The Magazine

Bush, Abortion, and Foreign Aid

No, the United States isn't killing women and children.

Feb 11, 2002, Vol. 7, No. 21 • By NICHOLAS EBERSTADT
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IN CONTEMPORARY political debate, there is no surer way to discredit and delegitimize a policy than to establish that it injures women and children. Over the past year, a chorus of critics have lodged just this accusation at the Bush administration's foreign aid policy. According to their charges, cutting off U.S. funding to groups that perform or promote abortions will raise the death toll for women and children in the Third World.

The restrictions in question on U.S. international population assistance--known as the "Mexico City policy," or by its critics as the "global gag rule"--were originally implemented under President Reagan. President Clinton rescinded the policy for the entirety of his two terms. Then, on his first day in office, President George W. Bush reinstated the Mexico City policy. Detractors assert that move was not only unsound, but positively lethal. The Atlanta Journal-Constitution editorialized at the time that, through the new policy, "the President sentenced some of the world's poorest women to death." Similarly, California Senator Barbara Boxer argued that "no matter how [Bush] executes the policy," it "will lead to an increase in the number of deaths due to unsafe abortions."

Last fall, at the urging of Boxer and others, the Senate passed a foreign aid bill that would have revoked the Mexico City strictures. Under threat of a White House veto, the Senate-House aid bill ultimately excised Boxer's provision. But in the eyes of its critics, the global gag rule issue is by no means settled. As post-September 11 politics returns more nearly to pre-terror norms, Congress can be expected to revisit the Mexico City policy--possibly quite soon. And a return to the issue will mean a full airing of the critics' worst apprehensions about restrictions on U.S. population funding: namely, that these will cause higher rates of maternal and infant mortality, higher levels of unwanted pregnancy, and perhaps even higher overall levels of abortion as well. Happily, a closer examination of the evidence shows those fears to be unwarranted.

Determining the health consequences of the Mexico City policy is no simple exercise. In much of the developing world, vital registration systems are still rudimentary. Typically, a low-income country's statistical system is not capable of providing accurate annual tallies even of births and deaths. Consequently, for most countries that receive U.S. population assistance, one cannot trace the health effects of particular funding decisions with a great deal of precision. Nonetheless, we can be confident that the ultimate impact on maternal and children's health of the Mexico City policy is slight.

Why do I say this? We can begin by checking the record of the recent past. Over the past two decades, the United States government has already run a sort of "controlled experiment" with restrictions on its international population assistance funding. From 1984 to 1993, Washington enforced the Mexico City policy. For the following eight years, the policy was suspended. In addition, there have been substantial increases and decreases in U.S. international population assistance in recent years: Funding rose from $322 million to $576 million between 1992 and 1995, then fell to $384 million between 1995 and 2000.

At the time, those quite substantial changes in U.S. population assistance occasioned predictions of striking--indeed devastating--repercussions on the health and well-being of vulnerable, low-income populations. In 1996, for example, Dr. Nafis Sadik, then executive director of the United Nations Population Fund, had this to say about impending cuts in U.S. population funding:

"The way U.S. funding is going, 17 to 18 million unwanted pregnancies are going to take place, a couple of million abortions will take place, and I'm sure that 60,000 to 80,000 women are going to die of those abortions--just because the funding has been reduced overnight."

Similarly, in June 1997 the Planned Parenthood Federation of America warned that the 35 percent reduction in funding for U.S. population assistance that year would translate into:

"Four million more women [with] unintended pregnancies that will lead to 1.6 million more abortions, 8,000 more women dying in pregnancy and childbirth, and 134,000 more infant deaths."

Those dire forecasts turned out to be very bad forecasts indeed. International demographic and health experts did not detect any upsurge in global birth rates, abortion rates, maternal mortality rates, or infant mortality rates after the 1996 cuts in U.S. funding. To the contrary: The Census Bureau depicts continuous and uninterrupted declines in both fertility levels and infant mortality rates for "less developed countries" for the years 1995-2000. Nor, incidentally, has evidence been adduced that a prophesied shutdown of medical clinics and cutback in health services actually came to pass.