which the policy "did or did not reduce the incidence of induced abortion."

Still, Crane believes the current Bush administration's positions on reproductive health are having adverse effects in the developing world.

"There are technical impacts--where they can spend money, with whom they can work--but then there is the broader impact of having an anti-choice administration," said Crane, who is now executive vice president of Ipas, a Chapel Hill, N.C.-based organization that specializes in preventing unsafe abortion and improving treatment of its complications.

More than 350 family planning organizations complied with the Mexico City policy during the Reagan-Bush years, and most family planning providers have signed on to it this time around--if only to keep their U.S. funding.

However, a few of the big players in family planning have rejected the rule, and the severing of their ties with USAID could result in a less effective use of U.S. population assistance, Crane said. In countries such as Kenya, USAID may have to forge new relationships with "less committed, less experienced NGOs" because of the Mexico City policy, she said.

"What are the losses to USAID?" she asked.

Marie Stopes International, a British nongovernmental organi-zation that provides reproductive-health care around the world, has had a considerable presence in Kenya for many years.

NGOs such as MSI play a vital role in Kenya and similar underdeveloped countries, according to Crane. They are often more agile and responsive than government institutions, and are more willing to try innovative approaches.

NGOs also play a crucial role in reaching groups historically under-served by governments--the poor, ethnic minorities and young people.

And in countries such as Kenya, where the government clearly cannot keep up with demand for family planning and other reproductive-health services, NGOs simply help plug the gaps.

But to hear MSI's Kenya program director, Cyprian Awiti, tell it, some NGOs are having to plug their own gaps, thanks to the Mexico City policy.

"We had a proposal [with USAID] which was going to give us between $1 million to $2.5 million," he said. "This was the plan, and we arranged everything. Then along comes the gag rule."

In accordance with Kenyan law, MSI clinics in the East African nation do not provide or counsel on abortion. But since MSI refused to sign on to the Mexico City policy, Awiti lost access to U.S. funds, forcing him to slash 80 staff positions and close two clinics.

"We had to cut back our outreach program. The outreach program takes services to rural women," he said. About 80 percent of Kenyan women live in rural areas.

"So really, the gag rule has let Kenya down. The gag rule has made women suffer. The gag rule has made more women die, because they can't access safe family planning," he said.

Some reproductive-health workers say the Mexico City policy also is hampering the battle against HIV/AIDS. While the rule theoretically does not affect HIV/AIDS programs, in reality it may be doing so, said Crane, because it has resulted in funding cuts to groups such as MSI that are on the front lines of the battle against the deadly virus.

The Family Planning Association of Kenya, which does not perform abortions but also refused to sign on to the Mexico City policy, had to cut its outreach staff in half after losing U.S. assistance for its population programs. In addition, it shuttered three family planning clinics in traditionally under-served areas, and increased fees for services at clinics that remained open.

"When funding was cut, it affected mainly the grass roots," said Geoffrey Maina, a peer youth educator for FPAK.

Karen Austrian, an American who has worked with Kenyan youth on reproductive-health issues, said she noticed a significant scaling back of FPAK outreach programs last summer when she visited the country.

"The irony is they [FPAK] don't do abortions," she said, "but because of the gag rule they can't do a youth-outreach program for AIDS."

Rick Mercier, Viewpoints editor for The Free Lance-Star, traveled to Kenya to examine reproductive-health issues in the developing world. His research was made possible by a World Affairs Journalism Fellowship from the International Center for Journalists and the World Affairs Council.