Win or Lose, Trump’s Policies on Women’s Health Inflict Damage

Whether or not Donald Trump will be re-elected president on Nov. 3, a tough debate is likely to begin soon in the United States Congress over the national budget for the unpredictable year ahead. Reproductive health issues rank high on the agenda for women's rights advocates. Trump's proposed budget would continue to restrict funds for reproductive health sharply, including family planning, to suit the antichoice crowd that is apparently considered an important vote bank. These funds, moreover, would be limited to bilateral aid to allies and other supportive nations. These "friends of Trump" are expected to be active in the annual session of the Commission on the Status of Women, beginning on March 9 at the United Nations in New York. They include Bahrain, Saudi Arabia and Brazil, some diplomats say. Furthermore, earmarked funds are to be drawn from the Global Health Programs' account of Usaid's population and reproductive health projects. "No funds are requested for a U.S. contribution to the United Nations Population Fund (UNFPA), nor are voluntary contributions requested for other important UN agencies," an analysis of the budget by PAI, an independent research and advocacy organization, found. The 1984 Mexico City policy -- the global gag rule that has sharply cut reproductive health assistance worldwide, like the separate Congressional bar on all contributions to the UN Population Fund -- still stand at the discretion of the White House, based on legislative action purporting to end abortion everywhere. It is not covered directly by the federal budget, though it restrains Usaid. The agency's website contains extensive information on the rules to which it must adhere. Advocates are also concerned about the administration's attempt (which failed last year in Congress) to fold financing for important agencies dealing with assistance to women and children into a new "economic support and development fund" designed to help only a limited number of multilateral organizations that are seen to be in American strategic security interests. Reproductive health could easily be obscured in a dark corner. The 2021 White House budget, Trump's fourth, is laced with reminders that this is all about national security and the apple-pie phrase "the American people." It proposes a sum of $41 billion for the State Department and Usaid combined, which would again involve slashing programs for health (except some diseases), humanitarian activities and cultural and intellectual international exchanges that have enriched American life. Signing off for the State Department on an accompanying document titled "Congressional Budget Justification: Department of State, Foreign Operations, and Related Programs," Secretary of State Mike Pompeo wrote: "The budget puts U.S. national security interests first, while carrying out our fiduciary responsibility to the U.S. taxpayer through necessary trade-offs and reductions. With the support of Congress, this budget will position the State Department and USAID to achieve America’s strategic priorities and remain world-leading instrumentsof diplomacy, development, and freedom." That isn't quite how the rest of the world views the US now. The American electoral calendar ensures that negotiations over reproductive health and rights (among many other divisive issues) could play out against an overheated, possibly brutal and personal, political campaign. The American fiscal year begins on Oct.1, a date Congress rarely manages to meet even in the best of times. That coincides with the run-up to the voting a month later for not only a president but also for all the 435 members of the House of Representatives, now with a Democratic Party majority, and one-third of the 100 Senators, where a conservative Republican majority has turned back or refused to vote on most progressive measures sent for consideration by the House. The stakes are obviously high. During the hiatus between the November national election and the swearing-in of newly formed or reorganized executive and Congressional government branches in mid-January 2021, advocates for many issues will be recalculating their next moves depending on which parties have majorities in both houses. Trump and his ultraconservative budget director, Mike Mulvaney -- who is also the president's acting chief of staff in the revolving-door White House -- staked out their hostile position on women's reproductive health and rights in the Feb. 10 budget proposals for 2021 (and the remaining months of fiscal 2020). Relevant committees in the House of Representatives, where spending bills originate, will soon begin meeting with counterproposals. By mid-to-late summer, amid traffic jams on the campaign trail, House proposals should be ready for adoption, and the haggling with the Senate will be on. While the official support for reproductive health and family planning is hobbled by powerful ideological (often more than religious) lobbies in the US, European countries are increasing their funding. The growing support from Europe has materialized during years that international family planning and reproductive health organizations generally have lost American financing because they refused to accept the harsh abortion-related rules imposed by the Trump administration. The International Planned Parenthood Federation and Marie Stopes International are two leading examples. The Federation, which estimated that it was likely to lose $100 million in funds because of Trump policies, said in a memo last year that the effects of policies such as the global gag rule go beyond financial implications in developing countries. "It instills fear in organizations and causes them to self-censor. . . . means that medical staff get fired, HIV and family planning programs get closed, and women, girls and their families are shut out of care." "With clinics closing, the hard-won trust between healthcare providers and the communities they serve has been broken," the memo added. "Fewer people will be able to access healthcare, thus rates of sexually transmitted infections including HIV, unsafe abortion and preventable deaths may rise." On Feb. 4, the organization Countdown 2030: Europe, published a review of funding by 12 European countries over the past two years, showing support growing and solidifying, contrasted with shrinking care in Washington about the crucial needs of women. Countdown 2030 is a consortium of 15 leading European nongovernmental organizations working to ensure advances of human rights and investment in family planning. "The majority of European countries under review (10 out of 12) either increased or maintained funding to SRH/FP , even where in some instances cuts to official development assistance (ODA) have been made," the review said. "The combined figure for all 12 European donor countries gives an estimated support of 845 million Euros ($912 million) to SRH/FP for 2018, an overall increase of 4 percent when compared to 2017. . . . There is also an increase of 25 million Euros ($27 million) in funding to UNFPA between 2017-2018," the report said. Ireland, once another restrictive country, raised its contributions by 50 percent since 2017, followed by Spain at 42 percent. In Washington, PAI's calculations of Trump's ideas of what is enough American aid to reproductive health and family planning programs that can save the lives of women and girls pale in their comparative insignificance. Trump's budget request for $237 million for reproductive health "represents a massive 61 percent cut from the congressionally-appropriated level for bilateral and multilateral programs for the current fiscal year," PAI reported. "It is identical to the cut the president requested last year that that Congress subsequently ignored." Reproductive health is on the legislative agenda again, but with lawmakers preoccupied in an intense year, electing a Congress that can act to override hostility toward women's issues -- or vote for enough new faces to overturn Trump's policies completely -- will be a major task.

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