2017 IN REVIEW

As soon as Donald Trump became U.S. president in January 2017, he imposed a “global gag rule” that bars use of U.S. funds from going to any program whose employees even discuss abortion. The full impact of that decision has not yet been measured.

The rule applies to $9.5 billion in funding for health programs, including those targeting HIV/AIDS, malaria and children’s health. It forces many anti-AIDS health agencies serving LGBT people and many other populations to choose whether to deny their patients lifesaving anti-HIV therapy or unrestricted lifesaving counseling about reproductive health services.

The rule applies to PEPFAR, a George W. Bush initiative that has reduced HIV infections, so PEPFAR-funded organizations have to decide whether to cut budgets and close down clinics or muzzle employees whose job is to counsel pregnant women about their health-care options. The Ugandan government has estimated that unsafe abortions contribute to 8 percent of maternal deaths.

In October, a study by Human Rights Watch found that the policy had indeed triggered reductions in key sexual and reproductive health services in Uganda and Kenya by well-established organizations that cannot easily be replaced.

For example, Family Health Options Kenya (FHOK), which ran 16 healthcare facilities in the country, decided that it could not comply with the restrictions and therefore will lose US funds, which make up roughly 60 percent of its budget. It said it may have to cut as many as half of its services. By the fall, the organization had already closed one clinic and canceled 100 planned outreach events, including for cervical cancer screening, HIV testing, and family planning counseling, which typically reach 100 people each time.

In other words, in that one example, Trump’s decision denied anti-AIDS and other health-care services to 10,000 people.