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Reproductive Injustice: The Mexico City Policy in the Era of COVID-19


Women's March Political Rally by Robert Jones


Article by Hayley Durudogan,


The Mexico City Policy (MCP) was harmful for reproductive healthcare access prior to the start of the COVID-19 era. The pandemic, however, has severely magnified its impact. Passed by the Trump Administration in 2017, the MCP, or Protecting Life in Global Health Assistance Plan, requires “nongovernmental organizations to agree as a condition of their receipt of Federal funds…[to] neither perform nor actively promote abortion as a method of family planning.” Furthermore, if an NGO receives any global health funding from the US that is tied to the MCP, all their activities are restricted by the policy. This means that if an NGO runs two programs, one which is concerned with treating malaria, and one which is concerned with reproductive healthcare, even if US global health dollars are only used to fund the malaria program, the reproductive healthcare program cannot provide or advise patients on abortion care. The two programs could have no relation with one another aside from falling under the umbrella of the same NGO, and yet the reproductive healthcare program will still be bound by MCP limitations.


In theory and in practice, the MCP hampers the work of foreign organizations by imposing US-centric, anti-choice constraints on their work and advocacy. In 64 nations across the globe, from South Africa to Nepal, the MCP prevents patients from accessing the reproductive healthcare services they need. The policy effectively subjugates patient needs to US foreign policy goals and enables the United States to pursue its course of isolationism as it exercises global influence on reproductive healthcare access. 


First enacted in the Reagan administration, the MCP is by no means a novel anti-choice approach to foreign policy. Republican administrations have uniformly enacted the policy while Democratic administrations have uniformly overturned it. The Trump Administration’s iteration of this hydra-esque policy goes further than any previous versions and drastically increases the types of funding tied to the MCP. Previously, the policy applied only to NGOs receiving US family planning funding. Today, the MCP restricts the services of organizations receiving federal funding for global health issues ranging from malaria to AIDS to maternal and child health. In 2019, the Administration further extended the policy to prevent NGOs receiving US global health funding from supporting organizations that provide abortion care.


The policy’s efficacy derives in part from the fact that it forces health care providers to choose between providing a comprehensive spectrum of reproductive health care and receiving critical US funding.” Faced with such a dilemma, many NGOs reasonably choose to accept funding for the sake of effecting some good, though at a high price. 


The MCP’s full potential for harm was not realized until March of 2020, however, when the COVID-19 pandemic began its lethal spread. The impact of COVID-19 on reproductive healthcare access has been disastrous, with “health facilities in many places…closing or limiting services.” A lack of providers, a shortage of personal protective equipment, and breakdowns in contraceptive production systems prevent patients from accessing reproductive healthcare and increase the risk of unintended pregnancies. While some nations, such as the United Kingdom, have expanded access through legislation permitting patients to access abortion care from home, many countries continue to render access to abortion care in the COVID-19 era difficult at best, and impossible at worst.


In April, the United Nations Populations Fund released a groundbreaking report on the impact of COVID-19 on reproductive healthcare and family planning. Among its many concerning revelations, the report estimated that “if the lockdown continues for 6 months and there are major service disruptions due to COVID-19, an additional 7 million unintended pregnancies are expected to occur.” As the report was released in late April, we are quickly approaching the six month mark, with no end in sight and little hope for a vaccine available en masse in the near future. Many such unintended pregnancies will likely be the result of limitations on reproductive healthcare access caused by COVID-19 and compounded by the MCP’s restrictions.


For patients in need of care, losing access to abortion can be lethal. Research by the International Women’s Health Coalition found that the restrictions imposed by MCP prompted many patients to make the heartbreaking choice to seek unsafe abortion care. When provided by a licensed medical practitioner, abortion is “one of the safest types of medical procedures.” In a report by the National Abortion Federation, a US organization, the rate of serious complications in early stage abortions is 0.5%. However, in contexts where safe abortion care is inaccessible, the rate of complications increases. In Kenya, a nation impacted by the MCP, unsafe abortions account for approximately 25% of all maternal mortality. The lives of patients in foreign nations should not be jeopardized by the US executive branch’s anti-choice ideology.


As the largest global health funder in the world, the United States effectively uses its wealth to impose its domestic anti-choice agenda on the international community. According to a 2016 study by Kaiser Family Foundation, out of the 64 countries who receive global health funding from the United States, “37 allow for legal abortion in at least one case not permissible under the MCP.” Why should foreign citizens and nations, with no vote and no say, be harmed by the United States’ anti-choice agenda when they themselves have instituted domestic policies that diverge from that agenda? Not only is there no public health rationale for this policy but also the MCP runs afoul of the United States’ obligation to respect “the right to life of a pregnant woman or girl” under the International Covenant on Civil and Political Rights.


During times of great economic, social, and political turmoil, bodily autonomy and the right to decide if and when to have children is foundational to an individual’s capacity to live a safe and healthy life. In fact, a UN Working Group addressing discrimination against women stated in 2017 that “women’s human rights include the rights to equality, to dignity, autonomy, information and bodily integrity and respect for private life and the highest attainable standard of health, including sexual and reproductive health.” The report goes on to say that “expert international human rights mechanisms and entities have repeatedly concluded that, in some situations, failure to provide women access to legal and safe abortion may amount to cruel, inhuman or degrading treatment or punishment or torture, or a violation of their right to life.”


Unintended pregnancies exacerbate the stresses on individuals, communities, and nations already in the fight of their lives against COVID-19. Unfortunately, the toxic combination of COVID-19 healthcare disruptions and the MCP will likely extend far beyond the course of this pandemic. This is due in large part to the fact that the policy will effectively prevent organizations who need US federal funding from rebuilding reproductive healthcare networks post-pandemic. Fragile reproductive health ecosystems may not recover from the economic losses occasioned by COVID-19, meaning that those in nations where abortion access is tenuous or only newly available may see a backslide in access. Without US global health funding to help rebuild these systems, abortion access may cease to exist in many countries.


The United States should not seek to engage in ideological imperialism by using strings-attached funding to make NGOs de-facto agents of US foreign policy goals. Under the auspices of providing aid, the MCP effectively extends US influence on a largely domestic policy issue far beyond the remit of US borders and into the many nations where NGOs use US global health dollars to effect change. With increasing isolationism in American foreign policy, the MCP effectively requires foreign organizations and citizens to abide by American-imposed healthcare restrictions at a time when the United States is taking a step back from its formerly key role in the international community. In effect, the United States’ withholding of funding to further its foreign policy aims not only bears devastating effects of Western imperialism, but also violates international human rights.


In 2018, the United Nations affirmed that abortion access is a human right, declaring that “state parties may not regulate pregnancy or abortion...in a manner that runs contrary to their duty to ensure that women and girls do not have to undertake unsafe abortions, and they should revise their abortion laws accordingly.” If abortion access is to be upheld as a human right, regulations like the MCP must be challenged by the United Nations. It is not enough for the MCP to merely be overturned by an executive order or congressional mandate, because, as we have seen, whether or not the policy is in effect changes depending on who is in the White House. In order to ensure that the right to abortion is upheld and enforced, the UN must condemn the MCP as a violation of human rights. A right to abortion without access is futile–it is a right in name but not in nature. Medieval in its formulation and antiquated in its aims, the MCP allows the United States, without legislative power, to curtail the rights of foreign citizens, and that, in and of itself, should be sufficient to concern all those who believe in democracy and the rule of law.


Author

Hayley Durudogan (J.D. Candidate, Class of 2023) is a Contributor to Travaux. Hayley's interests include international human rights law, reproductive justice, and gender justice. Prior to attending Berkeley Law, Hayley worked in political communications in the field of reproductive rights.

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