Restrictions On US Global Health Assistance Reduce Key Health Services In Supported Countries
- PMID:32897794
- DOI: 10.1377/hlthaff.2020.00061
Restrictions On US Global Health Assistance Reduce Key Health Services In Supported Countries
Abstract
The 2017 expanded Mexico City Policy prohibits non-US-based nongovernmental organizations from receiving US global health assistance if they either perform or refer for abortion services. We study the effects of the expanded policy on implementing partners of US-funded HIV programming by the President's Emergency Plan for AIDS Relief (PEPFAR) via a primary survey in all recipient countries and key-informant interviews in South Africa and the Kingdom of Eswatini (May-November 2018). Survey results showed that 28 percent (56 of 198) of organizations reported stopping or reducing at least one service in response to the policy. Reported service reductions included reducing the delivery of information about sexual and reproductive health, pregnancy counseling, contraception provision, and HIV testing and counseling. Interview data highlighted how these reductions were often a result of decreased patient flows or implementation of the expanded policy beyond what is required. Reductions disproportionately harmed pregnant women, youth, and key populations such as sex workers and men who have sex with men. Reduced delivery of sexual and reproductive health services has the potential to negatively affect many intended beneficiaries of PEPFAR funding, especially in areas with high HIV prevalence. Policy makers must respond to disruptions in service delivery and end any implementation that undermines US investment in high-quality HIV and sexual and reproductive health services.
Keywords: Abortion; Abortion law; Contraception; Family planning; Global health; HIV/AIDS; Health policy; Intellectual Property; Mexico City policy; PEPFAR; President's Emergency Plan for AIDS Relief; Reproductive health.
Similar articles
- Mapping the impact of the expanded Mexico City Policy for HIV/ family planning service integration in PEPFAR-supported countries: a risk index.Sherwood J, Sharp A, Honermann B, Horrigan C, Chatterjee M, Jones A, Cooney C, Millett G.Sherwood J, et al.BMC Public Health. 2018 Sep 12;18(1):1116. doi: 10.1186/s12889-018-6008-2.BMC Public Health. 2018.PMID:30208876Free PMC article.
- The U.S. Global Gag Rule in Ethiopia: a foreign policy challenging domestic sexual and reproductive health and rights gains.Vernaelde JM.Vernaelde JM.Reprod Health. 2022 Jun 13;19(Suppl 1):56. doi: 10.1186/s12978-022-01329-6.Reprod Health. 2022.PMID:35698199Free PMC article.
- Policy change and micro-politics in global health aid: HIV in South Africa.Kavanagh MM, Dubula-Majola V.Kavanagh MM, et al.Health Policy Plan. 2019 Feb 1;34(1):1-11. doi: 10.1093/heapol/czy103.Health Policy Plan. 2019.PMID:30629158
- The United States President's Emergency Plan for AIDS Relief: a story of partnerships and smart investments to turn the tide of the global AIDS pandemic.Goosby E, Dybul M, Fauci AS, Fu J, Walsh T, Needle R, Bouey P.Goosby E, et al.J Acquir Immune Defic Syndr. 2012 Aug 15;60 Suppl 3:S51-6. doi: 10.1097/QAI.0b013e31825ca721.J Acquir Immune Defic Syndr. 2012.PMID:22797740Review.
- PEPFAR's evolving HIV prevention approaches for key populations--people who inject drugs, men who have sex with men, and sex workers: progress, challenges, and opportunities.Needle R, Fu J, Beyrer C, Loo V, Abdul-Quader AS, McIntyre JA, Li Z, Mbwambo JK, Muthui M, Pick B.Needle R, et al.J Acquir Immune Defic Syndr. 2012 Aug 15;60 Suppl 3:S145-51. doi: 10.1097/QAI.0b013e31825f315e.J Acquir Immune Defic Syndr. 2012.PMID:22797736Review.
Cited by
- Impact of the Trump Administration's Expanded Global Gag Rule Policy on Family Planning Service Provision in Ethiopia.Sully EA, Shiferaw S, Seme A, Bell SO, Giorgio M.Sully EA, et al.Stud Fam Plann. 2022 Jun;53(2):339-359. doi: 10.1111/sifp.12196. Epub 2022 May 31.Stud Fam Plann. 2022.PMID:35639923Free PMC article.
- Postabortion and safe abortion care coverage, capacity, and caseloads during the global gag rule policy period in Ethiopia and Uganda.Stillman M, Kibira SPS, Shiferaw S, Makumbi F, Seme A, Sully EA, Ha L, Giorgio M.Stillman M, et al.BMC Health Serv Res. 2023 Feb 1;23(1):104. doi: 10.1186/s12913-022-09017-8.BMC Health Serv Res. 2023.PMID:36726121Free PMC article.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical