By Nicole Gaouette, CNN
Updated: Thu, 12 Sep 2019 18:21:17 GMT
Ivanka Trump swept through three Latin American countries last week to promote women's entrepreneurship and empowerment -- a mission that faces regional headwinds of wage inequality, staggering levels of violence against women, high rates of adolescent pregnancy and, experts say, the policies of her own administration.
In promoting her "Women's Global Development and Prosperity Initiative," Ms. Trump emphasizes the link between stable, productive societies and women's ability to work -- connections borne out by research.
But experts say a key factor enabling women to thrive economically is their ability to control when and how many children they have. They say that ability is being undermined across the globe by the Trump administration, which "is hurting women and hurting women's access to basic care," and puts lives in danger.
As US states pass laws to limit abortion and possibly trigger a Supreme Court challenge to the Roe v. Wade ruling that legalized the procedure, the Trump White House is making unprecedented efforts to ensure no US government funds are used to provide or promote abortion overseas. Paradoxically, studies show those efforts are only likely to increase the number of abortions taking place.
The administration's "Protecting Life in Global Health Assistance" policy is affecting US global health spending not only on abortion, but on contraception, reproductive health, and everything from child nutrition to tuberculosis treatment as well.
It has sent aid groups scrambling to prevent maternal and newborn deaths in Jordanian refugee camps and struggling to respond to an explosion in sex trafficking along the Venezuelan border. The US policy has led to the closure of mobile health clinics in Uganda and Zimbabwe, ended a contraception program for 170,000 poor women in Madagascar, and cut into programs intended to prevent HIV, malaria and the Zika virus.
Experts say the approach not only undermines Ivanka Trump's program, but also President Donald Trump's official peace and security strategy, which "recognizes that societies that empower women economically and politically are far more stable and peaceful."
"The reality of what the evidence says is that you cannot achieve those goals if you don't have access to comprehensive sex education, family planning, safe access to abortion," said Stephanie Psaki, director of the Population Council's Girl Innovation Research and Learning (GIRL) Center, an NGO focused on global health and development research. "If you work with women and girls, it's impossible to do that if you don't do those other things."
A senior administration official said Ivanka Trump's efforts don't touch on "important health issues," but are "focused entirely on the workforce and the women who have restrictions on the ability to do the same jobs as men. It is a narrow focus because we want to make sure that it has tangible results."
Ms. Trump's program aims to help 50 million women in developing countries worldwide by 2025, by giving them job training and eliminating barriers to the workplace. Trump encouraged Cote d'Ivoire's recent decision to do away with laws that restricted women from owning or inheriting property.
Her Latin America trip took her to Colombia, Argentina, and Paraguay, where she met with women and officials, launched an entrepreneurship program and announced the US intent to fund investment managers who consider gender.
Latin America needs such initiatives, experts say. The World Bank says women there typically become a mother too young, earn less than men and often live in fear. The region is home to 14 of 25 countries with the highest femicide rates in the world.
"The Trump administration has been very strongly committed to women's issues and women's empowerment programs throughout its tenure," the official said. Trump's Latin America trip is "just another example of our strong demonstration of commitment."
Giselle Carino, the CEO and regional director of International Planned Parenthood Federation's operations in Latin America, said Ms. Trump's initiative and US policy make for a contradiction.
"To have Ivanka Trump in Colombia when the administration is cutting resources to women who have experienced the most difficult circumstances, it's a contradiction. The administration is hurting women and hurting women's access to basic care at the same time it's going around talking about women's empowerment -- those are empty promises," Carino said. "Without having bodily autonomy, you can't really have equality."
The Trump administration inherited what was once called the Mexico City Policy. The measure has been adopted by Republican administrations and dropped by Democratic ones since its creation in 1984, and previously affected about $600 million in aid for family planning clinics.
Clinics that even discussed abortion would lose their funding for contraception and reproductive health care, giving rise to the policy's other name, the global gag rule.
Under Trump, the White House has dramatically expanded the policy to cover an estimated $8 billion in global health spending. Hospitals and aid groups that receive US aid have to certify that they will not use funds from any source -- even non-US donors -- to perform or discuss abortion. If they do, they lose all US aid, including funding for health programs that range from maternal and child health to sanitation, and treatments for cancer and tropical diseases.
In March, Secretary of State Mike Pompeo expanded the rule yet again, announcing that the US would cut funds to NGOs that fund other groups that support abortion.
Pompeo defended the policy to an audience in Kansas on Friday. "We still want to support women's health issues all around the world, all of things that are important -- values, things that we all hold dear," he said. "But we've been diligent in trying to protect the unborn in every dimension of American foreign policy, and we'll continue to be."
Data show the policy isn't having its intended effect.
A Stanford University study published by The Lancet Global Health journal in June found that the Trump administration's expanded efforts to end abortion instead increase it by 40% and create a greater risk of women dying. The study's findings "provide only a partial estimate of the policy's harm to maternal health," the authors said.
When the US cuts funding, contraceptive use drops, unintended pregnancies rise and women opt for abortions, often unsafe ones that are a major cause of maternal death.
Research by Rutgers University in 2018 and Stanford University in 2011 shows that the original Mexico City policy caused abortion rates in African countries to double. In Latin America, women were up to three times more likely to have the procedure.
The Stanford study "should compel the Trump administration to finally reexamine this disastrous policy," said Sen. Jeanne Shaheen, a New Hampshire Democrat who sits on the foreign relations committee. The statistics, she added, "should ring alarm bells for policy makers."
Administration officials sidestep -- or outright deny -- the impact.
Asked why the administration is pursuing a policy that increases abortion, the State Department pointed to comments Pompeo made in March when he was asked about the documented rise in abortions.
"They're just wrong," said Pompeo, declining to address studies and on-the-ground reports. "They're just wrong about that."
The administration "is entitled to its own opinion, of course," Kate Gilmore, the United Nations Deputy High Commissioner for Human Rights, said. "But it is not entitled to its own facts."
"The epidemiology and the medical science is unequivocal," Gilmore said in June at Women Deliver, a conference on women, development and security. "The policies that are being enacted will lead to more deaths -- of pregnant women, of women at the point of giving birth, and of the newborn."
Asked for comment, the White House referred CNN to USAID, where an official pointed to a common administration defense, that the "policy does not change funding levels by one dollar."
Workers in the field say this ignores the fact that the funding doesn't go to the same places. The shift also often leaves poor women, rural residents and marginalized groups, such as sex workers, suddenly cut off from health services.
International aid groups say the impact is stark.
Dr. Carole Sekimpi, a country director for Marie Stopes International, which provides reproductive health care services, said her group lost 17% of its funding, or $50 million through 2020.
"This continues to have devastating impact on the most vulnerable women and girls around the world," she said. "As a direct result of the global gag rule, 1.4 million women and girls globally will lose access to Marie Stopes services and care and this will result in an estimated 1.8 million unintended pregnancies, 600,000 unsafe abortions and 4,600 maternal deaths."
Ann Erb-Leoncavallo, a senior advisor in the global humanitarian division of the UNFPA, said that if other donor countries hadn't made up for US funding cuts to their programs in Jordan's Za'atari refugee camp, home to thousands of displaced Syrians, "there would be an increase in maternal and newborn deaths, for sure."
'No other country'
But the US cuts still have an impact, she said. "We are doing less than what we needed," Erb-Leoncavallo said. "If half of the amount is coming, we are reaching half of the population" in need, she said.
Marta Roya, executive director of ProFamilia, a nationwide chain of reproductive health care clinics in Colombia, said they had to close three centers in the poorest parts of the country that provided basic care for women.
The US funding cuts come as demands have been particularly intense, she said, with millions of Venezuelans fleeing to Colombia in the largest recorded refugee crisis in the Americas. The impact, she said, "has been absolutely enormous."
"This time, the gag rule has expanded not only to what we're used to, but it has also intruded into things like HIV, Zika," Roya said. "You have these programs going on all the time and then suddenly they stop."
Carino, of the International Planned Parenthood, said that other countries have tried to step in and make up for the loss of US funding, Carino added, "but no other country can fill the gap, really."
CORRECTION: This article has been updated to correctly reflect Stephanie Psaki's title.