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The impacts of the global gag rule on global health: a scoping review

BACKGROUND: The 1984 Mexico City Policy is a U.S. federal policy that has prohibited foreign nongovernmental organizations that receive U.S. international family planning assistance from using their own, non-U.S. funds to provide, counsel on, or refer for abortion services as a method of family plan...

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Autores principales: Mavodza, Constancia, Goldman, Rebecca, Cooper, Bergen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6714436/
https://www.ncbi.nlm.nih.gov/pubmed/31485484
http://dx.doi.org/10.1186/s41256-019-0113-3
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author Mavodza, Constancia
Goldman, Rebecca
Cooper, Bergen
author_facet Mavodza, Constancia
Goldman, Rebecca
Cooper, Bergen
author_sort Mavodza, Constancia
collection PubMed
description BACKGROUND: The 1984 Mexico City Policy is a U.S. federal policy that has prohibited foreign nongovernmental organizations that receive U.S. international family planning assistance from using their own, non-U.S. funds to provide, counsel on, or refer for abortion services as a method of family planning, or advocate for the liberalization of abortion laws- except in cases of rape, incest, and life endangerment. The policy became known as the global gag rule (GGR) due to its silencing effect on abortion advocacy. Historically, it has only been attached to family planning funding, until 2017 when a presidential memorandum expanded the policy to nearly all US$8.8 billion in global health foreign assistance. In light of the aforementioned expansion, this scoping review aimed to describe and map the impacts of the GGR on global health, which in turn would identify research and policy gaps. This is the first time that all of the existing literature on the policy’s impact has been synthesized into one article and comprehensively reviewed. METHODS: The review utilized Arksey and Malley’s five-stage methodological framework to conduct a scoping review. Fourteen peer-reviewed databases and 25 grey literature sources were searched for publications between January 1984 and October 2017. Organizations and individuals working on GGR research and impact were also contacted to access their works from the same time period. These publications reported on impacts of the global gag rule on 14 domains in global health. RESULTS: The searches yielded 1355 articles, of which 43 were included. Overall, 80% of the identified sources were qualitative. The misunderstanding, miscommunication, and chilling effect of the policy underpinned the GGR’s impacts. The frequently reported impacts on family planning delivery systems (34 articles) and the loss of U.S. funding (21 articles) were often related. Sources reported on the impact of the GGR on HIV and AIDS programs, advocacy and coalition spaces, and maternal and child health. Only three studies (6.9%) quantified associations between the GGR and abortion rates, concluding that the policy does not decrease rates of abortion. DISCUSSION: The GGR’s development and implementation was consistently associated with poor impacts on health systems’ function and outcomes. More peer-reviewed and quantitative research measuring and monitoring the policy’s impact on health outcomes are needed. More research and policy analysis exploring the GGR’s development and its implementation on the ground will improve knowledge on GGR consequences, and potentially shape its reform.
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spelling pubmed-67144362019-09-04 The impacts of the global gag rule on global health: a scoping review Mavodza, Constancia Goldman, Rebecca Cooper, Bergen Glob Health Res Policy Review BACKGROUND: The 1984 Mexico City Policy is a U.S. federal policy that has prohibited foreign nongovernmental organizations that receive U.S. international family planning assistance from using their own, non-U.S. funds to provide, counsel on, or refer for abortion services as a method of family planning, or advocate for the liberalization of abortion laws- except in cases of rape, incest, and life endangerment. The policy became known as the global gag rule (GGR) due to its silencing effect on abortion advocacy. Historically, it has only been attached to family planning funding, until 2017 when a presidential memorandum expanded the policy to nearly all US$8.8 billion in global health foreign assistance. In light of the aforementioned expansion, this scoping review aimed to describe and map the impacts of the GGR on global health, which in turn would identify research and policy gaps. This is the first time that all of the existing literature on the policy’s impact has been synthesized into one article and comprehensively reviewed. METHODS: The review utilized Arksey and Malley’s five-stage methodological framework to conduct a scoping review. Fourteen peer-reviewed databases and 25 grey literature sources were searched for publications between January 1984 and October 2017. Organizations and individuals working on GGR research and impact were also contacted to access their works from the same time period. These publications reported on impacts of the global gag rule on 14 domains in global health. RESULTS: The searches yielded 1355 articles, of which 43 were included. Overall, 80% of the identified sources were qualitative. The misunderstanding, miscommunication, and chilling effect of the policy underpinned the GGR’s impacts. The frequently reported impacts on family planning delivery systems (34 articles) and the loss of U.S. funding (21 articles) were often related. Sources reported on the impact of the GGR on HIV and AIDS programs, advocacy and coalition spaces, and maternal and child health. Only three studies (6.9%) quantified associations between the GGR and abortion rates, concluding that the policy does not decrease rates of abortion. DISCUSSION: The GGR’s development and implementation was consistently associated with poor impacts on health systems’ function and outcomes. More peer-reviewed and quantitative research measuring and monitoring the policy’s impact on health outcomes are needed. More research and policy analysis exploring the GGR’s development and its implementation on the ground will improve knowledge on GGR consequences, and potentially shape its reform. BioMed Central 2019-08-29 /pmc/articles/PMC6714436/ /pubmed/31485484 http://dx.doi.org/10.1186/s41256-019-0113-3 Text en © The Author(s) 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Review
Mavodza, Constancia
Goldman, Rebecca
Cooper, Bergen
The impacts of the global gag rule on global health: a scoping review
title The impacts of the global gag rule on global health: a scoping review
title_full The impacts of the global gag rule on global health: a scoping review
title_fullStr The impacts of the global gag rule on global health: a scoping review
title_full_unstemmed The impacts of the global gag rule on global health: a scoping review
title_short The impacts of the global gag rule on global health: a scoping review
title_sort impacts of the global gag rule on global health: a scoping review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6714436/
https://www.ncbi.nlm.nih.gov/pubmed/31485484
http://dx.doi.org/10.1186/s41256-019-0113-3
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